I have found myself back in a drug and alcohol detox placement; an environment that I have not worked in for over two years. It is amazing though how the range of medications, and associated physical health issues, have resurfaced from the recesses of my brain, usefully emerging to help me with my learning within the workplace.
For alcohol detox, usually over 7 days, patients withdraw using a drug called chlordiazepoxide (Librium), which is gradually reduced. In order to reduce cravings, a drug called acamprosate (Campral) is also given during the detox, plus also during the period when the patient goes home. For a patient who weighs less than 60 kg, a slightly lower dose of acamprosate will be given.
People who have drank heavily are usually deficient in essential vitamins, caused by a poor diet and alcohol destroying vitamin B levels. Patients may be experiencing neuropathy in their fingers and toes – a kind of pins and needles feeling. They may also be experiencing myopathy – a muscle weakness in their arms and legs, which might even be effecting their mobility. Additionally, they may also be experiencing short term memory problems. In order to replenish the body therefore, patients are usually given three Pabrinex intra-muscular injections – one injection daily for three days; although in very heavy drinkers whose health has been compromised even further, two injections over three days, making a total of six, may alternatively be given. Pabrinex is a nourishing liquid medication of vitamin B and C. In order to maximise the bodily effects even further, patients are also given vitamin B and thiamine tablets, and are encouraged to carry on taking these when they get home.
For heroin detox, patients withdraw using liquid methadone. It is a gradually reducing regime over 14 to 28 days, depending upon the amount of heroin that was previously being used. In order to help with withdrawals, a drug called lofexidine (Britlofex) is also given; but before administering, the patient’s pulse should be checked, in order to ensure that it is not less than 50. For the common side-effect of restless, aching legs, there is a drug called Baclofen. Additionally, a seven night prescription of Zopiclone is also usually available, in order to help with sleep problems.
For specific withdrawal symptoms there are a range of medications to provide relief: loperamide (Imodium) is for diarrhoea; metaclopromide is for sickness; chlorphenamine (Piriton) is an anti-histamine for itching; Gaviscon is for stomach acid; senna or lactulose is for constipation; and of course, there are paracetamol and ibuprofen for general aches and discomfort.
It is both interesting and very sad to hear about the life problems that have caused patients to start abusing drink or drugs. Common triggers can be bereavement, divorce, unemployment, or depression; there may be singular causes or there may be multiple and cumulative causes. Whatever the reasons, it is interesting to note that substance misuse could potentially happen to anyone. Patients should never be judged; they are nice, normal people who have often had to cope with some terrible problems, and they have made a brave and honest choice to undergo detox, to admit their drink or drug problems and to ask for our help. I am proud to be involved in helping these patients, and I wish them all success and much happiness in the future.