Ivan’s Addictions: Alcohol Detox
I want to discuss what people can expect when detoxing off of alcohol, inspired by my patient Ivan. He was a long-time patient, though I hadn’t seen him in a while. He was big time addicted to opioids years ago, and he had dragged his sorry butt into my office, barely coherent, begging for help. That’s how we met. I managed to get him clean off of the oxy’s he so dearly loved, but I would learn that Ivan had a very addictive personality…this guy could get addicted to oxygen. Anyway, that’s where it started with Ivan, and over the subsequent years I saw him in the office here and there. Now fast forward twenty years and in walks Ivan. It looked like the years had not exactly been kind to him. He looked like an alcoholic. Red swollen nose, check. Ruddy grey skin, check. Blood shot eyes, check. Balance just slightly off kilter, check. Gaunt frame with distended belly, check. I could go on, but suffice it to say that after so many years of doing what I do, I can spot an alcoholic from 50 yards. He said he was still clean, off opiates, but admitted to drinking in excess for many years. I burst his bubble with a sharp prick of cold harsh truth: he was an alcoholic. When I said it, he might’ve flinched, but he didn’t argue.
I asked him what he was doing for work. He said he was rehabing properties. He had inherited some money, bought a bunch of properties, fixed them up and rented them out. He collected the rent paychecks every month from his “magic money mailbox.” That sounded great, but the down side of this equation was that he wasn’t expected to be anywhere at any given time. And that left a lot of time for drinking. When I asked how much he was drinking, he admitted to drinking at least ten of those 2 ounce airline mini bottles a day. He had found some place where they only cost a buck a bottle. I was floored. That is an incredible deal. But I digress. I told him that we would have to do a medical detox, and he was on board. What follows are all of the things I told him.
To start, I explained that he needed to hydrate. Even though alcohol is liquid, it is very dehydrating, so there must be copious amounts of water during detox. As I told Ivan, drink water until you think you’ll burst. Next, start eating healthy foods. This is critical, getting food in your system, because alcohol causes irritation of the walls of the stomach and intestines. Also, you have to kick start the digestive tract, because alcoholics don’t eat well, if they eat at all. Next, start taking an over the counter stomach proton pump inhibitor like Prilosec or Prevacid. This will help to decrease the acid in the stomach as well as heal the stomach wall and the esophagus. Next, start taking B complex vitamin and multivitamin to replenish the system. He said he understood as he dutifully wrote all of this down.
Next, I explained the important warnings about detox, the reasons why it’s important to medically detox. We have to use a type of drug called a benzodiazepine to prevent severe alcohol withdrawal. Without it, you will start shaking, you can become delirious and confused and have grand mal, full body seizures. There is a possibility of death: up to 25% of people actually die from severe alcohol withdrawl when they don’t use the benzodiazepines. I use medications liberally to prevent the withdrawl and safely detox. My goal is to keep patients comfortable with meds, but never nodding out. I wrote a scrip for 2mg alprazolam and told him to take one 2 or 3 times a day. I also gave him one to take immediately in the office because it had been 16 hours since his last drink and he was really starting to feel it. He had all of his instructions, so I told him I’d call him at 8pm that night as well as every six hours thereafter, and that he could call my cell phone anytime with questions or problems. With that, he left.
That night when I called, he said he was feeling not so great, but that he had eaten, was drinking lots of water, and taking the vitamins. When I called him the next morning, he said he woke up feeling very uneasy, very tense, and with some slight tremor. I told him to take the alprazolam right then and to take another in the afternoon around 2 or sooner if he felt tremulous. He repeated the alprazolam schedule on day 2 and also took it that night. When day 3 came, I explained that this is the most dangerous time. While seizures and delirium can happen at any time, they are most likely to happen on day 3. It’s also the worst day. It was really tough for Ivan. He was sweating. He had tremors. He was a little confused. His girlfriend came over and made him chicken soup, served with some TLC, and checking to be sure he was hydrating and taking the vitamins. He took the alprazolam three times that day, but didn’t sleep much. I gave him a drug called mirtazapine for sleep, and this helped. The fourth day dawned and Ivan saw the light at the end of the tunnel. Day 4 was better than day 3, but he was still feeling tremor, still sweating, and still needed 2 alprazolam that day. On day 5, he had no tremor. The sweating had lessened, but he still felt restless. He took just 1 alprazolam that day. As of the 6th day, he didn’t need the alprazolam at all. The detox was done. I told him to continue the vitamins and the Prilosec stomach meds for 2 months, keep up the improved diet, and keep hydrating.
Ivan followed all of my instructions and he came out the other side and did pretty darn well. He got in great shape by walking his dog Malcom for a minimum of 3 hours a day, and he felt better every day. In fact, Ivan had dodged some serious bullets in that he had no major organ damage from the alcohol. There are several very common things that go bad with alcoholism. Most didn’t happen to Ivan, but let me caution you what can happen with alcohol abuse. Pancreatic issues are common. The pancreas is the most important organ for blood glucose regulation and digestion. You become a diabetic if your pancreas shuts down. Gastritis quickly becomes a potentially lethal problem. Gastritis is extremely dangerous, it is irritation or bleeding of the stomach, leading to bleeding ulcers. Aspiration pneumonia is a concern: where you are so drunk that you throw up or cough up stomach contents and you breathe the stomach contents into your lungs, causing a serious and life threatening infection. A very common issue with alcoholics is that they get drunk, fall, and break a bone or hit their head, causing subdural hematomas of their brain. And you can’t forget liver disease. One of the key features of chronic alcohol abuse is liver failure and liver cirrhosis. The liver shuts down and so the body diverts the blood flow around the liver because the liver is so scarred and gnarly that it no longer accepts blood. As a result, you get big vessels forming in the esophagus and rectum, and they explode, causing hemorrhage and death. Ivan was lucky… he didn’t have any of those things. But he didn’t get off scott free. The most common thing I see with alcohol- that no one escapes- is cognitive damage. The brain slows down. It is permanently damaged. As a result, you cannot think straight. You are not as coordinated as you were. You become less active so there can be muscle wasting. These had happened to Ivan. As I said, no one escapes this. So Ivan was little bit slower, a little less coordinated, legs a little weaker. But he’s not drinking, and that’s a major accomplishment. I’ll continue to follow him in his clean and sober life. If you are abusing alcohol, Ivan would advise you to medically detox, as would I. If you would like to read more about alcohol withdrawl, medical detox or more patient stories, check out my book, Tales from the Couch, available on Amazon.com.Learn More
Dr. Mark Agresti discusses the benefits of stopping drug use.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
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- Wanted to get high.
- Just wanted to.
- To get a mini vacation.
- Just wanted to checkout.
- Needed a reward.
- Out of anger.
- Out of frustration.
- Works hard and deserves it.
- Thought I could have just one.
- Everyone else was doing it. (more…)
It’s the Holy Grail in the world of addiction to find drugs that will block the craving for alcohol. There are three medications on the market that have been studied and show some benefits.
Pros and Cons of Drug Used for Alcohol Dependency or to Block Craving
Campral, also known as Acamprosate, is used to block craving. Studies have found a reduced incidence of relapse with veterans in Philadelphia who took this drug.
The daily dosage is two 333mg tablets, three times a day, and in my practice dealing with addiction and alcoholism, that has a limited benefit.
Topamax, or Toprimamate, an anti-seizure drug used to prevent migraines, is sometimes used to treat alcohol dependency and prevent alcohol cravings, but I’ve have had minimal success with it, and have found it to produce complications. It may cause mental slowing, cognitive slowing, and may effect the kidneys. (more…)Learn More
Initially the attraction is euphoria taking a mini vacation. Someone once told me getting high is like God putting a warm blanket around you and rubbing your temples telling you everything will be alright. This is a powerful draw. The mini vacation to escape life’s hardships becomes more frequent and all encompassing. Physically the body comes addicted. Psychologically the individual needs the drug to maintain emotional stability and to cope with life’s stress. Individuals with addicted family members are at an unfair disadvantage. Once they get a taste of euphoria from a drug, their bodies crave more drugs. Something is different with this group, they are genetically built to use excessively. Their bodies experience powerful cravings to use addicting drugs and keep using them. Their favorite word is more. Genetic predisposition is one unlucky factor. Another unlucky factor in making someone drug dependent, is being raised and living around drug dependent people. So, there are two forces at work, one is a genetic predisposition to use, another is a learned behavior.
That’s just the start. Once the psyche experiences the high, the escape, and a free ride from life’s problems; new forces take over. The individual goes undercover and must now conceal their activities. They have to make some time to get drugs and to do the drugs. They have to start explaining to others lost blocks of time, money, energy, and different thoughts and behaviors surface. By thoughts I mean all the using and getting drugs takes a lot of planning, manipulating and lying. They need to form a group of people who each contribute something to getting drugs, a place to use them and help with the cover story to disguise what’s really going on. (more…)Learn More
Let’s look at the opiates first. An opiate is a narcotic pain killer like Roxycodone, Oxycodone, Loratabs, Loracet, Methadone, Vicodin, Actiq, and Stadol. The action of these drugs may last varying amounts of time and has varying doses. For example, some people can be on 100mg a day of oxycontin while others may take 1000mg a day of oxycontin.
When a person goes through the detox process, problems begin soon after the initial part of the detox at and around five days. Mood problems are the most common with depression and anxiety. Occurring frequently people become lethargic, sad, anhedonia (unable to enjoy anything), unable to concentrate, feeling hopeless, helpless, worthless, despair, negative thinking, worrying, having tension, unable to relax, fearful.
Another thing that happens in recovering opiate addict is they can’t wait for anything. Everything needs to be immediate. They don’t like plans, tend to be impulsive and they just like to do it now. It’s called instant gratification. Problems with sleep last for months if not years. People may develop cravings for sugar and increased sexual drive may occur. Difficulty thinking develops; they may have apathy towards everything which is a lack of interest in all activities. They don’t want to do leisure activities or work. They have difficulty setting goals, finding motivation and have difficulty following through on tasks. They become preoccupied with using opiates. (more…)Learn More
The first question most people ask when visiting a doctor is “What’s wrong with me?” As a psychiatrist I usually beat them to the punch by asking them, “Why are you here?” That question itself is diagnostic in nature. It speaks volumes of an individual’s perception and self assessment of their problem. If the patient is presenting with an addiction issue, invariably there are several assumptions they have already made. Most of the time they assume that they have a disease. That it is chronic. That it is incurable. And that after a period of detoxification their disease will be managed by daily doses of 12-step activity. This in spite of overwhelming statistic that traditional 28 day treatment programs have about a 16% success rate.
This has always been a great curiosity to me. If one in six patients who attend these conventional treatment programs remain abstinent for one year post discharge, why would anybody waste the time, money and psychic investment required by these programs. I would not buy a car that started one out of six times. More importantly, I would not buy a car that stopped one out of six times I applied the brakes.
What if we were treating a disease that does not exist? In my profession that is called a misdiagnosis. What if we spent our time, energy and money trying to stop “addiction” rather than trying to understand addiction? An entire industry has developed around causation rather than cessation. If you had a choice of either understanding why you drink or stopping your drinking the decision would be obvious. Even if you are a comprehension junky for whom the process trumps the product, at some point all growth starts with stopping. (more…)Learn More
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Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist – Psychiatrist, discusses why people it is beneficial and best to work with a psychiatrist when detoxing from drugs. Many times drug abuse and drug use come to help with mental illness. If you don’t work on the symptoms of what causes the use of addictive drugs (i.e. depression), you’ll find it difficult to detox completely from addictive drugs.
Call Dr. Agresti today to get help with Drug & Alcohol Addiction.
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Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist – Psychiatrist, explains how to tell if a family member or friend is suffering from alcohol or drug addiction. He explains the signs, symptoms of behavioral, social and physical changes of someone with Drug & Alcohol Addictions. Alcohol & Drug Addiction should be treated with help. Learn how to approach your loved ones with drug and alcohol addictions.
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Dr. Agresti, West Palm Beach Mental Health Specialist – Psychiatrist, talks about drug addiction rehab options. If you or a loved one has a problem with drug or alcohol addictions, you should know the options for addiction detox rehab. Not all drug addictions require in-patient treatment. Many drug addictions can be treated in outpatient care. Dr. Agresti, in this video, shares the time periods to expect for drug addiction rehab.
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