Misc Alcohol Withdrawal Help - Urgently Needed

[Swimmingdancer]

My friend is an alcoholic and is attempting to quit drinking right now and I'm looking for any advice on what he can do to help with the withdrawal symptoms and on how I can be most supportive for him. His doctor prescribed him some clonazepam (not sure how much he has) but he is not really being supervised. Other than making sure he gets lots of fluids and vitamins/nutrients, is there anything else that could help? Any OTC meds or supplements? It is really hard to get him to eat anything and he is really depressed. He has been drinking about 1.5 litres of wine in the mornings and maybe another 1.5 to 2 litres later on. Would GABA supplements be helpful?

Also is taking the clonazepam when he is still drinking dangerous? (I know there have been times when he took a bunch of clonazepam, claimed they weren't helping, and went out and got some booze. Hopefully he is actually going to be not drinking soon or at least drinking a lot less though.)

Any other advice would be greatly appreciated.

*Not too sure if this is the right forum, feel free to move it if not. I did do a search but wasn't able to find much on treating the symptoms of alcohol withdrawal alone, as most of the threads I found were about people who were kicking alcohol and benzos, and the only suggestions I really saw for alcohol WDs were "take benzos" or "go to detox" - I am looking for more detailed info than the former and the latter is not a current possibility for this person. If there are already some good threads on this topic please post the links. Thanks.

 

[tricomb]

I'm pretty sure this is the right forum, although I am not nor have I ever claimed to be a professional with alcohol and alcoholism, the only experience I've had was first hand having to babysit family members, loved ones, girlfriends, etc. all night to make sure they were still breathing. It is one of the hardest addictions to watch progress.

Benzodiazepines are a start but usually doctors prescribe more than just benzos because that would trade one addiction for another.

Are you, or your friend worried about him having seizures or anything serious due to the alcohol WD?

How abrupt was his taper/discontinuation? What other medications is he taking?

 

[Swimmingdancer]

I am going to try to talk him into seeing the doctor again soon, but it might have to wait for few days before he can get into see the dr. He hasn't really done any tapering, he does not seem very capable of that level of self-control when it comes to alcohol. I don't think he's taking any other meds right now, but he used to take anti-depressants and painkillers (don't know what type but dont think they were super strong). I think he stopped taking both and has just been drinking a lot instead. I am very concerned about him

He is supposed to be quitting cold turkey today but we'll see if that happens. Hopefully the clonazepam helps!

Yes he seems worried about the potential serious physical withdrawal symptoms such as DTs, but I really have no idea how likely seizures etc are or the extent of his current physical dependence to alcohol, he has been on a binge for a couple weeks straight but was drinking less before that.

 

[madog11]

I would suggest going back to the doctor. If he is detoxing as an outpatient he should be in CONSTANT contact with his doctor anyway.

 

[Deblanc]

I'm a recovering alcoholic who has been exactly where your friend is now a few times. It may sound strange, but he shouldn't stop drinking on his own. The possibility of seizures are great, and it can be deadly, but the most common problem is the depression. It's central to the disease and when you stop on your own with zero support, the result is usually to begin drinking again and it can lead to a deadly binge. The depression makes you give up your quest to stop, then you hate yourself more for giving up, you drink more to knock it back, you justify going past your limit, now it's double the amount you usually drink, and throw some clonazapam in there and you wind up dead. It happened to me last year, I dies in the ambulance twice, and luckily was revived to be here today. My BAC was .54, and it happened because of exactly what I describe, with slightly different circumstances. So, if he wants to quit, he needs to check in to a rehab or hospital, and you should confiscate those benzos. Don't try to use them to detox him at home. He's gonna drink you can't control the outcome. It's really hard. I feel for the guy.

 

[RorerQuaalude714]

All of the above posts are absolutely true. Deblanc's, in particular, has the absolute best advice. I don't mean to parrot him but your friend definitely needs to get into a detox and then to rehab. At this point, he needs constant monitoring and professional management. As with any addiction, the only way to treat it is through intense professional intervention with equally steady followup during any outpatient treatment. I personally feel that this doctor is being foolish for not doing constant followup and monitoring of your friend. To repeat myself, your friend needs to get to detox and then to rehab ASAP before he ends up in a potentially lethal situation.

 

[Cane2theLeft]

I was planning on posting almost the same thing as deblanc.

Obviously it's essential that he detox safely so he doesn't seize or have other serious complications but the misery of detoxing is going to be for absolutely nothing if he doesn't get help to address the addiction issues. The detox is the easy part compared to trying to stay sober and deal with all the bullshit that lead to the drinking problem without anesthetizing himself with alcohol (or something else).

You can't force your friend into treatment or 12 step programs or anything and he'll probably insist he just needs to get past the w/d and he'll be fine but if he does go this route, relapse is statistically inevitable essentially. If you want him to get clean and stay clean, it will almost definitely take more than just some clonazepam unfortunately.

 

[Donewthislife]

His doctor is an asshole not only for not monitoring and following up with him but, not sending him into a detox!!! The quantities of alchohol he is consuming is not something he can detox from at home. Jesus H Christ....where to these doctors come from!! Not to beat a dead horse here but he REALLY needs to seek professional help. The hard part is trying to convince him he can not do this at home. I'm sure he will give you every excuse in the book that he can stop on his own. What you can do is inform him of the serious dangers of doing so. Alcohol detox is no joke. I have been to rehabs before where people STILL seizure even when they are medically supervised and treated. Imagine your friend trying to do the same thing but at home by himself?? Its pretty scary and I wish the best for your friend SD!

 

[Deblanc]

One of the cruelest realities for most alcoholics is the need to hit bottom, and truly be done with drinking, for recovery to be successful. For me, it was dying in the ambulance. I got lucky, the impact was profound and my urge to drink had evaporated when I came out of the coma. For most people the bottom is not so extreme and life altering, so the work is harder to face. I desperately wanted to stop, for years, but I could not. Most alcoholics I know desperately want to stop, and I suspect your friend does as well. But another cruel reality is when you are that bad, your mind is so altered and your defenses and denial are so great it is almost impossible to break through with reason. One is truly insane at that point. The very best hope you have to convince him to go into a clinical detox is by getting it set up in advance for him, then being there when he is most vulnerable. Be there when he is vomiting bile and his stomach is on fire from not eating and all the tannins and sugars in the wine. Be the friend who isn't judgmental, isn't scolding, but says at the lowest moment, "If you are willing we can go now". It takes a lot of patience, and you may not get him on the first try or even the 10th. Problem is, by the tone of your post, you seem to know he is about to really crash, and thats a dangerous time. He should not be alone, and you MUST get rid of that Klonapin. Feel free to message me if you want.

 

[Swimmingdancer]

Thanks for all your replies! I took him to the doctor so we'll see how that goes and I'll give you guys an update.

 

[Swimmingdancer]

I can't force/convince him to go to detox/rehab. Last time he ended up in the hospital he just escaped anyway. He also doesn't have any money, although I'm sure there is probably some sort of free detox available. But he is unwilling to go, at this point at least. I guess I will just do some research on the options available for detox in our area so that I can give him that info in case he changes his mind and decides to go.

The doctor just gave him more clonazepam and said maybe he can see another doctor after the weekend. The only real reasons he (my friend) thinks he will be able to keep himself from drinking right now is because he has no money left and because I and another friend are hanging out with him so he's not alone. But if lack of money was able to stop alcoholism then there wouldn't be so many homeless alcoholics. Personally I think he could still beg/borrow/steal or pawn all his stuff in order to get more booze if he really wants to. I feel like all I can really do right now is be there, be supportive and encouraging and non-judgmental, try to keep him eating and hydrated and make sure he doesn't take too many clonazepam at once or take it with alcohol. At least if things seem really serious/life-threatening I can call an ambulance. He seems a lot more coherent now, after eating/drinking juice etc, but does it get worse after the first day? How long do alcohol withdrawals usually last and at what point are they most severe?

I am very familiar with addiction as I was addicted to heroin for over 10 years, and I am familiar with the mental sides of alcoholism because my father and one of my exes were alcoholics, but I don't know as much about the physical side of withdrawals etc, (probably because neither of them ever quit, nor was their use as high/constant), other than that they can be very horrible and serious.


ETA: I understand that relapse in the future is very likely, but my main concern right now is getting him through the present alive. If he doesn't quit drinking very soon I think he will die, but I am also worried about his health from the effects of trying to quit drinking. At least if he can quit for a while and make it through the withdrawals safely, that will add some time onto his life and provide an opportunity to work on the mental aspects of his addiction. He is in no state to go to meetings or socialize or read self-help books or work on his mental health in other ways as things currently are. Even if he is able to stop drinking for a few weeks I think would greatly improve his health from where it is right now. Also I'm not sure how irresponsible his doctor was, because I have no idea what he said to his doctor, he may have minimized his situation for all I know, and he had his phone off the hook so it could be possible the doctor tried to call him. Our other friend and I just went to his house and banged on the windows because we were so concerned. But yeah, I agree that it seems like a bad idea just to give benzos to an alcoholic and send them home.

One more question, would it be a good idea for him to start taking his anti-depressants again? Or would that increase the risk of seizures? I think it is Venlafaxine. (I'm assuming it's probably best for him not to take it unless he is both not drinking and his symptoms of alcohol withdrawal have subsided).

 

[Deblanc]

The length of wd is contingent on lots of things, from his weight, to how much he drank, to other health issues like diabetes or liver ailments, his body chemistry and how out of whack it all is. Generally you are looking at the 72 hrs after the first day as the worst and most dangerous period, but again it just depends on so many factors. Watch him and look for tremor. If he has a pronounced tremor that worsens over time, it can be a precursor to seizure. Look for any signs of hallucination, aggression, or severely confused thinking, these can also be precursor to seizure. Do not give him antidepressants. Yes, they can add to the risk of seizure, and can exacerbate his depression, ironically. He needs to get his chemistry back on track first.

Time is super slow in the early part of drying out. A day is a long time. By the end of the first week he will feel like a different person. At two weeks he will be feeling great, right on top of the big pink cloud. This is the time to make resolutions and encourage the long term sobriety, and if he makes it that far he will be motivated. Take advantage of it because right around the corner that cloud is gonna turn grey and stormy and that's when the real hard,slow process begins. This is when people relapse, about 3 weeks in. In AA they encourage 90 meetings in 90 days. The reason is it takes about 90 days for your body to get turned around and your mind to iron itself out. If he's not gonna do meetings, still 90 days is a good goal post to shoot for. Try to get him to keep a daily journal of some kind of reflective thinking. Get him out of the house and social if he isn't naturally. Tent get him to start exercising once he's over the wd phase. And he really needs some counseling, someone to talk to about his mess. It makes a huge difference.

You are a great friend, and you have a thankless task. Many alcoholics have by this point alienated everyone and are alone. You get a big gold karma star for all of this.

 

[Swimmingdancer]

Thanks Deblanc I guess for the next few days I will just try to be there for him, watch that his physical condition doesn't get too bad, make sure he is eating/drinking (fluids, not alcohol obviously) and taking his clonazepam as prescribed, and give him the info about detox in case he decides to go. He does have a support system of people who care about him and a counsellor etc so if we can be there for him and encourage him in his recovery I think that will help. I think a big part of why it got so bad this time was that he had withdrawn from everyone, wasn't answering his phone, not going to doctor appointments, meetings, work, social engagements, etc. He seems really happy that I and our other friend cared enough to go looking for him and are spending time with him and being supportive with what he's going through. I know when you're in the throes of an addiction it's easy to just avoid other people and wallow in your depression, so hopefully we can keep him from spending so much time alone and help lift his spirits a bit.

He is feeling relatively okay today but is very afraid of tomorrow.

 

[jasper kent]

Swimmingdancer, bless you for being there for your friend. I've been through alcohol withdrawal more than once, including DT's, and it ain't no picnic. Deblanc gave good advice.

Personally I was never able to detox at home, but then I didn't have someone there for me 24/7. What invariably happened to me was that I'd either abuse the benzos and run out too soon or I'd get to feeling a little better and then find a way to drink with the pills. Either way it led to worse withdrawals and I'd end up in the ER. Inpatient detox & treatment followed by outpatient treatment(and support groups) worked best for me.

When your friend can eat, I strongly suggest vitamin supplements, especially thiamine(B1). It will help with the shakes and depression. Heavy drinking flushes all nutrients out of the body, but alcoholics tend to be particularly deficient in thiamine.

 

[Swimmingdancer]

Thanks Jasper And thanks again to everyone else who responded

I have some B1 so I will give him some if he thinks he can keep it down. I think B vitamins in general are also supposed to help flush toxins out of the body.

 

[jasper kent]

Thanks Jasper And thanks again to everyone else who responded

I have some B1 so I will give him some if he thinks he can keep it down. I think B vitamins in general are also supposed to help flush toxins out of the body.

Be sure he's able to eat something with the vitamins. Otherwise, he'll just puke them up.

 

[Cane2theLeft]

I would certainly not give have him start taking the venlafaxine now during the detox but if they were helpful and well tolerated in the past, when he starts feeling better that might be a good idea to give him a little boost in mood and mitigate the PAWS a lot.

He is truly lucky to have you but make sure you are still taking care of yourself (especially emotionially). You seem to have realistic expectations so I'm not too worried but I have just seen so many family members and friends of alcoholics put so much hope into them getting better that it destroys them a little more each time it doesn't work out. You seem like a strong individual with a great head on your shoulders so hopefully that won't be a problem but I would just hate to see your recovery process and tapering adversely affected by all of this. Oftentimes addicts use helping others as a way to avoid dealing with their own problems and this typically catches up eventually. I don't see any reason to think you're doing this but I've just seen it happen so many times that I wanted to toss it out there for you to keep an eye on.

To reiterate, your friend is incredibly lucky to have you and please make sure you're taking care of yourself too!

 

[Swimmingdancer]

Aw thanks I don't really have any expectations, I just want to support him when he wants help. And it doesn't affect me TOO much because I don't live with the guy or anything and he isn't a family member, of course I worry about him and dont want to die and want him to be happy, but it doesn't have a huge effect on my life like it would if it was someone I was in love with or something - does that make sense? I think if anything taking care of others is good for me because it helps me to not spend all my time dwelling on my problems or thinking about how crappy I feel, but you're right, its important to still take care of myself and not get stressed out or anything. So far my friend seems to be doing really well considering and we even went to an (alcohol-free) outdoor concert today. Just taking it one day at a time like the 12-steppers say