From the Guidelines
Alcoholics should receive thiamine, folate, magnesium, zinc, and vitamin B6 in addition to multivitamins, with benzodiazepines like lorazepam or diazepam for withdrawal management, and acamprosate or naltrexone for longer-term treatment to reduce cravings and prevent relapse. The management of alcohol withdrawal and related nutritional deficiencies is crucial for preventing complications and supporting recovery. According to the most recent guidelines 1, symptomatic alcohol withdrawal is based on treatment with benzodiazepines until symptoms disappear.
Key considerations for treatment include:
- Thiamine supplementation to prevent Wernicke's encephalopathy, with a recommended dose of 100-300 mg/day 1
- Benzodiazepines, such as lorazepam (1-2mg every 4-6 hours) or diazepam (5-10mg every 4-6 hours as needed), for managing withdrawal symptoms and preventing seizures 1
- Acamprosate (666mg three times daily) or naltrexone (50mg daily) for longer-term treatment to reduce cravings and prevent relapse 1
- Magnesium supplementation (200-400mg daily) to address deficiencies common in alcoholics that contribute to tremors, seizures, and cardiac arrhythmias
- Zinc (25-50mg daily) to address alcohol-depleted zinc levels, affecting immune function, wound healing, and taste perception
- Vitamin B6 (50-100mg daily) to address pyridoxine deficiency, which can lead to peripheral neuropathy
These supplements and medications address the nutritional deficiencies and neurochemical imbalances caused by chronic alcohol use, supporting recovery and preventing complications of alcoholism. It is essential to prioritize the most recent and highest-quality evidence when making treatment decisions, as seen in the 2022 guidelines from the French Association for the Study of the Liver and the French Alcohol Society 1.
From the Research
Supplements and Medications for Alcoholics
In addition to thiamine (B1) and multivitamins, the following supplements and medications may be given to alcoholics:
- Benzodiazepines, which are the best-assessed drugs for preventing a severe alcohol withdrawal syndrome, particularly the risk of seizures 2
- Acamprosate, naltrexone, and disulfiram, which can reduce the frequency of relapse when used in combination with psychosocial treatment 3, 4
- Thiamine supplementation, which is widely recommended to prevent serious complications in alcohol-dependent patients, with high doses used to compensate for poor absorption 2, 5
- Magnesium and other electrolytes, which may be given to prevent deficiencies and support overall health, although there are no specific recommendations on hydration 2
- Vitamin supplementation, including retinoids (vitamin A), niacin (B3), and other vitamins, which may be beneficial in treating alcohol-related illnesses, although more research is needed 6
Treatment Approaches
The treatment of alcoholics may involve:
- Symptom-triggered dosing of benzodiazepines, based on a withdrawal rating scale, to minimize the total benzodiazepine dosage 3
- Use of a long-acting benzodiazepine, such as chlordiazepoxide, in uncomplicated patients 3
- Parenteral thiamine administration in patients with established or suspected Wernicke's encephalopathy, followed by oral thiamine supplementation 5
- Psychosocial treatment and participation in support groups, such as Alcoholics Anonymous, to help patients achieve and maintain abstinence 3