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admin | Obstructive Sleep Apnea | 19.08.2015
Alcohol acts in the brain by stimulating the gamma-aminobutyric acid (GABA) system (remember this–it’s important), which both inhibits excitatory brain impulses and enhances inhibitory ones.
However, when alcohol is suddenly withdrawn, all of these many GABA receptors are suddenly unoccupied, which causes the opposite effect of intoxication: Excitatory brain impulses are enhanced and inhibitory brain function is suppressed. The key point here is that withdrawal is caused by exposed, unoccupied, irritated GABA receptors in the brain. By “empiricism,” I mean direct studies proving the efficacy of hydroxyzine for alcohol withdrawal. The reason that hydroxyzine and the rest fell into disuse is this: as soon as benzodiazepines were introduced and tried as alcohol withdrawal agents, it was clear that they are vastly superior to hydroxyzine and everything else that had come before.
Based on this and many other similar studies, medical textbooks no longer recommended the use of hydroxyzine for alcohol withdrawal by the early 1970s, and instead recommended that “alcohol withdrawal should be treated with medications that have a similar chemical structure to alcohol”—like chlordiazepoxide. No current medical textbook nor any practice guideline recommends using hydroxyzine for alcohol withdrawal. Hydroxyzine is not used as a primary alcohol withdrawal agent in inpatient alcohol rehab centers outside of jails and prisons. At least, almost every single alcohol rehab center and inpatient alcohol treatment center that I have ever come into contact with uses benzodiazepines. I suspect that the reason that many jails have been using hydroxyzine instead of benzodiazepines to treat alcohol withdrawal is a desire to keep all controlled substances out of the jail for fear of abuse. I mentioned earlier that many other agents besides benzodiazepines have been studied as treatment for alcohol withdrawal. This entry was posted in Drug Evaluations, Jail culture, Medical Practice, Studies, Withdrawal and tagged Alcohol withdrawal syndrome, correctional medicine, evidence based medicine, GABA, GABA receptor, inmates, jail medicine, prisons on January 9, 2014 by Jeffery Keller MD. Alcohol abuse affects each individual differently, and the withdrawal symptoms of alcohol detox vary based upon the amount of use, frequency of use, and length of abuse. However, in the other 10 percent of alcohol detox cases, individuals will experience severe withdrawal symptoms. When alcohol detox takes place, these changes that have been accepted by the brain stop suddenly.
The GenPsych Ambulatory Detox Program offers a unique opportunity for individuals suffering from chemical dependency. Alcohol consumption in the United States is extremely prevalent and binge drinking is no exception. Detoxification, or detox, is the process by which toxic substances are removed from the body. Like detox, treatment for alcohol abuse is most successful when supervised by a medical professional.
One who regularly exceeds the above guidelines is at a high risk for developing alcohol abuse or addiction. Alcohol withdrawal may be treated with a pharmacologic agent that exhibits cross-tolerance with alcohol. Group therapy, counseling, and alcohol education is strongly recommended for recovering addicts in order to help cope with the mental, social, and behavioral changes associated with treatment. If you or someone you know is suspected to be suffering from alcohol abuse or dependency, GenPsych can help.
For example, one of the very first studies using benzodiazepines for alcohol withdrawal was done in 1969 (reference here) and compared hydroxyzine to chlordiazepoxide (Librium). However, since 1969, nothing, and I mean nothing has ever outperformed benzodiazepines as therapy for alcohol withdrawal.
The benefits of benzodiazepine use for alcohol withdrawal (the best medication for a potentially life-threatening condition) clearly outweigh the potential for abuse. Benzodiazepines used for alcohol withdrawal are only given for a short time—a few days at most.

Patients being treated for alcohol withdrawal should be housed apart from the general population anyway, so that you can keep an eye on them. Inpatient alcohol treatment centers use benzodiazepine almost exclusively to treat withdrawal. The possibility of abuse of benzodiazepines during short term use by alcohol withdrawal patients is small (in my opinion). Carbamazepine and Valproic acid are both superior to hydroxyzine for treating alcohol withdrawal (though both are inferior to benzodiazepines). Benzodiazepine withdrawal is quite tedious compared to alcohol withdrawal unless the patient is prescribed a very high dose, or abuse the benzodiazepines. About 90 percent of individuals struggling with alcohol abuse suffer mild withdrawal symptoms.
While it is always recommended that alcohol detox take place under medical supervision, it is imperative that an individual seek medical attention if severe symptoms occur.
Alcohol works as a depressant, while also increasing dopamine (or pleasure chemicals) levels in the body. Not only are our clients safely and comfortably detoxed with the assistance of medication under the care of our medical team, but they are also offered therapeutic programming to learn more about their addiction, as well as relapse prevention skills to help manage and sustain their recovery. With more than 25 percent of US adults admitting to binge drinking or heavy drinking within the past month (2013), it can be difficult to draw the line between having fun and struggling with addiction. In the case of alcohol abuse, detox treatment involves the discontinuation of alcohol consumption altogether. Doctors can help make the recovery process following detox as safe, healthy, and painless as possible.
In the brain, alcohol is a central nervous system depressant that acts to suppress the excitatory nerve pathway and increase the inhibitory nerve pathway. One example I have run into repeatedly is the practice at many jails of using hydroxyzine to treat alcohol withdrawal. With high-level repetitive drinking, the brain makes more GABA receptors, so that the same amount of alcohol will exert less effect on the GABA system.
Just like there are various levels of intoxication in various individuals depending on the number of GABA receptors reacting to alcohol (from pleasantly “buzzed,” to slurred speech, to staggering, to comatose, to not breathing), there are also various levels of withdrawal symptoms correlating to how many GABA receptors are unoccupied. When you give a patient withdrawing from alcohol Valium or Librium, these drugs slide right into the empty GABA receptors and thus attack the problem of withdrawal at its source.
This does cause a low level of sedation and neurological slowing, but since it does not act in any way, shape, or form on the GABA system, there is no theoretical way that hydroxyzine can perform as well as benzodiazepines in treating withdrawal—not even close. All recommend using benzodiazepines as the primary treatment agent for acute alcohol withdrawal.
If you know of an inpatient alcohol detox center that uses hydroxyzine instead of benzos, I’d like to know about it! Such symptoms, if not monitored by a medical professional, can cause great pain and, in extreme cases, be fatal. For more information on GenPsych’s Ambulatory Detox Program or to begin your path to recovery, click here.
It is estimated that over 16 million Americans suffer with Alcohol Use Disorders (AUDs) each year (National Institute on Alcohol Abuse and Alcoholism). Unlike detox from other drugs, detox following alcohol abuse can be especially difficult as alcoholic beverages are easily accessible and socially acceptable. Those who abuse alcohol have not yet developed a chemical dependency, but consistent long-term abuse can lead to physical and psychologically addiction. This means that there are 8 parts of alcohol for every 10,000 parts of blood in the bloodstream.
This therefore causes normal brain functions to slow down and is responsible for the relaxed and sluggish symptoms associated with alcohol use.

In fact, in my experience in my own jails and reviewing cases elsewhere in the country, alcohol withdrawal is a common cause of death in jail. This process is called “habituation.” Over the course of many years, the brain can make a lot of GABA receptors so that alcoholics can be amazingly tolerant of the effects of alcohol. About the best that can be said for the results is that hydroxyzine did perform better than placebo. A very few list hydroxyzine as a possible “adjunct,” meaning something that can be given in addition to the primary treatment agent.
GABA receptors, which inhibit pain, become extremely low without alcohol consumption, making the body more susceptible to the pain of the aforementioned symptoms. Upon admission to the program an individualized but safe and conservative detox protocol is used to ensure the medical safety and comfort of each client. Medically facilitated detox is often recommended for this reason, as professionals can provide specialized support and resources to help an individual quit. BAC differs slightly between men and women and can be influenced by weight, food consumed, number of drinks consumed, and the time interval between drinks consumed.
When a person develops a dependency to alcohol, these nerve pathways become disrupted in that they adapt to the slow and depressed neural system. In fact, it may be the second most common cause of preventable deaths in jail, behind only suicide. My personal record is a guy I saw in the ER who was walking and talking intelligibly with a blood alcohol of 0.59.
I cannot find references to any studies using hydroxyzine for alcohol withdrawal since the 1970s. If you insist on using something other than benzodiazepines for alcohol withdrawal, look these up! You can call 1-855-436-7792 or click here to schedule an assessment and be seen the same day. When the body begins to tolerate a foreign substance such as alcohol, it accepts and adapts to the changes occurring and operates around them. In NJ, nearly all individuals in detox and treatment programs use alcohol, either independently or in combination with other drugs. Those struggling with alcohol addiction may also experience withdrawal symptoms during the detox treatment process. Some brain cells die and certain receptors become inactivated such that in the absence of alcohol, the brain and spinal cord enter a state of hyper-excitability. If your facility uses hydroxyzine as the primary treatment for alcohol withdrawal, you should change your protocol.
And, yes, hydroxyzine was used to treat alcohol withdrawal in alcohol rehab clinics in the 1960s. Alcohol detox can be a difficult process, but is a necessary first step when recovering from abuse.
Without medical supervision, these symptoms, which range from anxiety and nausea to seizures and tremors, can be life-threatening. Second, I don’t want anyone in my jails ever thinking that they can give withdrawal patients hydroxyzine instead of benzos.
In addition to medication, group therapy, counseling, and alcohol education is also strongly recommended during recovery. Following alcohol abuse, detox treatment can be pursued in NJ through GenPsych’s Ambulatory Detox program, which provides both transportation and medical care for those in need.

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