Isolation, boredom, financial stress, and endless jokes about “quarantinis”— for anyone struggling with alcohol use disorder, the coronavirus pandemic has only made matters worse.
But there’s a silver lining: Thanks to new treatment guidelines, most patients can safely undergo alcohol withdrawal without checking into an inpatient facility. In other words, you can now safely “detox” at home.
“In the past, inpatient withdrawal management was the only option, but that was never practical, economical, or evidence-based,” says Jeff Allgaier, M.D., an addiction medicine specialist and co-founder of Ideal Option. “Even before COVID-19, we should have been treating the lion’s share of people with AUD in an outpatient setting. Fortunately, we can do that now. And we have the evidence that it’s just as effective, perhaps even more so.”
The new guidelines, in the works prior to the pandemic, were issued by the American Society of Addiction Medicine in response to a new reality. With COVID-19 still spreading, fewer people want to check into traditional “rehab.” Many inpatient clinics have been forced to close at a time when heavy drinking is on the rise. Others have long waiting lists.
Under the new treatment model, most patients can stay at home while taking medication to prevent uncomfortable and sometimes dangerous effects of alcohol withdrawal, often referred to as “detox.” The withdrawal process typically lasts four or five days. During that time, patients are instructed to stay home under the care of a responsible adult who can call 911 if necessary and make daily visits to an outpatient clinic such as Ideal Option. An addiction medicine specialist closely monitors symptoms and the patient’s gradual taper off medication.
From there, patients transition to a long-term treatment plan, combining traditional counseling or 12-step support with medication to control cravings and prevent relapse, shown to boost the odds of sustained sobriety.
It’s a two-step model of medication-assisted treatment — at-home withdrawal followed by long-term abstinence — that many folks with AUD, and even many physicians, know little about.
“The general public is aware of the concept of “detox” – you see commercials for Betty Ford and other clinics,” says Brian Dawson, M.D., senior medical director of Ideal Option. “But most people are unaware that withdrawal can be safely managed as an outpatient.
Stabilizing the Brain as You Withdraw From Alcohol at Home
The shift to at-home withdrawal does not mean the process is less risky than previously thought; it’s simply an acknowledgment that in most cases, with a carefully designed medication plan and daily oversight from a healthcare professional, patients can get through the withdrawal period just as safely and effectively as they can with round-the-clock supervision.
“Alcohol withdrawal can be life threatening, more so than opioid withdrawal,” says Dr. Dawson.
For this reason, patients must be carefully screened for their risk of developing severe symptoms. Those deemed at mild to moderate risk are accepted for at-home withdrawal management.
“If you talk to a lot of older doctors, they’ll say: ‘With outpatient, the risk is too high.’ That’s how everyone was trained, including me,” says Dr. Dawson. “But our addiction medicine and round-the-clock nurse care team are well-equipped to manage home-based withdrawal, more so than most primary-care clinics.”
At Ideal Option, the process begins on a Monday with a visit to the clinic for assessment and treatment planning. In addition to diagnosing AUD and assessing the likely severity of withdrawal symptoms, providers test urine and blood for alcohol content and other substances that may be present. We use this information and the patient’s history and situation to design the safest and most effective medication plan for each patient.
Typically, during the withdrawal period, patients are prescribed a medication in the benzodiazepine family, such as Librium (chlordiazepoxide) or Ativan (lorazepam). These medications minimize the agitation most patients feel during withdrawal and prevent minor withdrawal symptoms from becoming severe.
“During withdrawal from alcohol, the prescribed medication gradually allows the brain to stabilize,” says Larry Nye, PA-C, one of Ideal Option’s addiction medicine providers. “If you took it all at once, it would create complete chaos in the person’s brain. You want to slowly turn down the volume.”
Of course, stabilizing after withdrawing from alcohol is only the first step on the winding path toward recovery. Following the 5-day withdrawal period, patients work with their provider to develop a recovery plan. Typically, the plan includes a long-term medication as well as one-on-one counseling or group support.
This combination will ease the difficult early period of recovery.
“Patients with AUD go through a period of low emotional state at first,” says Larry. “It’s difficult to reset their brain. We tell them: ‘You’re not going to feel this way forever. Stick with our plan, and you’ll beat this.’”
To find out more about how Ideal Option treats alcohol use disorder or to make an appointment, visit https://www.idealoption.com/alcohol.