 Many chronic alcoholics become maintenance drinkers, drinking daily, to avoid withdrawal symptoms. Withdrawal symptoms can include anxiety, irritability, nervousness, weakness, insomnia, appetite loss, gastrointestinal distress, elevated blood pressure, tremors, seizures and hallucinations. Unfortunately, repeated unmedicated alcohol withdrawal can produce an aggravation of tremors and depression called "kindling." Repeated alcohol withdrawal and relapse may be more damaging to the alcoholic's health, than continued maintenance drinking. Robert Post, at the National Institutes of Health, found kindling can also occur with epilepsy and depression.Many traditional alcohol detoxification programs prevent only grand mal seizures. These programs often allow the nausea, gastric distress, anxiety, insomnia, nervousness, tremors, rapid pulse and unhealthy blood pressures to continue, during detoxification. PET brain scan studies prove merely preventing grand mal seizures, during alcohol detoxification allows increased nerve membrane potentials and voltage to damage neurons, causing permanent damage. Allowing permanent brain damage to occur during alcohol detoxification is cruel and unnecessary. Why is this allowed? Skilled anesthesia eliminates any tremors or twitching during detoxification. Dr. Sponaugle is a Board Certified Anesthesiologist and has perfected a technique which prevents these unpleasant and dangerous symptoms.In many alcoholics, the severity of withdrawal symptoms increases after repeated withdrawal episodes. This exacerbation may be attributable to a kindling process. Kindling is a phenomenon in which a weak electrical or chemical stimulus, which initially causes no overt behavioral responses, results in the appearance of behavioral effects, such as seizures, when it is administered repeatedly. Both clinical and experimental evidence support the existence of a kindling mechanism during alcohol withdrawal. Withdrawal symptoms, such as seizures, result from neurochemical imbalances in the brain of alcoholics who suddenly reduce orcease alcohol consumption. These imbalances may be exacerbated after repeated withdrawal experiences. The existence of kindling during withdrawal suggests that even patients experiencing mild withdrawal should be treated aggressively to prevent the increase in severity of subsequent withdrawal episodes. Kindling also may contribute to a patient's relapse risk and to alcohol-related brain damage and cognitive impairment. Becker, H, (1998), p 25While the alcoholic is sedated with alcohol, the body up regulates excitatory neurotransmitters including acetylcholine, epinephrine, and glutamate. At the same time, feedback mechanisms down regulate GABA (gamma-aminobutyric acid), which is the most abundant inhibitory neurotransmitter in the brain. Magnesium is also severely depleted by alcohol. Magnesium is necessary to relax muscles and used in hospital treatment of delirium tremens, which can be fatal, if untreated. During alcohol withdrawal, tremors and seizures may occur, since the excitatory neurotransmitters acetylcholine, glutamate and epinephrine are elevated, while the inhibitory neurotransmitter GABA and serum magnesium levels are decreased.Some of the medications used to reduce severity of tremors are Gabapentin, Topiramate and Clonidine. Gabapentin is an anticonvulsant, closely resembling the inhibitory neurotransmitter, GABA. Gabapentin may be used, when liver damage is present, since it is eliminated, in the urine, and not metabolized by the liver. Topiramate is a newer anticonvulsant which is also non addictive. Clonidine (Catapres) is used to reduce the elevated blood pressure and rapid heartbeat of alcohol withdrawal. Medications which can reduce craving and increase abstinence include Acamprosate, Naltrexone and Topiramate. Acamprosate, recently approved by the Food and Drug Administration, has been used for over 10 years in Europe to manage increased anxiety from alcohol abstinence and has been proven to increase sobriety rates. Acamprosate appears to reduce pre-synaptic release of glutamate. Acamprosate may be used, when liver damage is present, since it is eliminated, in the urine, and not metabolized by the liver. Naltrexone is an opiate antagonist and has been proven to reduce alcohol cravings and relapse rates. Topiramate has also been proven to increase abstinence rates and appears to augment GABA levels. |
