Because of the physical dependence induced by many of mood altering drugs, other drugs are often used to facilitate medically monitored withdrawal and detoxification safely. Studies suggest that when using protocols with PRN dosage of medication (versus fixed dosage), less medications are used and symptoms are controlled, however, PROTOCOLS MUST BE INDIVIDUALIZED AND ASSESSED DAILY WITH APPROPRIATE ADJUSTMENTS INSTITUTED AS NECESSARY IF PROTOCOL IS NOT CONTROLLING SYMPTOMS.

1. A stat dose of sedative medication may be indicated for acute withdrawal if patient’s signs and symptoms are unmanageable on admission or during treatment. CIWA scores are measured on admission; (>15 is significant). When using stat doses of meds (30-60- mg oxazepam (Serax), 10-20 mg diazepam (Valium) or 60-120 mg Phenobarbital) assess size of patient tolerance (high CIWA score in face of intoxication. i.e. high BAL) and current signs and symptoms. If patient does not respond to stat dose within 20-30 minutes, consider repeating dose each ½-1hr until sedated.
2. If patients are not responding to PRN doses as scheduled, consider increasing protocols (5 mg/dose for diazepam (Valium), 15-30 mg/dose for phenobarbital and 13-30 mg/dose for oxazepam (Serax)).
3. If increased medications are necessary, wean doses of sedatives over the next 1-3 days as tolerated (indicated by patient pain outcome report, efficacy indication on withdrawal flow sheets, total medidications used and pain scores on withdrawal flow sheets. Once stabilized, goal is to decrease dose by 20-50% of sedative per day as tolerated by patient.

To effectively remain in recovery, all cross-reacting sedatives must be discontinued, prior to discharge. Benzodiazepines are contra-indicated for patients with addiction histories even if primary drug of choice is alcohol, opiate or stimulants. Alternative management of anxiety and sleeplessness should be considered (e.g. non medication, or if necessary, antihistamines, buspirone (Buspar), major tranquilizers). The use of substitute, nonaddicting drugs is acceptable, but not encouraged (if necessary, use minimal dose for minimal amount of time; e.g. antihistamines or major tranquilizers or buspirone). The treatment program will provide behavioral alternatives for symptom control (i.e. anxiety, sleeplessness, etc.) If patient has true panic disorder, institute use of tricyclics or serotonin reuptake inhibitors as soon as possible, thus avoiding the need for use of addicting drugs such as benzodiazepines. Much anxiety is relieved within the first 30 days of abstinence from addicting drugs like alcohol, benzodiazepines, opiates and stimulants.