[kragen]

i didn't realize that; thank you for the added information

psychiatric drugs can have surprising effects, but generally the terrible interaction benzodiazepines have with alcohol is that they send people into a potentially fatal coma, rather than causing suicide attempts or psychotic episodes

the hangover, though...

withdrawal from ghb doesn't sound like a picnic either, often including delirium

that blog post is pretty appalling; the author admits to intentionally submitting his 'friend' to alcohol withdrawal. doesn't he know delirium tremens routinely causes permanent brain damage

[tcj_phx]

GHB is approved for narcolepsy - I understand it helps improve the quality of sleep.

My friend ran out of alcohol - we were not aware of how much she was drinking. She lived with her mother at the time - her mother & aunt called the mental health crisis team on the first day of alcohol withdrawal. She was taken to the hospital. I think she was likely tranquilized with haloperidol. This is not an appropriate treatment for alcohol withdrawal, but it's reasonable under the psychiatric standard of care.

[kragen]

i think timely treatment with haldol can in fact significantly reduce or even entirely prevent the excitotoxic brain damage from alcohol withdrawal, but i'm not certain of that

https://en.wikipedia.org/wiki/Delirium_tremens#Treatment

[tcj_phx]

Haloperidol is sort-of useful for it's anti-serotonin properties [0]. The Soviets used this drug to induce agony in political dissidents.

The physiology of psychosis is now fully described, so there's no need to use haloperidol as a palliative 'anti-psychotic' anymore.

Someone responded to my comment yesterday [0] to mention pimavanserin, an antipsychotic that works as an anti-serotonin drug (rather than an anti-dopamine drug).

[0] my comment from yesterday: https://news.ycombinator.com/item?id=37136792

[kragen]

i didn't mean to prevent or arrest psychosis, i meant to prevent or arrest excitotoxicity

delirium tremens can induce psychosis but while that's pretty unfun it's usually less crucial to interrupt the psychosis than the neural damage

[tcj_phx]

I do appreciate the info about haloperidol and alcohol withdrawal. As you note, delirium tremens is a serious problem.

The essential feature of alcoholism is that the sufferers have broken metabolisms, and they find alcohol provides the calories they need to run their brains and bodies: https://twitter.com/JamesKnochel/status/1667570759034888192

Carbohydrates and protein provide 4 calories/gram, fats provide 9 calories/gram. Alcohol provides 7 calories/gram. Alcoholics train their nervous system to run on acetate, one of the breakdown products of ethanol: https://news.ycombinator.com/item?id=14085230

Rather than tranquilizing patients with haldol, how can the withdrawal patient's nervous system be fed?

A social worker I knew said one way to help with alcohol withdrawal is to provide a lot of sugar. The potassium in orange juice allows the body to use the sugar without having to release insulin. Other juices have less potassium, but would also be good.

I'm aware of some other gentle interventions too. Anything's better than inducing agony with haloperidol.

[kragen]

when i've seen people on haldol they haven't been in anything approaching agony; rather the contrary, it induces apathy, which tends to take away agony and anxiety

(of course, as i said above, psychiatric drugs can have a lot of surprising effects)

i'm skeptical of the metabolic claims in your comment