Alcohol is one of the most widely available and frequently abused drugs in the United States. Approximately 85.6% of adults have drunk alcohol at least once in their lifetime, and around fourteen million adults have developed an alcohol use disorder (AUD).
Although easily accessible, alcohol is a dangerous and addictive drug. In particular, alcohol withdrawal symptoms are among the most hazardous of any substance and, in severe cases, can be life-threatening. While anyone can safely withdraw from alcohol, professional medical detox is essential to ensure safety throughout the process.
Alcohol Abuse, Dependence, and Addiction
Alcohol-related problems are some of the most significant health issues in the United States. The terms alcohol abuse, physical dependence, and alcohol addiction are widely used in public discourse. You may have seen them on government messages, on informative websites, or in healthcare centers.
While people sometimes use the terms interchangeably, they have distinct meanings. Understanding the differences can help you determine how alcohol affects our bodies, lives, and society.
Alcohol abuse is a general term that refers to harmful or problematic drinking habits. This may include drinking that is bad for your health, drinking that causes harm to others, or using alcohol in unhealthy ways, such as a coping mechanism for mental disorders.
Usually, you can consider any drinking above the recommended levels (see the Center for Disease Control and Prevention drinking in moderation guidelines) to be alcohol abuse. This includes heavy drinking and binge drinking.
Alcohol dependence is when your body becomes physically dependent on alcohol to function normally. Alcohol dependence usually develops when you frequently drink alcohol above the healthy level.
After some time, the body becomes used to the presence of alcohol in the body and begins to adapt its natural production of certain chemicals in response. If you suddenly stop drinking, you typically experience withdrawal symptoms until your body readjusts. In some cases, these symptoms can be life-threatening.
Alcohol addiction, also known as alcoholism, refers to the compulsive seeking and drinking of alcohol despite any negative consequences. Characterized by physical changes in the brain, addiction causes strong urges to drink alcohol that can be difficult to resist.
Addiction is a distinct psychological and behavioral phenomenon. It is possible to abuse and be dependent on alcohol without being addicted.
Alcohol Use Disorder
AUD is a medical condition that encompasses alcohol abuse, dependence, and addiction. Characterized by an impaired ability to stop or control drinking alcohol despite adverse consequences, AUDs can be mild, moderate, or severe. The most severe AUDs typically involve addiction.
What Happens During Alcohol Withdrawal?
Alcohol is a central nervous system depressant that works by slowing down the brain. It increases the effects of gamma-Aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, making you feel calmer and more relaxed. It also decreases the presence of glutamate, a neurotransmitter that increases excitability.
Chronic alcohol consumption makes it difficult to increase GABA and decrease glutamate, so you have to consume more alcohol to experience the same effect. Your body begins to adjust to these chemical imbalances and produces less GABA and more glutamate in response.
If you suddenly stop or reduce your drinking, your body continues to underproduce glutamate and overproduce GABA. You may experience withdrawal symptoms such as anxiety, hyper activeness, restlessness, seizures, high blood pressure, and tremors as a result. This set of symptoms is also known as alcohol withdrawal syndrome (AWS).
Related article: Alcohol and sleep
What Are Alcohol Withdrawal Symptoms?
Despite the pervasiveness of alcohol in our society, alcohol withdrawal is among the most dangerous of any drug withdrawal.
The most severe withdrawal symptoms, including delirium tremens (DTs), can be life-threatening without proper medical care. For this reason, detoxing alone is extremely dangerous – you must undergo detox as part of a professional rehabilitation program.
Alcohol withdrawal symptoms can be mild to severe, depending on many factors. These include:
- Your alcohol use – If you regularly drink heavily and have a severe alcohol dependence, you are more likely to experience severe symptoms.
- Your physical health and biology – Our bodies are all different, and we respond to substances in different and unpredictable ways. Two people with the same drinking history could experience very different withdrawal symptoms. Underlying medical conditions can also exacerbate withdrawal symptoms.
- Your mental health – People with underlying mental health conditions may be more likely to experience severe psychological symptoms of alcohol withdrawal.
Some people – particularly those with mild or moderate AUDs – may only experience mild withdrawal symptoms. Mild symptoms may include:
- Mood swings
- Difficulty thinking clearly
- Nausea and/or vomiting
- Loss of appetite
- Mood swings
- Nervousness and anxiety
- Increased heart rate
- High blood pressure
More severe withdrawal symptoms include DTs, a potentially life-threatening condition that occurs in around 2% of people withdrawing from alcohol dependence. A medical emergency that requires immediate medical attention, symptoms can include:
- Extreme agitation and/or confusion
- High blood pressure
While DTs may sound scary, addiction treatment centers, like our own, work with licensed medics who are expertly trained to recognize and treat them. They ensure you receive the necessary level of care and professional supervision so you remain completely safe at all times.
What Is the Timeline of Alcohol Withdrawal?
Everyone’s experience of alcohol withdrawal is different, but a general timeline of alcohol withdrawal syndrome may look something like this:
- Six to twelve hours after your last drink – You begin to experience alcohol withdrawal symptoms. Early withdrawal symptoms are usually mild and may include headaches, insomnia, small tremors, and an upset stomach.
- Up to twenty-four hours after your last drink – Some people may experience hallucinations.
- Twenty-four to seventy-two hours after your last drink – In this time, many withdrawal symptoms peak and begin to ease again. Seizure risks are usually highest between twenty-four to forty-eight hours after your last drink. DTs usually appear from forty-eight to seventy-two hours after you stop drinking.
In rare cases, people experience prolonged symptoms for weeks or even months after withdrawal. Post-acute withdrawal syndrome (PAWS) symptoms are usually mild and include sleep disturbances, tiredness, and mood changes. However, most people who undergo medical detox and attend treatment services fully recover from alcohol withdrawal.
How Can I Detox From Alcohol Safely?
Because of the potential severity of alcohol withdrawal syndrome, detoxing from alcohol requires medical support. Medical detox offers support from medical professionals throughout the detox process to ensure your safety at all times. Alcohol detox involves gradual tapering off of alcohol rather than going cold turkey.
There are two main types of medical detox – inpatient detox and outpatient detox. Inpatient detox programs involve residential stays in a specialized treatment facility. They offer twenty-four-hour care from medical professionals to help make the process as comfortable as possible.
Outpatient detox involves regular visits to a treatment facility to receive medical check-ups and progress assessments. A medical professional will design your detox plan and prescribe any necessary medication, but you will continue to live at home.
Do I Need an Inpatient Detox?
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends twenty-four-hour medical support for alcohol withdrawal due to the potentially life-threatening symptoms. However, outpatient programs may be appropriate for people living with mild AUDs who wish to continue balancing work and home responsibilities while they undergo detox.
Should you attend our center, a professional medic will offer an assessment of your condition to determine whether you require an inpatient or outpatient detox. They may consider:
- The length of your drinking problem
- The last time you drank
- Your typical alcohol intake
- Previous alcohol detox experience
- Your medical history
- Co-occurring mental health conditions
- Access to support from family members and friends
- Experience of trauma
How Can You Treat Alcohol Withdrawal?
To treat alcohol withdrawal, we can prescribe certain medications to ease symptoms and reduce cravings. Research shows that medication-assisted treatment is an effective treatment method for substance use disorders and may help sustain lasting abstinence. Disulfiram, naltrexone, and acamprosate are all Food and Drug Administration (FDA) approved to treat AUD.
Below, we have outlined how these medications support withdrawal.
- Disulfiram acts as a deterrent for drinking by inducing adverse physical reactions to alcohol.
- Naltrexone blocks opioid receptors in the brain, disrupting the reward system that leads to alcohol cravings.
- Acamprosate can ease unpleasant withdrawal symptoms.
If you experience DTs, we may use benzodiazepines to treat symptoms and reduce agitation. Doctors typically use long-lasting benzodiazepines like diazepam and lorazepam to induce sedation. Because of the severity of DTs, treatment should take place in an intensive care (ICU) setting where possible, with a professional medic monitoring symptoms around the clock.
Aside from medication, certain other environmental factors can make the withdrawal process more comfortable. These include:
- A quiet place
- Soft lighting
- A positive and supportive atmosphere
- Healthy food to balance nutritional deficiencies
- Plenty of fluids, especially if you experience vomiting or diarrhea
Treating Medical Comorbidities
Chronic alcohol use is associated with several comorbid medical conditions, which may also require treatment during alcohol withdrawal. This includes liver disease, heart disease, and Wernicke Encephalopathy (WE), a neurological condition that results from vitamin B deficiency.
Comorbidities tend to be the rule rather than the exception for those with severe withdrawal symptoms like DTs. Inpatient medical detox allows doctors to properly care for these conditions and offer appropriate medication throughout the detox process.
What Is the Clinical Institute Withdrawal Assessment Alcohol Scale-Revised (CIWA-AR)?
Clinicians and physicians often use the Clinical Institute Withdrawal Assessment Alcohol Scale-Revised (CIWA-Ar) to diagnose and assess the severity of alcohol withdrawal syndrome. This involves assessing the severity of different withdrawal symptoms and assigning each symptom a score before totaling the numbers. A higher score represents more serious symptoms.
Your clinician may then use your score to determine your level of care and the prescription of medication you require.
What Comes After Alcohol Withdrawal?
Alcohol withdrawal is usually the first stage in the recovery process from alcohol addiction and substance abuse. However, detox alone is rarely sufficient to induce lasting recovery.
Long-term recovery from addiction involves identifying the underlying causes of substance abuse and developing the skills to overcome them. It is a journey of personal growth and lifestyle changes that requires lifelong commitment and dedication.
The good news is that there is plenty of support available to help you overcome your drinking problem and live a fulfilling sober life. According to the National Institute on Alcohol Abuse and Alcoholism, no matter how severe the problem may be, evidence-based treatment methods can help you achieve recovery and maintain sobriety.
The most effective substance abuse treatment programs combine a variety of treatment options to suit each client’s unique needs. Treatment options may include:
- Talk therapies, including cognitive-behavioral therapy (CBT)
- Group programming
- Support groups
- Experiential therapies
- Complementary therapies like yoga and mediation
- Life skills development
- Family therapy
If you or someone you love is struggling with a drinking problem, don’t hesitate to reach out for support. Attending a detox and substance abuse treatment program, such as our own, can be a life-changing decision that turns your future around. With compassionate and expert support, you can open the doors to the sober life you deserve.
You can easily reach out to us in Orange County, California. As these centers are located in a convenient area, you won’t have any trouble finding us.