Alcohol Detox Question

Esme12, ASN, BSN, RN · Mar 6, 2012

Antabuse is used as a treatment for maintenance of sobriety. Not for treatment during detox. The key word here is "detox" while Librium is used during detox to control withdrawal symptoms. Antabuse is considered maintenance.

caroladybelle, BSN, RN · Mar 6, 2012

Librium, along with agents, is used in the withdrawal/detox period to prevent DT's.

Antabuse is generally used in the aftermath of withdrawal, generally after it is determined that your pt is attempting to completely quite using alcohol whatsoever, and stay clean.

There will plenty of pts in the hospital that will need meds for withdrawal during hospitalization, but many of those pts may not necessarily be leaving the hospital to stay sober. That is their choice.

Even though "the book" may say that you can start antabuse within 12 hrs of the last drink, I personally have never seen it started that early, by far. From what I have seen, they generally wait until detox is done and pt has completed withdrawal, and risk of DTs has passed before starting antabuse.

But then I don't work psych. This is based on MS/ICU experience.

Clovery · Mar 7, 2012

Thanks for the replies. I guess I was confused about the 12 hour thing with the Antabuse. I thought they would start it right away during a detox program, since it helps with cravings. So detox = withdrawal? My text is really unclear about that.

nurseprnRN, BSN, RN · Mar 7, 2012

detox does not equal withdrawal unless you think of the period of detoxification as the period of withdrawal from alcohol.

if you think of withdrawal as only its symptoms, that doesn't equal detox because symptoms can be managed.

caroladybelle has given you a good description.

kids · Mar 7, 2012

Somewhat off topic...

Do you have any links to support the idea that Antabuse helps with cravings?

Everything I've been able to find makes it clear that it does not (which is consistant with everything I've ever known about it).

caroladybelle, BSN, RN · Mar 7, 2012

Most patients that I deal with in the hospital are not seeking long term detox so we are just managing withdrawal DT issues. Thus antabuse would not be warranted

Clovery · Mar 8, 2012

Somewhat off topic...
Do you have any links to support the idea that Antabuse helps with cravings?
Everything I've been able to find makes it clear that it does not (which is consistant with everything I've ever known about it).

I don't have anything to support that, it's just what my instructor said in class. It doesn't seem right to me, either, tbh. Maybe she meant that it's a deterrent to drink, i.e. when they get a craving they know drinking will make them really sick so they're forced to use an alternative coping mechanism to deal with the craving.

Clovery · Mar 8, 2012

Most patients that I deal with in the hospital are not seeking long term detox so we are just managing withdrawal DT issues. Thus antabuse would not be warranted

That makes sense.

But if you google alcohol detox programs, many of them advertise a week long inpatient program with antabuse treatment. We're in psych right now, so inpatient detox is what the question refers to... So I really don't think I was wrong, if the patients are given the antabuse before they're discharged. I think my instructor should have said "withdrawal" to be more clear, because that was obviously the point she was trying to make - that only the benzos help the withdrawal symptoms. I was thrown off, because when we got to that one she stressed "Read the question carefully" so I guess I overthought it, thinking she was trying to make a distinction between withdrawal and detox. We never learned what the difference was so it's totally my fault for overcomplicating it.

Esme12, ASN, BSN, RN · Mar 8, 2012

I don't have anything to support that, it's just what my instructor said in class. It doesn't seem right to me, either, tbh. Maybe she meant that it's a deterrent to drink, i.e. when they get a craving they know drinking will make them really sick so they're forced to use an alternative coping mechanism to deal with the craving.

If you are on antabuse and take a drink......how sick it makes you is quite the deterrent so the next time you want to drink the taste of vomit and how sick you wil be makes you want it less. Actually curb cravings.

Meriwhen, ASN, BSN, MSN, RN · Mar 8, 2012

There is no alcohol "detox" drug. Time and abstinence is how you detox an ETOH patient.

Librium is used during withdrawal to alleviate severe symptoms and prevent seizures. Any long-acting benzo can be used in its place--for example we would often give Ativan in if the patient's liver was seriously shot, since Ativan is metabolized differently. Valium is sometimes used as well.

Librium (or whatever LA benzo) doesn't always have to be given. In ERs and non-psych settings, they give it routinely so they don't have to deal with any withdrawal issues. More experienced CD doctors will more closely monitor symptoms and give it only when symptoms are severe.

Antabuse is used for behavior conditioning: you take Antabuse, you drink, you get very sick, you (hopefully) do not want to drink again. And it takes so little alcohol--and it doesn't even have to be ingested--to trigger that reaction, so patients have to watch their diet, topical products, etc. Antabuse works by inhibiting an enzyme that converts ETOH into a less-toxic form. It doesn't work cravings except that you might think about how sick you got last time and not want that drink. However, Antabuse doesn't work for everyone: I've treated patients who were on Antabuse and still putting away 12-packs despite getting sick as a dog each time.

Naltrexone and Campral do a better job of addressing specific cravings as they target the neurotransmitters (dopamine and glutamate, respectively).