Alcohol detox typically refers to physical withdrawal symptoms that can be experienced when cutting down or stopping regular heavy alcohol intake, as well as the accompanying medical treatment process. Alcohol detox is the first step in the journey of long-term recovery. Today, we will review A) why physical withdrawal symptoms occur with alcohol reduction or cessation, B) what types of symptoms may arise, C) how to predict alcohol withdrawal severity, D) the symptom timeline, and D) what treatment options are available.
Why does alcohol withdrawal happen?
Alcohol is a central nervous system depressant or “downer” that alters the body’s natural balance between relaxation and excitement. Alcohol contains powerful depressant chemicals that lower heart rate, breathing, and core body temperature. These physical changes create a sense of relaxation, sedation (tiredness), and disinhibition. Over time, if large amounts of alcohol are consumed regularly, the body eventually adjusts to these alterations and becomes dependent on the effects of alcohol.
What are common alcohol withdrawal symptoms?
Alcohol has pronounced depressant effects. When someone who drinks regularly and heavily suddenly stops or cuts down significantly, the body goes through a 5-7 day period of “excitatory” physical changes as the depressant effects of alcohol wear off. These excitatory physical symptoms can include mild changes like headache, anxiety, insomnia, depression, and agitation or more noticeable changes such as sweating, tremors, nausea, vomiting, confusion, and “pins and needles” physical sensations. In very rare and severe cases, untreated alcohol withdrawal can cause hallucinations, seizures, or death.
How do I determine what my withdrawal symptoms will look like?
Alcohol withdrawal symptom severity is primarily determined by how long you’ve been drinking, how frequently you drink, and how much you drink in each sitting. The longer the total length of regular drinking and the higher the quantities, the more noticeable the withdrawal symptoms will be when you try to stop. Other factors that contribute to more severe withdrawal symptoms include older age, multiple medical conditions (especially pre-existing liver problems), and the use of additional depressant medications or substances in addition to alcohol. The best overall predictor of future withdrawal symptoms is the most recent past withdrawal symptoms. Future withdrawal symptoms will closely mirror your most recent withdrawal period.
When do alcohol withdrawal symptoms start, and how long do they last?
Most physical alcohol withdrawal symptoms start somewhere between 12-24 hours after the last alcohol consumption and peak in intensity around 48-72 hours later. Alcohol withdrawal symptoms can begin as early as 2-3 hours after the last drink for very heavy drinkers. The highest risk period for an alcohol withdrawal seizure and/or development of delirium tremens (“DTs”) is 48-72 hours after the last drink. Most acute physical withdrawal symptoms from alcohol dissipate between 5-7 days after the last drink.
Some patients can experience more long-term, subtle changes following alcohol cessation. These milder, non-physical symptoms can last for up to 2 years. Known as post-acute withdrawal symptoms, or PAWS, these changes can include anger, irritability, sleep disturbances, changes in concentration and energy, and mood changes.
What are my treatment options?
Self-directed alcohol detox without medical supervision can be very dangerous. Although some folks need to complete the alcohol detox process inside a hospital, many others can safely accomplish this on an outpatient basis without ever leaving the comfort of their home. It is essential to consult with a medical professional to find out which option is best for you.
The most common medications used to treat short-term alcohol withdrawal symptoms are a class of drugs known as benzodiazepines. These are medications like Valium, Ativan, Librium, and Klonopin. They work to treat alcohol withdrawal by mimicking the depressant effects that alcohol has on the body. While these medications are very effective, they should only be taken as prescribed by your healthcare provider and for only the first few days of the alcohol withdrawal period. This is because these medications can be as physically addictive and habit-forming (or more) as alcohol itself.
Finally, whether you complete alcohol detox in a hospital or your home in consultation with medical providers, try to practice these self-care tips during the process: Aim to get at least 7-9 hours of sleep per night. Drink plenty of water. Staying very well-hydrated and well-rested will help to reduce the severity and discomfort of alcohol withdrawal symptoms. In addition, try to minimize or reduce any other stress during this time, including work and childcare obligations. Lastly, identify at least one close friend or family member who can support you emotionally and practically during this time window.
In consultation with medical providers, alcohol detox is very doable! It is often the beginning of a bright new chapter filled with hope and promise.
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About the author…Dr. Lauren Grawert MD.
Dr. Grawert is a double board-certified Addiction Psychiatrist. She completed her medical school training in 2009 and a General Psychiatry Residency in 2013 at the Medical University of South Carolina (MUSC). She then went on to complete an Addiction Psychiatry fellowship at MUSC, which she completed in 2014. After fellowship training, Dr. Grawert served as the Chief of Psychiatry and Addiction at Kaiser Permanente of the Mid-Atlantic. She has also worked in private practice specializing in general psychiatry, substance use disorders, and medically assisted treatment (MAT). Dr. Grawert has served as an expert for the San Diego Community Response to Drug Overdose Task Force, the Addiction Committee Leader for Kaiser Permanente National Mental Health & Addiction Leadership Organization, and a Professor of Psychiatry at Penn State College of Medicine. She likes to write, travel, and spend time with her two young children in her spare time.
