Alcohol withdrawal is a set of symptoms that occur with the elimination of alcohol when a
person is psychologically and/or physiologically addicted to it.
A majority of people who have been drinking alcohol and decide to stop (often for
health-related reasons) are able to do so without much trouble. Alcohol withdrawal typically
becomes difficult only when problem drinkers—alcoholics—attempt to quit. Almost
inevitably, alcoholics need help in achieving this goal. Sometimes, this help requires medical
intervention in detoxification centers.
Finding doctors who work with alcohol detoxification is often as easy as calling the local
chapter of Alcoholics Anonymous (AA) and asking for referral information. Most programs
successful in getting alcoholics to quit drinking are either part of the AA network or employ
AA techniques. Natural approaches to alcohol withdrawal should not be a substitute for detox
centers or for AA or AA-related programs.
Checklist for Alcohol
Withdrawal
What are the symptoms of alcohol withdrawal?
A person typically has a mild to severe hangover that lasts several days. Symptoms may
include stomach upset; headache; shakes or jitters;
feelings of generalized anxiety or panic attacks; and insomnia that may be accompanied by bad dreams. There may
be also be increases in heart rate, breathing rate, and body temperature. In a small
proportion of alcoholics, withdrawal may result in severe symptoms, such as hallucinations,
delirium tremens (DTs), or generalized seizures.
Medical treatments
Over the counter treatment involves supplementing with multiple B vitamins, including
thiamine.
Prescription treatments in detoxification centers may begin with an injection of vitamin B1 in cases that involve malnutrition. In treating severe
acute withdrawal symptoms, a nervous system depressant, such as the benzodiazepines such as diazepam (Valium®) and
lorazepam (Ativan®), is prescribed with a dosage that is tapered down over three to five
days. The beta-adrenergic blocking drugs atenolol (Tenormin®) and
propranolol (Inderal®) are also occasionally used.
Further treatment includes adequate nutrition, fluid intake, and rest.
Dietary changes that may be helpful
Some of the nutritional deficiencies associated with alcoholism can be caused by a poor
diet—a factor that needs correction on an individual basis. Improving the overall diet
should be done in conjunction with a doctor. Sometimes liver or pancreatic disease associated with alcoholism
also contributes to nutritional deficiencies. These problems require medical assessment and
intervention.
In one trial, a hospital diet was compared with a special diet including fruit and wheat germ and excluding caffeinated coffee, junk food,
dairy products, and peanut
butter.1 After six months, fewer than 38% of those on the hospital diet
remained sober, compared with over 81% of those eating the special diet. A review of the
research shows that diets loaded with junk food increase alcohol intake in
animals.2 In a human trial, restricting sugar, increasing complex carbohydrates, and
eliminating caffeine also led to a reduction in alcohol
craving.3 While the support for dietary intervention remains somewhat unclear, some
doctors suggest that alcoholics reduce sugar and junk food intake and avoid caffeine.
Lifestyle changes that may be helpful
Most experts agree that alcoholics must stop drinking completely in order to overcome the
addiction. Moreover, before nutritional supplements can be used, effective treatment of the malabsorption problems requires a complete avoidance
of alcohol.
Nutritional supplements that may be helpful
Many alcoholics are deficient in B vitamins, including
vitamin B3. John Cleary, M.D., observed that some alcoholics spontaneously stopped
drinking in association with taking niacin supplements (niacin is a form of vitamin B3).
Cleary concluded that alcoholism might be a manifestation of niacin deficiency in some people
and recommended that alcoholics consider supplementation with 500 mg of niacin per
day.4 Without specifying the amount of niacin used, Cleary’s preliminary
research findings suggested that niacin supplementation helped wean some alcoholics away from
alcohol.5 Activated vitamin B3 used intravenously has also helped alcoholics quit
drinking.6 Niacinamide—a safer form of the same vitamin—might have
similar actions and has been reported to improve alcohol metabolism in
animals.7
Deficiencies of other B-complex vitamins are
common with chronic alcohol use.8 The situation is exacerbated by the fact that
alcoholics have an increased need for B vitamins.9 It is possible that successful
treatment of B-complex vitamin deficiencies may actually reduce alcohol cravings, because
animals crave alcohol when fed a B-complex-deficient diet.10 Many doctors recommend
100 mg of B-complex vitamins per day.
Alcoholics may be deficient in a substance called prostaglandin E1 (PGE1) and in
gamma-linolenic acid (GLA), a precursor to PGE1.11 In a double-blind study of
alcoholics who were in a detoxification program, supplementation with 4 grams per day of evening primrose oil (containing 360 mg of GLA)
led to greater improvement than did placebo in some, but not all, parameters of liver
function.12
The daily combination of 3 grams of vitamin C, 3 grams
of niacin, 600 mg of
vitamin B6, and 600 IU of vitamin E has been used by
researchers from the University of Mississippi Medical Center in an attempt to reduce anxiety and depression in
alcoholics.13 Although the effect of vitamin supplementation was no better than
placebo in treating alcohol-associated depression, the vitamins did result in a significant
drop in anxiety within three weeks of use. Because of possible side effects, anyone taking
such high amounts of niacin and vitamin B6 must do so only under the care of a doctor.
Although the incidence of B-complex deficiencies is known to be high in alcoholics, the
incidence of other vitamin deficiencies remains less clear.14 Nonetheless,
deficiencies of vitamin A, vitamin D, vitamin E, and vitamin C are seen in many alcoholics. While some reports
have suggested it may be safer for alcoholics to supplement with beta-carotene instead of vitamin A,15 potential
problems accompany the use of either vitamin A or beta-carotene in correcting the deficiency
induced by alcoholism.16 These problems result in part because the combinations of
alcohol and vitamin A or alcohol and beta-carotene appear to increase potential damage to the
liver. Thus, vitamin A-depleted alcoholics require a doctor’s intervention, including
supplementation with vitamin A and beta-carotene accompanied by assessment of liver function.
Supplementing with vitamin C, on the other hand, appears to help the body rid itself of
alcohol.17 Some doctors recommend 1 to 3 grams per day of vitamin C.
Kenneth Blum and researchers at the University of Texas have examined neurotransmitter
deficiencies in alcoholics. Neurotransmitters are the chemicals the body makes to allow nerve
cells to pass messages (of pain, touch, thought, etc.) from
cell to cell. Amino acids are the precursors of these
neurotransmitters. In double-blind research, a group of alcoholics were treated with 1.5 grams
of D,L-phenylalanine (DLPA), 900 mg of L-tyrosine, 300 mg of
L-glutamine, and 400 mg of L-tryptophan (now available only by prescription) per day, plus
a multivitamin-mineral supplement.18 This
nutritional supplement regimen led to a significant reduction in withdrawal symptoms and
decreased stress in alcoholics compared to the effects of placebo.
The amino acid, L-glutamine, has also been used as an
isolated supplement. Animal research has shown that glutamine supplementation reduces alcohol
intake, a finding that has been confirmed in double-blind human research.19 In that
trial, 1 gram of glutamine per day given in divided portions with meals decreased both the
desire to drink and anxiety levels.
Alcoholics are sometimes deficient in magnesium, and
some researchers believe that symptoms of withdrawal may result in part from this
deficiency.20 Nonetheless, a double-blind trial reported that magnesium injections
did not reduce symptoms of alcohol withdrawal.21
Because of the multiple nutrient deficiencies associated with alcoholism, most alcoholics
who quit drinking should supplement with a high-potency multivitamin-mineral for at least
several months after the detoxification period. Whether or not the supplement should include
iron should be discussed with a doctor.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Milk thistle extract is commonly recommended to
counteract the harmful effects of alcohol on the liver.22 Milk thistle extracts
have been shown in one double-blind study to reduce death due to alcohol-induced cirrhosis of the liver,23 though another
double-blind study did not confirm this finding.24 Milk thistle extract may protect
the cells of the liver by both blocking the entrance of harmful toxins and helping remove
these toxins from the liver cells.25 26 Milk thistle has also been
reported to regenerate injured liver cells.27
Kudzu is most famous as a quick-growing weed in the
southern United States. Alcoholic hamsters (one of the few animals to become so besides
humans) were found to have decreased interest in drinking when fed kudzu extract.28
Traditional Chinese medicine practitioners generally recommend 3 to 5 grams of root three
times per day; some herbal practitioners also suggest that 3 to 4 ml of tincture taken three
times per day may also be helpful to reduce alcohol cravings. Nonetheless, a double-blind
trial using 1.2 grams of powdered kudzu root twice per day failed to show any benefit in
helping alcoholics remain abstinent from alcohol.29
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
practitioner, and/or pharmacist for any health problem and before using any supplements or
before making any changes in prescribed medications. Information expires March 2005.
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