ALCOHOL THERAPY

Pharmacologic treatment is not very popular for alcohol addiction compared to opioid addiction. Instead, most people attend Alcoholics Anonymous (AA) meetings.

Naltrexone is an opioid blocker. Initially developed for opioid cravings, Naltrexone turned out to fight alcohol cravings too (mechanism unknown). It can be given via a monthly injection. It's the first line therapy, and is especially helpful with combined alcohol and opioid addiction

Disulfiram is like a shock collar for booze. It blocks aldehyde dehydrogenase, the liver enzyme responsible for breaking down a noxious ethanol by-product called acetaldehyde. Acetaldehyde makes you feel flushed, anxious, tachycardic and uncomfortable. Drinking alcohol after taking Disulfiram will make you feel like shit.  Understandably, compliance is very low, making it a second line medication.

Acamprosate is another option for lowering cravings. It's not very popular for some reason. Low yield.

DELIRIUM TREMENS

The shakes

Delirium Tremens (DTs) is a serious complication of alcohol withdrawal that occurs on Day 3 or 4 of sobriety. If you keep in mind the timeline, you might be able to recognize this fatal and treatable disorder.

Day 1. Nonspecific “upper” symptoms like anxiety, tremors, diaphoresis, goosebumps, nausea and tachycardia.

Day 2. Serious, albeit non-life threatening, symptoms like seizures and hallucinations occur (tactile >>> visual > auditory >>> olfactory). You can still have a conversation with them provided they aren’t actually seizing. The symptoms from day 1 will still be there, and they’ll be getting worse. The patient will feel / look like shit  

Day 3 or 4. Five percent of those in withdrawal will enter the DTs. To remember the signs and symptoms, just think of the name - they’re delirious (confused) and tremulous (seizures). You would not be able to have a conversation with this patient. The hallucinations will worsen, the seizures will progress and they might get a fever! The DTs are dangerous! Without treatment, about half of patients with the DTs will die. With treatment, that number falls considerably. The DTs are treated with Benzos! You should generally pick Lorazepam. It’s one of the few Benzos that isn’t metabolized by the liver, and alcoholics tend to have crappy livers.