Alcohol is readily available, as well as legal and socially acceptable. The 2012 National Survey on Drug Use and Health (NDUH) reported that 87.6 percent of adults had consumed alcohol at some point in their lives. Drinking alcohol in moderation does not generally constitute a problem. The issue occurs, however, when someone’s drinking leads to a physical and mental dependence on alcohol.
An alcohol use disorder, or AUD, is a medical condition diagnosed when someone’s drinking causes them harm, yet they continue to drink. Alcohol abuse can have dangerous consequences, with the CDC publishing that alcohol-related death is the third leading cause of preventable death in America.
Problems can arise when someone attempts to stop drinking also. Not only can the cycle of addiction be difficult to break emotionally, but physical side effects may occur as well. Chronic or heavy drinking can lead to withdrawal symptoms when consumption levels are stopped or drastically reduced. These symptoms are uncomfortable and can become life-threatening if not properly monitored. Stopping alcohol use cold turkey may not be safe for some chronic drinkers either.
Detox refers to the process of removing toxins from the body. Alcohol detox can be performed either in an inpatient or outpatient setting depending on your needs. The safest place to detox from alcohol is in a detox facility offering around-the-clock medical care and supervision from consulting physicians.
Health Risks During Detox From Alcohol
Alcohol affects the brain, interfering with the normal production and function of its chemical messengers, or neurotransmitters. Chronic alcohol abuse leads to the suppression of the neurotransmitters GABA and glutamine. GABA functions to slow down brain activity and promotes calm and relaxing feelings, while glutamine is responsible for feelings of excitability. When alcohol is then removed from the brain during detox, these chemicals are no longer suppressed, and the brain can rebound leading to brain hyperexcitablity. This may manifest through anxiety, irritability, tremors, agitation, and, in severe cases, seizures and delirium tremens (DTs).
The severity of the withdrawal symptoms is typically directly related to the amount of alcohol consumed and the length of time the habit was perpetuated. Most episodes of heavy or binge drinking will result in some form of withdrawal symptoms.
There is a wide range of symptoms, including:
- Nausea and vomiting
- Loss of appetite
- Rapid heart rate
- Mood swings
One of the most severe withdrawal symptoms is delirium tremens, which is fatal between one and five percent of the time, as published by the American Society of Addiction Medicine. Delirium tremens is a medical emergency characterized by mental and nervous system changes, which can cause hallucinations, seizures, and disorientation. If you suspect DTs, seek immediate medical help as early intervention and treatment greatly reduces the mortality rate.Alcoholism is a disease, and relapse is common. Unfortunately, repeated episodes of detox can increase the risk for seizures and DTs. Medical supervision is recommended during alcohol detox to help manage withdrawal symptoms and lower the health risks.
Timeline of Alcohol Detox
Alcohol withdrawal varies from person to person depending on the level of dependence and duration of the substance abuse; therefore, so does the detox timeline. Typically, withdrawal symptoms will begin within six to eight hours of blood alcohol levels dropping drastically and peak around 24 to 72 hours. Tactile, visual, and auditory hallucinations may start between 12 and 24 hours of alcohol levels dropping, while seizures can begin to occur between 24 and 48 hours after stopping drinking. DTs typically appear within 24 to 72 hours after alcohol has been purged from the body. Withdrawal symptoms may persist for a long period of time.
Medications Used During Detox
Many times, the use of pharmaceuticals can be a helpful aid to relieve the intensity of many of the more severe withdrawal symptoms, and they are often added to the detox protocol. Medications used during detox include:
- Anti-anxiety medications
- Adjunctive medications
- Vitamin supplements
- Intravenous fluids
- Alcohol itself
Benzodiazepines are commonly used to help relieve alcohol withdrawal symptoms during detox. Valium and Librium, benzodiazepine medications, have tranquilizing and sedative effects. They work to suppress the central nervous system and help relieve convulsions and tremors related to alcohol withdrawal. Diazepam is another benzodiazepine medication also often used to counteract the anxiety that crops up during alcohol detox. Other pharmaceuticals, including adrenergic medications, may be used in addition to benzodiazepines as a supplement, or adjunctive medication, and may relieve other withdrawal symptoms like agitation and hallucinations.
Alcohol withdrawal can also cause severe vitamin deficiencies that can be balanced by vitamin supplements. For example, many chronic drinkers are deficient in thiamine, essential for energy metabolism, and this deficiency if left untreated can lead to Wernicke-Korsakoff syndrome, which can progress to irreversible dementia. Therefore thiamine, or vitamin B complex, is often added to the alcohol detox protocol. In some cases, severe dehydration occurs during alcohol withdrawal and intravenous fluids are necessary, which must be administered in an inpatient setting.
Since stopping alcohol suddenly can be problematic, sometimes tapering off alcohol is suggested. This method creates a schedule in which the drinker gradually reduces the levels of alcohol consumed down to zero over a period of time. Tapering off is typically not recommended, as it is safest to withdraw from alcohol in a controlled and monitored setting.
What Happens After Detox?
Detox is merely the first step in the recovery process. The emotional component of alcohol dependency should not be overlooked. Managing withdrawal symptoms is the initial goal during detox. After the alcohol is purged from your body, counseling and therapy are necessary to remain abstinent. Alcohol dependency manifests for many reasons, including both genetic and environmental factors. Alcoholism is a brain disease, and awareness of its root cause can be helpful in managing recovery options.
Cognitive Behavioral Therapy (CBT) can help you to identify what may trigger episodes of drinking and how to avoid or manage them. CBT also works to modify negative thought and behavior patterns. Support groups are an important part of the recovery process as well. Family and peer support can be vital in preventing a future relapse. Family, group, and individual therapy are vital tools also. Many support groups exist, including 12-Step programs, faith-based options, and other social support groups. Rehabilitation is a process and alcohol use disorders take time to recover from. Both your brain and body need time to heal.
After detox, there are also medications that can be useful to prevent future drinking. One of these medications, naltrexone, is an opioid antagonist that effectively blocks the opioid receptors from receiving the pleasure signals that drinking alcohol can release, therefore decreasing the desire to drink. A nutritious diet, exercise, and a healthy sleep schedule can also be effective tools during the recovery process.
Further Reading About Alcohol Detox
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.