Alcohol Detox and Withdrawal Symptoms

When you decide to stop drinking, you have to think about getting through the alcohol detox stage.

Read on to find out more about alcohol withdrawal symptoms and to learn what you can expect from an alcohol detox - such as:

• Common alcohol withdrawal symptoms; when they start and how long they last for
• What are the DTs (delirium tremens)?
• Can you do it on your own, or do you need professional help?
• Why do we get alcohol withdrawal symptoms anyway?

Alcohol Withdrawal Symptoms

If you drink heavily every day for a while you will likely experience alcohol withdrawal symptoms if you stop drinking suddenly.

Alcohol withdrawal symptoms will usually begin within 5 to 10 hours of your last drink and will get worse for about 48 to 72 hours. Withdrawals generally last for a few days, but they can endure for weeks.

Common withdrawal symptoms include:

• Fatigue
• Depression
• Anxiety
• Difficulty in concentrating and thinking clearly
• Irritability and moodiness
• Feeling shaky
• Having nightmares

Withdrawal symptoms sometimes experienced include:

• Nausea, vomiting and a loss of appetite
• Quickened heart rate
• Pale and clammy skin
• Headaches
• Dilated pupils
• Insomnia
• Sweating
• Tremor

Dangerous withdrawal symptoms sometimes experienced include:

• The DTs, see below for a complete description of these life threatening alcohol withdrawal symptoms¹

The Delirium Tremens

About 5% of people going through alcohol withdrawals will experience the life-threatening delirium tremens (DTs).²

You are more likely to get the DTs if:

• You have ever had the DTs before
• You have ever before had an alcohol withdrawal seizure
• You have another illness concurrently as you go through alcohol withdrawals
• This is not your first alcohol detox ³
  
• You drink more than 7 or 8 pints (473 ml) of beer per day or more than 1 pint of liquor per day
• You have been drinking heavily for more than 10 years

In addition to regular symptoms of alcohol withdrawal, people who get the DTs may also experience:

• Whole body shakes
• Significant confusion and an inability to maintain attention
• Significant agitation and irritability – rapid cycling between moods
• Excitement, fear or delirium
• Falling into a very deep sleep which persists for longer than 24 hours
• Having hallucinations
• Feeling very restless or becoming very active
• Significant fatigue and sleepiness
• Becoming overly sensitive to sensory stimuli such as touch, light and sounds
• Having seizures (seizures are most commonly experienced by people who have had difficult alcohol withdrawals in the past and occur most often within 12 to 48 hours after a last drink⁴

The DTs will most commonly occur within 48 hours of a last drink, but in some cases delirium tremens have emerged as long as ten days after a last drink.

The DTs are a medical emergency. Even with intensive medical care (which can include intubation etc.) and emergency medications and sedation between 5% and 15% of those with delirium tremens will die. Without emergency medical intervention, the fatality rate is much higher.

Do You Need Professional Help to Detox?

It depends on your situation:

• Some people can safely detox at home on their own (after consulting with a doctor)
• Some people can detox safely at home while participating in an outpatient detox program
• Some people cannot detox safely at home and need to enter an inpatient medical detox program
• Some people, such as those going through the DTs, will need to be transferred to an intensive care facility

Because a doctor can prescribe medications that can greatly ease the pains of alcohol withdrawal, and because for some people, going through a detox without medical supervision can be very dangerous, there is no reason why anyone should do an alcohol detox without first consulting with a doctor. You don’t necessarily have to go into a medical detox, but don’t be foolhardy and don’t go through unnecessary discomfort – SEE A DOCTOR FIRST!

You are likely going to need an inpatient detox under medical supervision if:

• You this is not your first alcohol detox and you have a history of severe alcohol withdrawal symptoms
• If you have gone through alcohol detoxification on multiple previous occasions
• If you have ever before had withdrawal seizures or delirium tremens
• If you have a co-occurring psychiatric or medical illness
• If you are pregnant
• If you have a recent history of very high alcohol consumption
• If you lack a sober and responsible social support network⁵

If your doctor gives you the green light to detox at home, you will still want to be aware of signs that could indicate a worsening situation and the need to get emergency medical assistance.

If you detox at home, you will need to have someone with you at all times who can monitor your symptoms and get you to the hospital/get emergency help if needed. You will also probably need to go see your doctor on a daily basis for a few days so she can evaluate your condition as it changes over time.

Why Do People Get Alcohol Withdrawal Symptoms?

If you use alcohol for long enough, and in sufficient quantities, your brain adapts to this use by making some changes to the way it works, and this is one reason why people who drink regularly will develop a tolerance to alcohol and need much more to feel the same effects as an occasional drinker.

When you drink alcohol it increases the release of a neurotransmitter called GABA in the brain. GABA is a neurotransmitter that controls the release of other neurotransmitters, like dopamine, norepinephrine and glutamate. GABA slows down and controls brain activity.

When you drink very heavily, your brain responds to this constant influx of alcohol by reducing the number of GABA receptors and by changing their function. Without sufficient GABA in the brain you would normally experience too much neural activity and symptoms like tremors and sickness and anxiety and many others - but since you are using a lot of alcohol each day, the alcohol slow things down in the brain just like a normal amount of GABA would.

If you then suddenly stop drinking alcohol, your brain isn’t getting enough GABA and it isn’t getting the alcohol to slow things down – and so it races and too many excitatory neurotransmitters get released and you experience alcohol withdrawal symptoms.

Fortunately, your neurochemistry largely recovers in a few days or weeks, and as GABA function normalizes, symptoms of alcohol withdrawal disappear.⁶