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The symptoms of alcohol withdrawal can be uncomfortable, painful and even life-threatening in some cases. The most common symptoms are rapid heartbeat, sweating, nausea and vomiting, tremors and exhaustion. Some of the more dangerous symptoms include hallucinations, panic and seizures.
When someone receives treatment for alcohol withdrawal, they may be given a benzodiazepine medication like Ativan. Benzodiazepines affect the same receptors as alcohol, making them effective for treating withdrawal symptoms.
Ativan is a widely used medication with a lot of utility in medicine. However, it is only officially approved for use in three different conditions, including anxiety, status epilepticus (emergent seizures) and anxiety before surgery/procedures. Ativan can also be used as an off-label treatment for:
Ativan works by attaching to gamma-aminobutyric acid (GABA) receptors. GABA is a neurotransmitter used in the brain and nervous system, and it works by slowing down signals sent through the central nervous system (CNS). Ativan attaches to GABA receptors and increases the signals sent by GABA in the body.
In a recent study by The Recovery Village involving over 2,000 respondents, people who underwent detox for alcohol (either at home or at a facility) reported experiencing the following withdrawal symptoms:
One way that addiction treatment specialists help their patients avoid these symptoms is by prescribing Ativan during the initial alcohol withdrawal period. Ativan works for alcohol withdrawal because it affects the same neurotransmitter that alcohol does.
Alcohol and Ativan both affect GABA transmission in the CNS. When a person is withdrawing from alcohol, their GABA receptors are not working well enough, which causes symptoms like tremors, anxiety and seizures. Ativan makes the GABA transmitters more sensitive, helping to reduce withdrawal symptoms.
The most useful benzos for alcohol withdrawal are those with a long half-life. Specifically, the most commonly used benzos for withdrawal are diazepam (Valium), chlordiazepoxide (Librium) and lorazepam (Ativan). All of these benzodiazepines take several days to clear from the body, so they are useful for treating alcohol withdrawal.
Benzos that metabolize quickly from the body are not useful for withdrawal symptoms. This is because drugs that clear quickly will cause withdrawal symptoms on their own.
Alcohol withdrawal is one of the most dangerous forms of drug withdrawal because it has the potential to cause death. People who expect to experience moderate to severe alcohol withdrawal should seek medical guidance before attempting to quit alcohol.
After the last drink of alcohol, withdrawal symptoms typically start within six to 24 hours. Symptoms usually worsen and are most severe 36 to 72 hours after the last drink. Symptoms usually last for two to 10 days and can include:
Symptoms like vomiting and diarrhea can cause severe dehydration, which is potentially a medical emergency. For this reason, it is important to stay hydrated when going through alcohol withdrawal.
For those with severe alcohol addiction, withdrawal symptoms may be more severe and can include:
Ativan is the brand-name version of lorazepam, a generic benzodiazepine drug. This drug makes GABA receptors in the brain more sensitive to GABA. Alcohol also does this, which is why Ativan will help ease withdrawal symptoms when you stop using alcohol. While each person’s Ativan dosage during alcohol detox will vary, Ativan dosage regimens generally fall into three categories.
A loading dose regimen (LDR) is essentially a single high dose of a long-acting benzodiazepine that is meant to lower the risk of delirium, seizure and other withdrawal symptoms caused by alcohol. LDRs usually use diazepam, but chlordiazepoxide or lorazepam can also be used. This type of regimen should only be used while being monitored in an inpatient setting.
A symptom triggered regimen (STR) is the most common inpatient treatment for alcohol withdrawal. Trained medical staff will assess withdrawal symptoms using a validated scale. The most commonly used scale for alcohol withdrawal is CIWA-Ar, which measures 10 different symptoms on a numerical scale. Ativan or another benzodiazepine is then dosed based on the symptom severity.
This type of regimen is best for when someone is getting treated in an outpatient setting. Outpatient treatment can be through an addiction treatment facility, or it can be done with the assistance of a primary care provider.
An FTDR is where a certain amount of Ativan is prescribed for several weeks and then the dose is slowly decreased. This regimen is more commonly called a taper. By slowly reducing the dosage over time, withdrawal symptoms are minimized.
Ativan carries several benefits for treating alcohol withdrawal. While most benzos will work in the same way to decrease alcohol withdrawal symptoms, Ativan is safer than most for people with liver disease. Ativan is also less likely to depress breathing than other benzos, making it a safer choice in general. It can also be used at a lower dose and for a shorter duration than other benzos.
One of the major problems with alcohol withdrawal is that it can lead to relapse. When someone feels uncomfortable during withdrawal, they are more likely to start drinking alcohol again. Drinking alcohol is one of the fastest ways to stop symptoms, but it also perpetuates the problem. Since Ativan helps relieve alcohol withdrawal symptoms, it can help reduce the risk of relapse.
Although Ativan is incredibly useful for the treatment of alcohol withdrawal, there are potential drawbacks as well. The biggest risk is that it has the potential for abuse and addiction. Ativan abuse is unlikely when a person is being treated in an inpatient setting because the dosage will be closely controlled. When a person is being treated in an outpatient setting, however, they may have access to a whole bottle that can be abused. It is important to be aware of the abuse potential when taking Ativan for alcohol withdrawal.
Ativan affects the same receptors as alcohol does, but it lasts much longer than alcohol. It makes GABA receptors more sensitive, so it directly reduces alcohol withdrawal symptoms. The long half-life of Ativan also makes it ideal for the treatment of alcohol withdrawal. Ativan will stay in the body for 50 to 100 hours, which is much longer than alcohol.
While Ativan can be beneficial for treating alcohol withdrawal symptoms, there are also some potential risks involved. Ativan and other benzodiazepines are highly addictive, even when used correctly.
Treatment professionals generally recommend only short-term use of Ativan, such as 10 to 14 days for alcohol withdrawal. This short duration of use should prevent addiction from developing and still allow alcohol to leave your system without serious symptoms.
Another possible drawback of using Ativan for alcohol withdrawal is that it can interact with alcohol and intensify its effects. Therefore, it is critical to stop alcohol when using Ativan. If someone relapses and begins drinking again while taking Ativan, it can lead to breathing problems or a fatal overdose in some cases. This is because both alcohol and Ativan act on the nervous system in the same way.
Medical detox is an important tool for people who are considering quitting alcohol. Since alcohol withdrawal can be fatal, participating in a supervised detox is more important than it might be for most other drugs. During medical detox, medications like Ativan can be used to help manage withdrawal symptoms like seizures, tremors and anxiety.
It’s important to keep in mind that Ativan will not prevent alcohol cravings that persist for weeks or months after the alcohol has left your system. Feelings of anxiety may return when Ativan is stopped as well. For these reasons, it’s important to follow up the detox process with a professional rehab treatment program. Treatment at a licensed, accredited facility like The Recovery Village Palmer Lake can help you cope with cravings and triggers that heighten the risk of relapse. It can also help you address the underlying concerns that led to an alcohol addiction in the first place.
If you or someone you know is struggling with alcohol addiction, The Recovery Village at Palmer Lake can help. Located just outside of Denver, Colorado, our facility is equipped to manage all types of drug and alcohol addiction, as well as co-occurring mental health conditions like anxiety. If you live outside of Colorado or would like to travel for treatment, we also have facilities located in Ohio, Florida, New Jersey and Washington.
Our licensed, accredited treatment centers offer a full continuum of care, including medical detox, inpatient care, partial hospitalization programming, outpatient treatment and aftercare. Contact us today to learn more about alcohol addiction treatment programs that can work well for you.
Because alcohol withdrawal can be dangerous – and even kill you – make sure you have medical advice from your doctor or a rehab facility when you decide to stop drinking.
There are many misconceptions about alcoholism that make it sound like an alcoholic is an easy person to spot, however, many alcoholics function effectively and lead relatively normal lives.
An alcohol abuse problem can include binge drinking, having negative consequences such as hangovers with your drinking but continuing anyway, and drinking despite the desire to stop.
In a recent study by The Recovery Village, 44% of respondents reported abusing alcohol in an attempt to ease uncomfortable feelings that stem from underlying anxiety.
Drinking more than three drinks in a single sitting will temporarily cause your blood pressure to rise, but extended binge drinking or regular alcohol consumption can cause a permanent increase in blood pressure.
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Bharadwaj, Balaji; et al. “Determinants of Success of Loading Dose […]wal: A Chart Review.” Journal of Pharmacology and Pharmacotherapeutics, 2012. Accessed February 27, 2022.
U.S. National Library of Medicine. “Lorazepam.” MedlinePlus, April 15, 2021. Accessed February 27, 2022.
Food and Drug Administration. “Ativan Label.” September 2016. Accessed February 27, 2022.
American Nurse. “Caring for patients in alcohol withdrawal.” June 2012. Accessed February 27, 2022.
Sachdeva, Ankur; et al. “Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.” Journal of clinical and diagnostic research, September 1, 2015. Accessed February 27, 2022.
World Health Organization. “Withdrawal Management.” 2009. Accessed February 27, 2022. Accessed February 27, 2022.
The Recovery Village at Palmer Lake aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.
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