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Long-term Effects of Toxicity

November 25, 2014

Toxicity and Its Long Term Effects

ToxicityToxicity- this refers to a degree to which a substance can be poisonous to anybody who uses it. Most of the drugs of recreation are toxic or are high in toxicity and using them for a long time results in damaged neurotransmitters among other problems. The degrees of toxicity can be categorized as acute, Sub-chronic and chronic. Acute toxicity involves harmful effects in an organism through a single or short-term exposure. Sub-chronic toxicity is the ability of a toxic substance to cause effects for more than one year but less than the lifetime of the exposed organism. Chronic toxicity is the ability of a substance or mixture of substances to cause harmful effects over an extended period, usually upon repeated or continuous exposure, sometimes lasting for the entire life of the exposed organism. This explains why those addicted to drugs are severely affected. The more you expose yourself to the substance the more the toxicity you are subjecting yourself to. Toxicity is not only a worry when dealing with recreational drugs, there are also other substances of high toxicity that you need to avoid. These may include pesticides, some window cleaners and other inhalants. With that said it is crucial to mention that in most cases we get these toxic substances by our own intervention especially through the use of drugs of recreation. Even some drugs that are used in hospitals may be toxic when recommended dosages are surpassed. For example benzodiazepines are very effective drugs when used within the specified dosages but are high in toxicity when used beyond the recommended dosages.

Long-term medical consequences of toxicity

Since exposure to different substances will result in different symptoms of toxicity in the long-term, I suggest we focus on one type of drug and for this purpose we will work with benzodiazepines. Benzodiazepines are also good in this case as they drugs that are used clinically hence the result of their misuse can be of help to many.

Depression and anxiety

Using benzodiazepine for a long time results in depression. It has been found that alcoholics who use benzodiazepines for a long time become depressed. It is possible that benzodiazepines cause or aggravate depression, perhaps by reducing central monoamine activity. However, anxiety and depression often coexist, and benzodiazepines are often prescribed for mixed anxiety/depression. Sometimes, the drugs seem to precipitate suicidal tendencies in such patients. It also causes Emotional anesthesia which is the inability to feel pleasure or pain. It is therefore recommended that benzodiazepines should not be used alone in treating depression.

Dependence

Due to high toxicity of some drugs they will affect the brain causing dependence on these drugs. The long term effect use of benzodiazepines for example can lead to both psychological and pharmacological dependence. After getting dependent on drugs other problems like tolerance and other withdrawal symptoms sets in whenever the person tries to stop using the drug.

Structural Brain Damage

There is insufficient to support the fact that long term use of benzodiazepines can cause structural brain damage. However some drugs have high toxicity and continued exposure to such drugs can cause structural brain damage.

Hemorrhoids – this is not limited to benzodiazepines alone. Long term use of other drugs with high toxicity can cause hemorrhoids where the varicose veins of the anus become painful, swell and itch. This is often caused by constipation and lack of dietary fiber.

Tolerance- long term use of certain drugs results in tolerance where a person will have to use more of a drug to feel the effect. This is a common problem that most people on long term use benzodiazepines go through.

Autopsy findings for inhalants

Inhalants are chemical vapors or gases that affect how the mind works when abused or misused by concentrating and intentionally inhaling these fumes. The inhalants may include volatile organic solvents, fuel gases, nitrites, and anesthetic gases. These inhalants may cause death when a person is exposed to them for a long time. Some of the common inhalants include;

ToxicityAmyl nitrites (poppers) – poopers are normally sold under such names as ram, rush, thunderbolt among other names. They are mostly used by gay men to prolong orgasm and enhance the sensation. Over a time the person will be dependent on these poppers so much that he can’t have sex without them. These poppers have been found to be responsible for many deaths especially through increased risk of HIV. However giving up on poppers isn’t easy since some people depend on it entirely for their sexual purpose. There is insufficient information on the number of deaths that have been caused by use of poppers however in one study it was found that 96% of gays who were HIV positive were using poppers.

Benzenes (gasoline) – CDC defines benzene as a chemical that is a colorless or light yellow liquid at room temperature. It has a sweet odor and is highly flammable. It is one of the inhalants that are greatly abused. When inhaled it alters the way the body cells work for example it can cause bone marrow not to produce enough red blood cells, which can lead to anemia. Also, it can damage the immune system by changing blood levels of antibodies and causing the loss of white blood cells. At extreme intoxication it causes death.

Finally, We at AWAREmed Health and Wellness Resource Center are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Toxicity and Its Long Term Effects

 

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Intoxication, Reward and Tolerance

November 25, 2014

Neurobiology of Intoxication, Reward and Tolerance

RewardAs stated earlier, neurobiology is the study of cells of the nervous system and how these cells are organized of these cells into functional circuits that process information and influence behavior. Neurobiology is a sub unit of both biology and neuroscience. Neuroscience is much broader as a scientific study of the nervous system than neurobiology. Neurobiology helps us to understand how the neurons are affected by whatever we ingest. The neurons as you and me now know are very crucial as they are the chemical messengers that transmit signals to initiate certain crucial responses. However these neurons are often affected by drugs of abuse that in most cases depletes them rendering them incapable to function normally. As studied earlier in our brain there are different neurotransmitters that perform different purposes to ensure that all functions of the brain are well attended to. There are inhibitory neurotransmitters as well as excitatory neurotransmitters and the balance between these neurotransmitters must be achieved for better functioning of the brain but these drugs of abuse interferes with these balance by causing depletion of certain neurotransmitters creating an imbalance between the different categories of the neurotransmitters in the brain. In this article we try to find out how intoxication, reward and tolerance come about to users of alcohol and other drugs.

Intoxication

According to World Health Organization (WHO) intoxication is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgment, affect, or behavior, or other psychophysiological functions and responses. The disturbances are related to the acute pharmacological effects of, and learned responses to, the substance and resolve with time, with complete recovery, except where tissue damage or other complications have arisen. They further explain that the term intoxication is a term that is commonly used in alcoholism and is the same in meaning to the common term drunkenness. Alcohol intoxication manifests in such symptoms as slurred speech, unsteady gait, disorderly conduct, impaired judgment, slowed reactions, loss of memory, vomiting, euphoria and insensibility among others. Alcohol has contents of ethanol among other fermented stuff. When taken ethanol will produce its depressive effects on certain areas of the brain resulting in physical and mental impairments. These problems will continue as the level of alcohol consumption is increased, therefore more alcohol means more intoxication.

Here is what happens in the brain

When alcohol is taken it increases the effect of the body’s naturally occurring neurotransmitter gamma amino butyric acid (GABA). As I mentioned earlier neurotransmitters are substances that chemically connect the signals from one nerve to the next allowing a signal to flow along a neural pathway. An inhibitory neurotransmitter (alcohol) reduces this signal flow in the brain. This explains how alcohol depresses both a person’s mental and physical activities. When you take alcohol 20% of ethanol will be absorbed into the bloodstream from the stomach while 80% is absorbed from the small intestines. However the more the ethanol stays in the stomach the slower it is absorbed into the bloodstream and the lower the peak in blood alcohol concentration. This is why when a person takes alcohol with empty stomach he will be intoxicated within such a short time. The food in the stomach normally slows the rate of alcohol absorption lowering the peak in blood alcohol concentration.

The reward system

The reward system is mainly dominated by the excitatory neurotransmitter known as dopamine. This hormone gives the brain its ‘high’, the euphoric feelings that is commonly sought by people who use drugs of recreation. Close to all addictive drugs directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who use drugs and teaches them to repeat the behavior. The persistent release of dopamine during chronic drug use progressively recruits limbic brain regions and the prefrontal cortex, embedding drug cues into the amygdala through glutaminergic mechanisms and involving the amygdala, anterior cingulate, orbitofrontal cortex, and dorsolateral prefrontal cortex in the obsessive craving for drugs Despite dopamine being the dominant neurotransmitter in the reward system there are also other neurotransmitters that work to modulate both the reward system and the psychomotor effects of addictive drugs. However there is still little literature to support this and so dopaminergic system is still the biggest consideration when reward system is to be tamed. Naturally the balance between the excitatory neurotransmitter and the inhibitory neurotransmitters enables proper functioning of the brain but with drugs the drugs will suppress the inhibitory neurotransmitters flooding the brain with dopamine which is the fuel behind reward.

RewardUnderstanding tolerance

Tolerance refers to a situation when a person ceases to react to a drug in initial doses and therefore higher dosage is needed for the effects to be achieved. This normally happens when a person has been using the drugs for a long time. This is common in the use of opioids in pain management, the patient will cease to respond to initial dosages and therefore need higher dosages to calm the pain. For example, morphine is often used for pain. It works by binding to opiate receptors where it triggers the inhibition of an enzyme called adenylate cyclase that orchestrates several chemicals in the cell to maintain the firing of impulses. After repeated activation of the opiate receptor by morphine, the enzyme adapts so that the morphine can no longer cause changes in cell firing. Therefore higher dosages will have to be administered for the pain to be calmed.

Finally, Dr. Dalal Akoury (MD) of AWAREmed Health and Wellness Resource Center is committed to helping all people trapped in drug addiction. Call on her today at Myrtle Beach, South Carolina for help.

Neurobiology of Intoxication, Reward and Tolerance

 

 

 

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Intoxication and Withdrawal

November 25, 2014

Clinical Signs and Symptoms of Intoxication and Withdrawal

Intoxication and withdrawalThe use of drugs and substance of abuse will eventually produce some effects on the user. Most importantly the user will suffer intoxication that is common to users of drugs for a long time. Withdrawal symptoms will be reached when a person’s neurotransmitters have been affected by the use of the drugs so much that certain signals cannot be sent without the use of the drug. This is called dependence; it is a situation where a person ceases to exist without the drug. The drug becomes the driver of life and whenever he has not used the drug he will be sick and his body will cease to work normally. In this instant if a person tries to stop using the drugs then the withdrawal symptoms will set in making it hard for them to quit using the drugs. In this article we are looking at some of the signs and symptoms that are associated with intoxication and withdrawal.

Clinical signs and symptoms of intoxication and withdrawal

According to World Health Organization (WHO) intoxication is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgment, affect, or behavior, or other psychophysiological functions and responses. Withdrawal is a known term as it has been defined in previous articles. Here are some signs and symptoms of intoxication and withdrawal. Different drugs will cause different signs and symptoms of intoxication and withdrawal;

Signs and symptoms of alcohol intoxication

The intoxication in alcohol will vary depending on the amount taken. When taken in low risk levels the person may feel reduced levels of anxiety and sedation but as the blood alcohol content increases so do the severity of the symptoms. These are some signs and symptoms associated with alcohol intoxication.

  • Confusion
  • Coordination difficulties
  • Expansive mood
  • Impaired memory
  • Poor judgment
  • Sense of well-being
  • Short attention span
  • Slurred speech
  • Talkativeness
  • Unstable gait

Signs and symptoms of alcohol withdrawal

  • Hallucinations – the user will have hallucinations of sights, sounds, or physical sensations on the skin. He will also experience abnormal changes about the temperatures.
  • Hand tremor
  • Insomnia- the sleep may be hard to come by or too short to let the brain rest and get refreshed.
  • Nausea, vomiting
  • Autonomic hyperactivity. This may include sweating and pulse rate greater than 100.
  • Delirium tremens showed as anxiety, increased heart rate, sweating, trembling and confusion. Delirium tremens is the most severe withdrawal symptom associated with alcohol.
  • Difficulty performing tasks involving coordination
  • Grand mal seizures– convulsions resulting in loss of consciousness and muscle contractions.

Signs and symptoms of cocaine intoxication

Cocaine is a drug of recreation that is normally taken for its euphoric effects. It gives a person an induced sense of well-being and may give a person an increased sense of sexuality. However as it is addictive anybody using it may become tolerant, taking in more and more which may result in severe intoxication. The following are signs and symptoms of cocaine intoxication.

  • hyperactivity and muscle damage
  • hyperthermia -seriously elevated body temperature
  • kidney damage
  • seizures
  • stroke
  • irregular heart beats
  • Anxiety and agitation
  • Chest pain or pressure
  • Enlarged pupils
  • Feeling of being “high” (euphoria),
  • Increased heart rate and blood pressure
  • sweating
  • tremors
  • confusion
  • sudden death

Signs and symptoms of cocaine withdrawal

Cocaine withdrawal symptoms are not so severe and they last for a shorter time possibly a week but still it depends on the immunity of a person. Just like any other drug when you stop using cocaine you are bound to experience some of the symptoms of withdrawal. These are some withdrawal symptoms that you will go through if you stop using cocaine.

  • Depression
  • Anxiety
  • Chills
  • Body aches
  • Tremors and shakiness
  • Pain
  • Inability to feel pleasure
  • Exhaustion
  • Challenges in concentration
  • Intense craving for cocaine

Signs and symptoms of opioid intoxication

Opioids are pain drugs. They are clinically used to help pain patients manage the pain. Opioids are commonly used by cancer patients and other chronic pain patients. However in some situation a patient may be overwhelmed by pain so much that he takes more than the prescribed dosage. When this happens intoxication will take place. The degree of intoxication will depend on the amount of the drug you have taken. Your level of intoxication depends on how much of the drug you take. Opioid drugs that are commonly used are: methadone, morphine, oxycodone, codeine and heroin. Some of the signs and symptoms of opioid intoxication include;

  • small (constricted) pupils
  • slowed breathing
  • absent breathing
  • extreme fatigue
  • changes in heart rate

intoxication and withdrawalSigns and symptoms of opioid withdrawal

As said earlier opiates are used in clinics to help patients with chronic pain. These patients may use these drugs for a long time that their bodies’ will get desensitized to opioids. The body will need more of the drugs to feel the pain relief, this is called tolerance. In the long term use you will become dependent so much that if you try to creep out of opioid use then you will suffer the withdrawal symptoms. These signs and symptoms may include;

  • nausea and vomiting
  • dilated pupils and possibly blurry vision
  • rapid heartbeat
  • high blood pressure
  • inability to sleep
  • yawning very often
  • diarrhea
  • abdominal cramping
  • goose bumps on the skin
  • muscle aches
  • restlessness
  • anxiety
  • lacrimation (eyes tearing up)
  • runny nose
  • excessive sweating

Access treatment and management

There various ways through which intoxication and withdrawal symptoms can be managed and treated. Visit us at AWAREmed Health and Wellness Resource Center, located in Myrtle Beach, South Carolina and get attended to by Dr. Dalal Akoury (MD) who has vast experiences in integrative medicine having worked with different addicts chained to different drugs.

Clinical Signs and Symptoms of Intoxication and Withdrawal

 

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SBIRT and Its Benefits

November 24, 2014

Screening and Brief Intervention and Referral for Treatment

SBIRTWhat is SBIRT?

SBIRT is an abbreviation that stands screening, brief Intervention and Referral for Treatment. It is an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels with the goal of reducing and preventing related health consequences, disease, accidents and injuries. Risky substance use is a health issue and often goes undetected. Screening, brief intervention and referral for treatment helps detect these health issues

It is a comprehensive, integrated, public health approach that provides opportunities for early intervention before more severe consequences occur of drug use occurs. There are tools that that have been approved to be effective in identifying people with or are at risk of a Substance Use Disorder that must be used in this procedure. Based on implementation of this model nationally, of 459,599 patients screened, 22.7 percent screened positive for a spectrum of use (risky/problematic, abuse/addiction). Of those who screened positive 15.9 percent were recommended for a brief intervention with a smaller percentage recommended for brief treatment (3.2 percent) or referral to specialty treatment (3.7 percent).

Why is Screening, brief intervention and referral for treatment Important?

SBIRT has been found to be effective in dealing with addiction. Apart from screening, SBIRT is an effective tool for identifying risk behaviors and providing appropriate intervention. Healthcare providers can use evidence-based brief interventions focusing on health and other consequences, preventing future problems by simply screening for high risk behavior.

The main objective of SBIRT is to identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use so as to formulate strategies to help them evade the dire consequences associated with drug use.

Research Demonstrates Effectiveness

All studies that have been done on this subject have shown that SBIRT is an effective approach to dealing with issues associated with drug addiction. It has been found to be very cost effective yet has very positive outcomes. Several research findings show that SBIRT is an effective way to reduce drinking and substance abuse problems.

SBIRT incorporates screening for all types of substance use with brief, tailored feedback and advice. It can also be done in different settings. Screening does not have to be performed by a physician. Research shows that Simple feedback on risky behavior can be one of the most important influences on patient behavior and change.

Through research it has been found that:

Brief interventions are cost effective and yield positive results. Brief interventions are most effective among persons with less severe problems. In a report of a study done for U.S. Preventive Services Task Force in 2004 it is quoted that; “Brief interventions are feasible and highly effective components of an overall public health approach to reducing alcohol misuse.”

Based on many researches that have been done on the subject there is substantial evidence for the effectiveness of brief interventions for harmful drinking. There is a growing body of literature showing the effectiveness of SBIRT for risky drug use.

Since 2003, SAMHSA has supported SBIRT programs, with more than 1.5 million persons screened. Out of these people, 40 percent showed a reduction in harmful use of alcohol by those drinking at risky levels and a 55 percent reduction in negative social consequences. The data also showed positive benefits for reduced illicit substance use. The evidence of this is in a review of SBIRT GPRA data (2003−2011).

Brief Intervention

Brief Intervention refers to a brief motivational and awareness-raising intervention given to risky or problematic substance users. There are steps involved in brief intervention.

Steps involved in Brief Intervention

  1. Build rapport– here begin with a general conversation to avoid tension and create a good relationship with the patient. Ask the patient to allow you to speak about alcohol and drugs, whichever he may be subject to. When the conversation is going on discuss the advantages and disadvantages of using alcohol, let him tell you these points.
  2. Provide feedback- ask the patient to allow you to give your feedback on the issue, discuss your screening findings with him and link any substance use behaviors to any known consequences.
  3. Build readiness to change- Create the urge to change in the patient, talk to the patient and let him know that you really have to know how much he is interested in making a change. You know how bad he wants the change by using a scale of 1-10. Ask him this question: On a scale from 1 to 10, 1 being not ready at all and 10 being completely ready, how ready are you to make any changes in your substance use?
  4. Negotiate a Plan for Change

SBIRTAfter knowing where his interest lies on the scale you will give him the opportunity to choose which way to take between the available options. Whether to choose a plan for reducing alcohol use to low risk levels or to go continue with receiving specialty treatment services.

What are the benefits of SBIRT?

This approach to treatment of alcohol and addiction to other drugs has been found to be very beneficial. Some of its benefits include: It prevents disease, accidents and injuries related to substance use, resulting in better patient outcomes. It also reduces the cost of healthcare needless to mention SBIRT is reimbursable, billing codes are available in New York State.

Finally, Here at AWAREmed Health and Wellness Resource Center we are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Screening and Brief Intervention and Referral for Treatment

 

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Withdrawal Syndrome

November 24, 2014

Withdrawal Syndrome, Withdrawal Seizures and the CIWA Scale

Withdrawal syndromeWithdrawal syndrome refers to is a set of symptoms that occurs when a person discontinues using a drug or when he reduces the dosage of the drug. Not all drugs will result in withdrawal symptoms but some prescription drugs and other drugs of recreation will result in withdrawal syndrome when one discontinues using them. For example a person who has been using alcohol for a long time will suffer withdrawal syndrome when he reduces the amounts he takes or when he stops taking alcohol completely. Normally the withdrawal syndrome will result in the patient taking more of the drug and for a longer time. In case of alcohol the withdrawal syndrome may make the addict to continue using alcohol as an escapade or other to mitigate the effects of the severe withdrawal symptoms.

People using different drugs will suffer withdrawal syndrome when they stop using the drugs or when they reduce the dosage, however there will be different symptoms. For example a person who has stopped using opiates will exhibit such symptoms as; Shaky hands, Sweating, Mild anxiety, Nausea and/or vomiting, headache and Insomnia. On the other hand a person who has stopped using opiates will exhibit the following withdrawal syndrome symptoms; muscle ache, restlessness, anxiety, lacrimation (eyes tearing up), runny nose, excessive sweating, inability to sleep and yawning very often. Withdrawal syndrome will most likely affect someone who has used the substance of abuse for so long that he has got dependent on the drug. It does not only happen to those who ate suing the recreational drugs alone but can also happen with prescription drugs. For example many people who are prescribed opioids to help manage their pain end up exhibiting withdrawal syndrome symptoms and in most cases have to be helped to quit using the drugs that were once given with medical intentions.

Withdrawal seizures

Withdrawal seizures may occur as a withdrawal syndrome symptom. It refers to the convulsions that occur when a person has stopped using a drug he has been using for a long time. It is common to users of opiates and alcohol addicts. As for alcoholics it occurs in up to one-third of alcoholics when they abruptly reduce their alcohol intake, the effects of which peak within 24 hours after the most recent alcohol ingestion. These seizures are in most cases brief or partial. It however should not be taken lightly since if not taken care of in good time an alcoholic who suffers seizures may develop delirium tremens. Most alcohol withdrawal seizures normally resolve spontaneously or respond well to benzodiazepines but the risk of delirium tremens should not be overlooked. In most addicts it is said that withdrawal seizures is responsible for their physical injuries such as burns and wounds.

Withdrawal delirium

Withdrawal delirium is common among alcoholics. In fact it is the most severe form of withdrawal syndromes associated with alcoholism. It causes sudden and severe problems in your brain and nervous system. It is approximated that five percent of hospital patients being treated for alcohol withdrawal also experience Alcohol withdrawal delirium. Alcohol Withdrawal delirium is also known as delirium tremens or Delirium tremens. It is a medical emergency.

Alcohol withdrawal delirium is mostly caused by sudden stop in alcohol consumption after a long time of heavy drinking. However other causes may include; reduce their alcohol use too quickly, don’t eat enough when reducing alcohol use, have a head injury and infections. A person suffering from alcohol will show the following symptoms among others;

  • hallucinations
  • nightmares
  • fever
  • fatigue
  • nausea
  • restlessness
  • chest pain
  • excitement
  • fear
  • sudden mood changes
  • delirium
  • sensitivity to light
  • sensitivity to sound
  • sensitivity to touch
  • anxiety
  • agitation
  • irritability
  • confusion
  • delusions

Treating alcohol withdrawal delirium

Firstly, you should know that withdrawal delirium can cause death and so treatments should only take place in hospital. It is also crucial that the patient should access treatment as soon as possible. When a delirium tremens patient has been taken to hospital the doctors may employ the following means to treat him;   anticonvulsants to prevent or stop seizures, sedatives to calm agitation and treat anxiety, antipsychotic medications to prevent hallucinations, medication to reduce fever, treatment for other alcohol related conditions and rehabilitation to help you stop drinking and avoid future cases of the disease striking again.

Clinical Institute Withdrawal Assessment for Alcohol

Withdrawal SyndromeOften abbreviated as CIWA, Clinical Institute Withdrawal Assessment for Alcohol is an item that is used in assessment and management of alcohol withdrawal. The main purpose of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal. The scale is used to test for severity of the common withdrawal syndrome symptoms independently after which the aggregates will be used as an insight into the severity of alcohol withdrawal. The ranges on the scale show what should be done at each level to manage the withdrawal symptoms for example administering benzodiazepines. The maximum score on the CIWA scale is 67; while any score less than 15 is termed a mild alcohol withdrawal, moderate with scores of 16 to 20, and severe with any score greater than 20. The ten items evaluated on the scale are common symptoms and signs of alcohol withdrawal, and are as follows:

  • Nausea and vomiting
  • Tremor
  • Paroxysmal sweats
  • Anxiety
  • Agitation
  • Tactile disturbances
  • Auditory disturbances
  • Visual disturbances
  • Headache
  • Orientation and clouded sensorium

Finally, Here at AWAREmed Health and Wellness Resource Center we are committed to availing help to addicts by availing some of the most integrative approaches to healing an addict. We advocate for natural healing to all kinds of addiction. Call on Dr. Dalal Akoury (MD) at Myrtle Beach, South Carolina for help.

Withdrawal Syndrome, Withdrawal Seizures and the CIWA Scale

 

 

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