For someone who is severely and chronically dependent on alcohol, the brave choice to stop drinking can save their life. But the process of withdrawal can be dangerous to your life. Delirium Tremens (DTs) is the worst and most dangerous type of alcohol withdrawal. It is a real medical emergency that needs a lot of hospital care. A Direct Primary Care (DPC) doctor doesn't treat active DTs in their office, but they are the most important person you can trust to help you make a safe detox plan so this crisis never happens again.
Delirium Tremens is a serious type of alcohol withdrawal that causes the brain and nervous system to become suddenly and dangerously hyper-excitable. If not treated aggressively in a hospital, it is a life-threatening condition with a high death rate.
The Life-Threatening Symptoms: For people who have a history of heavy, long-term alcohol use, DTs usually start 48 to 96 hours after their last drink. These are some of the symptoms:
Acute Confusion and Disorientation (Delirium): Not knowing who you are or where you are.
Very agitated and restless.
Seeing things that aren't there, like bugs or animals, is a common type of vivid hallucination.
Deep Autonomic Instability: A body in overdrive, with a high fever, a fast heart, high blood pressure, and a lot of sweating.
Seizures are also common when you stop drinking alcohol too quickly.
It Needs to Be Treated in a Hospital: Even with modern treatment, delirium tremens can kill up to 5% of people who get it. It needs to be cared for in a hospital, usually in an ICU, with high doses of benzodiazepines to calm the nervous system, IV fluids, and other supportive measures.
Warning: Doctors who work in Direct Primary Care do not treat people who have Delirium Tremens. This is a life-threatening emergency that needs to be treated right away in a hospital. DPC is very important for preventing the crisis and helping people recover in the long term.
This is why DPC is the best partner for someone with a high-risk alcohol use disorder:
Making plans ahead of time for a safe detoxification: This is the most important thing a DPC doctor can do to save a life.
A Place to Talk Safely: In a DPC practice, the relationship is strong, trusting, and non-judgmental, which makes it safe for you to talk honestly about your drinking and your desire to quit.
Risk Assessment by an Expert: Your DPC doctor can figure out how dependent you are on drugs and how likely you are to have severe withdrawal symptoms.
How to Avoid a "Cold Turkey" Crisis: If your risk is high, your doctor will explain how dangerous it is to quit "cold turkey" at home and will help you make a plan for a safe, supervised, inpatient medical detox. This is the most important thing you can do to stop DTs.
A "Medical Home" for Long-Term Recovery: After a successful detox, the real journey begins. Your DPC doctor will be with you for the rest of your life.
A steady, helpful relationship: They give you a stable medical home to help you get better over time.
Taking care of recovery medications: They can give you medications that help you stop wanting alcohol and keep you from going back to drinking.
Holistic Health Management: They are experts at taking care of all of your other health issues, which are often many in people who have a history of drinking too much alcohol, such as liver disease and high blood pressure.
Urgent Triage and Family Education: Your DPC doctor teaches you and your family how to spot the signs of severe withdrawal. If a patient chooses to quit at home against medical advice and starts to shake or get confused, their DPC doctor will tell them one thing: "Call 911 or go to the emergency room right away."
Case 1: David, 60, tells his DPC doctor that he has been drinking a fifth of vodka every day for years and wants to stop. His doctor checks him out and finds that he is very likely to get delirium tremens. The doctor talks to David for an hour about the risks of quitting on his own. With David's permission, the doctor arranges for him to go directly to a local medical detox center for a safe, supervised withdrawal, which completely avoids a medical disaster.
Case 2: Linda, 50, is one month out of a successful inpatient detox. She goes to see her DPC doctor for regular checkups. The doctor is in charge of her medications to help her stop drinking, checks her liver function labs, gives her ongoing counseling and support without judgment, and talks directly to her therapist. They are the real quarterback for her recovery team.
Q: I drink a lot every day. Is it risky for me to stop drinking on my own? A: Yes, it can be very dangerous. If you are very physically dependent on alcohol, stopping suddenly can cause serious withdrawal symptoms, such as seizures and the deadly condition known as delirium tremens. Before you stop, it's important to talk to a doctor so you can do it safely.
What is the main way to treat active DTs in the hospital? A: The main part of treatment is giving a lot of benzodiazepine drugs (like lorazepam or diazepam) to calm down the nervous system, which is dangerously overactive. Patients also get IV fluids, electrolytes, and, most importantly, a lot of IV thiamine (a B vitamin) to stop a serious type of alcohol-related brain damage called Wernicke's encephalopathy.
Q: What can DPC do for me if I'm not ready to stop drinking completely? A: This is where DPC's strong relationship comes in handy. Your doctor can come to you. They can help you come up with a "harm reduction" plan, give you counseling without judging you, treat the health problems that come from drinking too much, and be ready to help you make a safe detox plan whenever you feel ready.
DPC is clearly better for patients who drink alcohol in dangerous amounts because
Doing well at prevention by giving proactive, non-judgmental care: The DPC model makes it possible to have open conversations about drinking and make plans for a safe medical detox.
DPC is the best place for the full, long-term medical and mental health care that people need to make a full and lasting recovery after detox.
Making triage easier to save lives: A DPC doctor can quickly spot the warning signs in a patient who is in early withdrawal and make sure they get to the hospital right away.
It's brave of you to stop drinking; it's the first step on a new path. People who are very dependent on alcohol should not go on this journey alone. You can stop delirium tremens from happening. Direct Primary Care is a reliable, proactive partner that can help you make a safe plan for detox and support you for the rest of your life as you recover.
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