Alcohol is one of the few substances where quitting on your own can be dangerous. Not uncomfortable. Dangerous. That is why alcohol withdrawal and medication get discussed together so often, and why the first question is never which pill; it is whether you are safe to stop at all.
In this article, Michael Damioli, LCSW, CSAT, Clinical Director at Colorado Medication Assisted Recovery, explains what CMAR actually prescribes, how the team decides who needs daily monitoring, what happens if withdrawal worsens, and why the medication question is usually a shame question in a costume.
If you are trying to work out whether you can just stop drinking this weekend, start here.
Alcohol Withdrawal and Medication: Two Kinds, and People Mix Them Up
This is the confusion Damioli untangles most often, so it goes first.
Getting through withdrawal
During the withdrawal window itself, the medical team uses comfort medications to keep you safe and functional while your nervous system settles. Blood pressure, tremor, sleep, anxiety, seizure risk.
This part is short. It tapers down over days, and the end date is written into the plan before you start.
Staying stopped afterward
That is a separate conversation, and it usually happens once the first part is behind you. There are three FDA-approved options for alcohol use disorder, and they do genuinely different jobs.
| Medication | What it does | Who it tends to fit |
| Naltrexone | Quiets cravings and blocks most of the reward of drinking. Daily pill or monthly injection | People whose main obstacle is craving, or who know they will not take a daily pill |
| Antabuse | Makes you physically ill if you drink | People who want a hard wall between themselves and the decision |
| Acamprosate | Helps steady brain chemistry after you have stopped | People who have stopped and are managing ongoing discomfort |
None of this is decided before an assessment; our medical provider makes that call, not a website.
“Most people arrive assuming medication means one pill forever. That’s almost never what it turns out to be.”
Can You Safely Stop Drinking on Your Own?
Some people can. But alcohol withdrawal can cause seizures and delirium tremens, and the NIAAA is clear that severe withdrawal is a medical event, not a rough weekend.
The question Damioli asks first
Not how much you drink. When.
If you are drinking in the morning to stop the shakes or fix what last night did to you, that is not a habit anymore. That is physical dependence, and that person should not be stopping alone.
The same conversation applies if there has been a seizure before, or DTs, or years of heavy daily drinking.
Who is usually lower risk?
Someone who drinks hard on weekends and wakes up rough but steady is a different clinical picture. Not risk-free, but different.
Here is the honest problem with that distinction: everybody reading this assumes they are the second category. That is human, and it is also the one part of this where guessing wrong has real consequences.
A free assessment takes about ten minutes on the phone and answers it properly. Call CMAR at (833) 448-0127 and ask before you decide anything.
How CMAR Decides Who Needs Daily Monitoring
CMAR uses ASAM criteria, six dimensions that sound more clinical than they are:
- Withdrawal risk based on your history and your last drink
- What is happening medically
- What is happening emotionally
- Where your readiness actually sits
- What happened in previous attempts
- Your living situation
The dimension that decides more cases than people expect
That last one.
Damioli has had patients who were textbook candidates medically and still were not a fit, because there was alcohol in the kitchen and a partner at home who did not think any of this was necessary. The medication does its job, and the environment undoes it every night.
What the schedule actually looks like
Daily visits are for the higher-risk end. Significant withdrawal history, medical complications, a home situation that will not help.
Less frequent visits work for people whose vitals are holding and who have somewhere safe to sleep.
And it is not locked in. We start somewhere, watch how you respond, and adjust. Responding well means spacing it out. Struggling means tightening it up.
What Happens If Withdrawal Gets Worse?
This is the question Damioli thinks people should ask every program they call, because the answer tells you whether they are being straight with you.
The monitoring is the point
Vitals, symptoms, how you slept, what your hands do when you hold them out. That is what the visit schedule is for.
If symptoms climb faster than expected, the first move is adjusting medication. If they keep climbing, we move you up a level of care, and that can mean medically supervised detox at a higher intensity. We arrange it. You are not making phone calls in that condition.
That is not a failed attempt
Moving up a level is the system doing exactly what it was built to do.
“The scenario I’m trying to prevent is somebody at home at 2 a.m. deciding on their own whether what they’re feeling is normal. At that hour, alone, nobody makes that call correctly.”
If you are somewhere in that window right now, or you are watching someone who is, that is a reason to call tonight rather than in the morning.
“Isn’t This Just Trading One Dependency for Another?”
Damioli hears this constantly, and he thinks it usually comes from a decent instinct that has landed on the wrong target.
Dependence and addiction are not the same thing
A diabetic is dependent on insulin. Nobody says they are addicted to it.
There is a real difference between a drug that is wrecking your family, your job, and your health, and a medication that is helping you function inside your life.
With withdrawal medication, it is days
Not years. It is a taper, and it ends.
With naltrexone, the question falls apart
There is nothing there to get hooked on. Naltrexone is a blocker. No high, no euphoria, no withdrawal when you stop taking it, no street value, not a controlled substance.
According to SAMHSA, it reduces cravings and blocks the effects of alcohol, which is the opposite of what a substance of abuse does. We covered how that plays out month to month in Vivitrol for alcohol use disorder.
The part underneath the question
Damioli puts this carefully because it can land the wrong way.
Most of the time, this question is not really about pharmacology. Shame is the single biggest thing keeping people out of treatment, and “I should be able to do this myself” is one of the ways it shows up wearing reasonable clothes.
Nobody asks a person with pneumonia to fight it off on principle.
What Comes After Withdrawal
Getting through the first week is not treatment. It is the thing that makes treatment possible.
The medication quiets the chemistry. It does nothing about the 6 p.m. trigger, the stress, the relationships, or the reason drinking became the answer to every feeling you have.
That is why what happens after detox matters as much as the detox itself. At CMAR that usually means stepping into PHP or IOP, where the therapy and group work happen, and where any co-occurring depression or anxiety gets treated rather than waited out.
Anyone comparing alcohol rehab in Denver should ask what that handoff looks like, because a detox with no plan behind it is where a lot of people lose the progress they just made.
How CMAR Handles Alcohol Withdrawal in Denver
CMAR runs outpatient detox with medical oversight, which means you sleep at home while a medical team manages the withdrawal.
- Assessment before anything is prescribed, by a medical provider, not an intake script
- Monitoring frequency matched to your actual risk, adjusted as you go
- Comfort medications during the withdrawal window, tapered on a plan
- A conversation about maintenance medication once you are through it
- A direct handoff into therapy and groups, because the medication is one half
As a CARF-accredited provider of alcohol rehab in Denver, CMAR is in-network with most major commercial plans and accepts Colorado Medicaid.
You can verify your coverage before you commit to anything.
Ask a Clinician: Michael Damioli on Withdrawal and Medication
Is it safe to stop drinking on your own?
“Some people can. But alcohol is one of the few things where stopping on your own can genuinely kill you, and I say that plainly because the alternative is people finding out at home on a Tuesday night. The first thing I ask isn’t how much somebody drinks. It’s when. If you’re drinking in the morning to stop the shakes, that’s physical dependence, and that person shouldn’t be doing this alone.”
How do you decide who comes in daily?
“Six things, and the one that decides the most cases is the living situation. I’ve had patients who were textbook candidates medically and still weren’t a fit, because there was alcohol in the kitchen and a partner at home who didn’t think any of this was necessary. The medication does its job, and then the environment undoes it every night.”
What if withdrawal gets worse mid-program?
“We’re watching for exactly that. Vitals, symptoms, how you slept, what your hands are doing when you hold them out. If it climbs, we adjust the medication first. If it keeps climbing, we move you up a level, and we arrange it. That’s not a failure of outpatient. That’s the system working.”
Is medication just trading one dependency for another?
“A diabetic is dependent on insulin. Nobody says they’re addicted to it. There’s a difference between a drug that’s wrecking your family and a medication that’s helping you function. And with naltrexone, there’s nothing there to get hooked on at all. It’s a blocker. No high, no withdrawal, no street value.”
Frequently Asked Questions
Comfort medications during withdrawal manage symptoms like tremor, blood pressure, anxiety, and seizure risk, and they taper over days. Separately, three FDA-approved medications support staying stopped: naltrexone, Antabuse, and acamprosate. Which ones fit you is decided by a medical provider after an assessment.
Symptoms usually begin within 6 to 24 hours of the last drink, peak between 24 and 72 hours, and ease over roughly a week. The peak window carries the highest medical risk. Post-acute symptoms like sleep disruption and mood swings can continue for weeks afterward.
Some people can with medical supervision, which is what outpatient detox provides. Stopping entirely alone is risky if you drink daily, drink in the morning, or have had seizures or DTs before. An assessment determines which category you are in, and it is free.
No. Naltrexone is an opioid blocker, not an activator. It produces no high, no euphoria, and no withdrawal when stopped, and it is not a controlled substance. It reduces cravings and blocks the rewarding effects of alcohol, which is the opposite of how a substance of abuse works.
For naltrexone, yes. You generally need to be alcohol-free for about a week and fully opioid-free before starting. That gap is exactly what CMAR’s outpatient detox is designed to bridge, with medical supervision instead of willpower carrying you through it.
