Surviving Alcohol Withdrawal & Detox

Although alcohol is the most widely abused substance worldwide, many people underestimate how devastating alcoholism can be. What may start as “social drinking” or the occasional glass of wine can spiral into obsessive consumption that destroys families, causes financial ruin and puts the health and safety of the addict at serious risk.

While there are factors that can make a person more susceptible to alcohol addiction, such as family history of addiction, mental illness, trauma, abuse or stress, it is important to note that this is an affliction that affects people from all walks of life. Although most people who are addicted to alcohol are adults, preteen children have also fallen victim. Many people with alcohol addictions also use other substances, such as marijuana, cocaine or prescription opioids. This can exacerbate the harmful effects of alcohol and make withdrawal symptoms potentially more dangerous.

Any decision to overcome an alcohol addiction is a positive step, but the addict must first go through withdrawal, a process that carries its own set of risks. For this reason, almost all physical and mental health practitioners recommend that people who want to quit alcohol go through a program of medical detox, whereby a doctor guides them through the worst of the withdrawal symptoms, keeping them safe and comfortable.

What is Alcohol Withdrawal?

Alcohol is a central nervous system depressant that produces a sense of relaxation and confidence, and reduced social shyness. As people develop a tolerance for alcohol, they have to consume greater quantities in order to achieve these effects. While this is happening, the addicts become physically and psychologically dependent on alcohol – meaning that they cannot do without it.

They feel intense anxiety when alcohol is not available, and they start to experience physical symptoms such as high blood pressure, abdominal pain and headaches. These withdrawal symptoms can start to appear as little as six hours after the body’s last exposure to alcohol.

Acute Alcohol Withdrawal

Acute alcohol withdrawal describes the symptoms that appear within the first few days after alcohol was last ingested. In general, these symptoms last for a week to ten days. They appear in three general stages.

Stage 1: Starting around eight hours after the last exposure to alcohol, the individual will experience agitation and restlessness, along with headaches, abdominal pain, nausea and vomiting. Some mild shivering may also occur.

Stage 2: One or two days after the last alcoholic drink, some higher risk symptoms may start to appear. These include high blood pressure, elevated body temperature and a higher than usual heart rate. The individual may also struggle to sleep and experience some confusion.

Stage 3: 2-4 days after the last drink, the alcohol addict is at risk of delirium tremens. Symptoms during this stage include audio and visual hallucinations, fever, seizures and extreme agitation that may be accompanied by aggression.

Alcohol withdrawal symptoms peak within a few days, and start to subside within approximately one week.

What is delirium tremens?

Sometimes called alcohol withdrawal delirium (AWD), delirium tremens is estimated to affect roughly five percent of people who experience alcohol withdrawal symptoms. It generally happens in heavy drinkers who reduce their alcohol use too quickly, who do not follow good nutrition habits while they are reducing their alcohol consumption, or who try to quit while they are suffering from an illness or infection. Individuals with a history of seizures are also more prone to AWD.

The more severe symptoms of AWD include chest pain, confusion, delusional thinking, hallucinations, seizures, increased heart rate, delirium, dehydration and fever. If left untreated, AWD can have serious long-term repercussions on physical and mental health.

Post-Acute Withdrawal Syndrome (PAWS)

Some individuals can experience prolonged alcohol withdrawal for up to one year. These post-acute withdrawal symptoms include emotional volatility, anxiety, low energy levels, insomnia, impaired memory, dizzy spells, poor reflexes, and a tendency to be accident prone.

How Alcohol Withdrawal Symptoms Can Affect Your Life

While acute withdrawal symptoms pass within one or two weeks, some post-acute symptoms can linger for some time after the completion of an inpatient or outpatient rehab program. These symptoms can affect the recovering addict’s everyday life in a variety of ways.

Insomnia: Prolonged insomnia can affect a person’s energy, memory, and cognitive functioning. The individual might feel irritable and unmotivated to perform simple tasks. This can have impacts on work, school, and relationships with friends, family members and peers.

Nausea and vomiting: In most cases, this symptom gets progressively milder as time passes, but it can result in the individual limiting his or her activities, and it can exacerbate existing feelings of fatigue.

Mood swings: As the body and mind try to adjust to living without alcohol, agitation can set in easily. The recovering addict may become easily frustrated and emotionally unpredictable. This can reduce the quantity and quality of social interactions.

Headaches: Headaches usually occur because the brain is not getting the alcohol it is accustomed to. They can affect cognitive functioning, memory and the ability to perform physical or mental tasks or activities. Some people experience migraines, which cause debilitating pain, and severely impact vision and cognitive functioning. These kinds of headaches can render the individual completely incapable of self-care, work performance and social relationships.

Hand tremors: Weakened or shaking hands can limit dexterity and make it difficult to complete certain tasks, such as electronic repair, hobby work, writing, fixing small objects, and other tasks that require fine motor skills.

Impaired memory: This symptom manifests differently from person to person, with some individuals failing to recall the names of friends and family members, while others are unable to remember important life events or learn new tasks.

Paranoia: People who have used alcohol for an extended time may experience long-term damage to the brain and central nervous system. This can result in paranoia, which can affect the individual’s responses to everything from everyday events and interactions, to special occasions and major life changes. Alcohol paranoia gradually diminishes over time, and can be alleviated with medication in some circumstances.

Can alcohol withdrawal be fatal?

It is a commonly held belief that for people with alcohol addiction, the sudden withholding of alcohol can lead to death. It can certainly feel that way: repeated use of alcohol over a period of time can affect the brain’s ability to produce dopamine - the chemical that makes us feel good. People in withdrawal, whose brains are no longer capable of producing dopamine naturally, can literally feel as if they will die without they drug they have become dependent on.

No matter how severe the addiction is, though, the simple withholding of alcohol cannot result in death. However, some potentially fatal complications can arise from the withdrawal symptoms.

Examples include the following:

• Confusion and hallucinations can result in the individual driving or operating dangerous machinery without an understanding of the risks.
• If someone in withdrawal experiences epileptic seizures, they can be at risk of choking on food or suffering a head injury if nobody is with them to help them.
• The person might experience cardiac arrhythmia, where the heart goes into spasm. This can result in cardiac arrest.
• People who experience nausea and vomiting are at risk of dehydration, which can lead to organ failure and death if left untreated.

What is Medical Detox?

Because of the severity of alcohol withdrawal symptoms, it is generally recommended that individuals go through this process under the supervision of a medical professional. This is especially important for people who have a history of seizures or heart disease, whose alcohol consumption has been extremely heavy, or who have a history of alcohol withdrawals and relapses.

During medical detox, a doctor monitors vital signs and withdrawal symptoms, and administers treatments and medications as necessary, to keep the patient safe and comfortable.

Detox begins as soon as the individual is admitted to the facility, and it continues until all alcohol has worked its way out of the blood stream. At that point, the patient is ready to begin an inpatient or outpatient alcohol addiction treatment program.

The Use of Medications During Detox and Rehab

Most people with alcohol addictions are able to go through detox and rehab without medication. However, medication can be an important part of an addict’s treatment plan, as it can help with the management of cravings and severe symptoms of withdrawal.

Medications that may be used in the treatment of alcohol withdrawal syndrome include the following:

Antabuse/disulfiram: This medication is used as a form of aversion therapy. It causes individuals who use alcohol to become violently ill, thereby reducing the likelihood of them using it again. The success of this medication depends on the alcohol addict being highly motivated to quit. Without this motivation, the individual will stop taking the medication, and within 48-76 hours, they may be able to drink alcohol again without feeling ill. Although disulfiram does not deal with the withdrawal symptoms, it does ensure that the patient stays off alcohol so they can go through the necessary process of withdrawal.

Campral/acamprosate: Like Antabuse, this medication does not have an impact on withdrawal symptoms. However, it does help manage alcohol cravings in some individuals who have already been through the initial withdrawal symptoms. It can be an effective tool for people who have the motivation to go through a rehab program but fear that they may not be able to control the cravings.

ReVia/naltrexone: Originally used to help control cravings for opiates, this medication is now thought to be more effective at reducing alcohol cravings.

Benzodiazepines: While this class of medications can effectively manage alcohol withdrawal symptoms such as seizures, hallucinations, anxiety and insomnia, they are used with extreme caution. Benzodiazepines are themselves highly addictive drugs. However, with diligent medical supervision, the longer-acting benzodiazepines such as Librium, Ativan and Valium can be safely used to manage severe symptoms. Over time, as the symptoms subside, the patient can be gradually weaned off the benzodiazepines.

It is important to note that while medically supervised detox is recommended, some alcohol addicts choose to go through withdrawal by themselves. These individuals should ensure that they have a support person with them, who can seek medical help if needed. It is imperative that individuals who experience delirium tremens are immediately seen by a medical professional.

Alcohol addiction and withdrawal can have a profound impact on the addict’s life. During the period of addiction, the body becomes accustomed to alcohol and starts to rely on it. When the alcohol is withheld, a new phase of adjustment has to begin, and this can be a challenging journey for even the most resilient people.

Countless studies and pieces of anecdotal evidence point to the efficacy of detox and rehab programs for recovering alcohol addicts. Through proper treatment, the individual can learn new life skills and coping techniques that open the door to a positive, productive life, with healthy relationships and no reliance on alcohol.

Photo credit: Find Rehab Centers. This picture has a Creative Commons attribution license.