The assessment comes first
Alcohol withdrawal is the one form of withdrawal that can be medically dangerous, so the first visit is an assessment before it is anything else. Dr. Escarria asks how much you drink, for how long, when your last drink was and what happened the last time you stopped. You are examined, your vital signs are taken, and a withdrawal risk score is calculated using a standard scale that rates tremor, sweating, anxiety, pulse and blood pressure. Blood work checks your liver, blood count, electrolytes and nutrition, which heavy drinking depletes.
From that, we decide where withdrawal can safely happen.
- Safe for office-based care: mild to moderate symptoms, stable vital signs, no history of withdrawal seizures or delirium tremens, no serious medical illness, and someone at home who can check on you. This describes most people who come to us.
- Needs hospital-supervised withdrawal: a past seizure or delirium tremens during withdrawal, very heavy daily drinking with severe symptoms, unstable vital signs, confusion or hallucinations, or a medical condition such as heart disease that makes withdrawal risky. In that case we refer you to the hospital for the first days and take over your care once you are stable. We would rather send someone to the hospital for three days than take a chance.
Getting through withdrawal in the office
For patients who are safe to treat here, Dr. Escarria prescribes a short, supervised course of medication to prevent seizures and ease shaking, sweating and anxiety, on a tapering schedule over several days. You are seen or called daily during that period, given thiamine and other vitamins to protect the brain and nerves, and told exactly which symptoms mean you should go to the emergency room. Most people are through the worst of it within a week.
Staying sober: medication
Withdrawal is the short part. The longer work is not going back, and medication makes a measurable difference.
- Oral naltrexone, one tablet daily, blocks the reward alcohol gives and reduces craving. It is the usual first choice, it is available as a generic, and it is not habit-forming.
- Vivitrol, the monthly naltrexone injection, for people who want to take the daily decision out of it. Prior authorization is required.
- Acamprosate, taken three times a day, helps settle the restlessness and sleep disturbance that follow stopping. The doctor may suggest it when naltrexone is not suitable, for example with liver disease.
- Other options the doctor may discuss depending on your history, including treatment for the sleep problems, anxiety or low mood that often run alongside drinking.
Does insurance cover it? Office visits are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna in the same way as any doctor's visit. Generic oral naltrexone and acamprosate are usually covered without prior authorization. Vivitrol requires prior authorization from virtually every plan, which we submit for you. Labs are covered when medically necessary. Self-pay is available. Read more about insurance and self-pay.
What to expect
- First visit: history, exam, withdrawal risk scoring, labs and a decision on where withdrawal can safely happen. Bring your medication list and be honest about how much you drink; the plan depends on it.
- Withdrawal week: medication, daily contact and vitamin support, or a hospital referral if that is safer.
- Follow-up: weekly for the first month, every two weeks in month two, then monthly, with craving medication adjusted and counseling arranged.
- Ongoing: liver tests are repeated over time and usually improve, which is a motivating thing to see on paper.
Counseling and family
Medication reduces craving; it does not rebuild the habits and relationships that drinking damaged. We coordinate individual counseling from the start, in the clinic, with partner counselors or by telehealth. With your permission, a spouse or family member is welcome at visits. They often notice changes before you do, and they need to know what to watch for in the first weeks, including the signs that mean a trip to the emergency room.
Do I have to stop drinking before the first visit?
No. Come as you are. If you drink heavily every day, do not stop suddenly on your own before you are seen; that is exactly the situation where withdrawal can be dangerous. The assessment decides how and where to stop safely.
Is my treatment confidential?
Yes. Records of substance use treatment are protected by federal law (42 CFR Part 2) as well as HIPAA, and nothing is shared with an employer, family member or anyone else without your written consent.
How long will I take naltrexone?
Most patients take it for six to twelve months, and some longer. It is not habit-forming and there is no withdrawal when it is stopped. The decision is made together with the doctor based on how you are doing.
Which clinic offers alcohol treatment?
Both. Dr. Escarria sees patients at Davie for Broward County and at Boynton Beach for Palm Beach County, and Vivitrol injections are given at either clinic.
What if I am already in bad withdrawal?
If you have a seizure, hallucinations, severe confusion, a racing heart or you cannot keep fluids down, go to the emergency room or call 911. Office-based care is for people who are medically stable. Once the hospital has you through the acute phase, we take over your ongoing care.