Pharmacological Interventions
Detoxification
Where possible Home Detox should be in a shared care arrangement between
GP and CDDS.
Patients suitable for home detox are:-Refer To CDDS
Motivated for abstinence- Assess
Supportive other to supervise- Shared Care Plan GP/CDDS
Suitable home environment- Education
No history of seizures- Monitor medication
No significant physical/- Physical state
psychological conditions

Regime
Chlordiazepoxide (Librium) Withdrawal Regime
Days 1,2, & 3- Chlordiazepoxide 20mg qds.
Days 4- Chlordiazepoxide 15mg qds 2 days.
Days 5- Chlordiazepoxide 10mg qds.
Days 6- Chlordiazepoxide 5mg qds
Days 7- Chlordiazepoxide 5mg b.d. *Then Stop
Thiamine 50mg qds for 10 days *Then Stop
Vitamin B Co Strong 2 tablets b.d. for 10 days *Then Stop

Common Problems Associated With Alcohol Withdrawals
Many of these symptoms are normal in withdrawals. First instance reassure patient they
will improve during detox. Avoid unnecessary treatment, only treat if severe:-

Sleep- Sleep hygiene - Do not give hypnotics, if severe consider increasing
nocte dose of CDZ for 1-2 days.
Appetite- Encourage diet, if under weight consider Build-up and
vitamin prophylaxis.
Nausea- Metoclopramide 10 mgs O/IM.
Heartburn- Gaviscon 10mls PRN.
Anxiety- Very common in withdrawals, often resolve after 3-4 days,
may persist and reveal pre-existent anxiety.
Depression- Very common, majority of depressive symptoms in with-
drawal resolve after 2/4 weeks without treatment (in 90%).
Monitor for severe/persistent symptoms/suicidal ideation.
Treat SSRI.
Transient- Common, short lived insight retained,
Hallucinatorymay herald onset delirium tremens/alcoholic hallucinosis,
Experienceno specific treatment neccessary.
Alcoholic- 2nd person/3rd person/running commentary, 2nd
Hallucinationsmdelusional system, acute onset, clear consciousness, lasts
usual < 1 month. Short course antipsychotic.
Alcohol Withdrawal- rates of alcohol use in SMI, rates
& Dualof violence suicide, withdrawals risky not for home
Diagnosisdetox exacerbation ? re-emergence of psychotic symptoms.

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