When a person drinks heavily, abuses alcohol, or binge drinks, he or she may be at risk of developing a physical dependence upon the substance. There are two major signs of a physical dependency: tolerance and withdrawal. Tolerance occurs when a person has to consumer larger quantities of alcohol to achieve the same effect. Withdrawal occurs when a person experiences certain unpleasant symptoms when he or she does not drink, and these symptoms are reduced when alcohol is once again consumed.
Dependency occurs because the body adapts to the chemical changes that occur upon ingestion of alcohol. Once the body becomes used to receiving the substance, it becomes negatively affected when it no longer receives the chemicals. In order to overcome this dependency, the body must detox from the substance. This process often causes physical symptoms that are typically unpleasant, and might be life threatening.
Many drugs and mood-altering substances have unpleasant withdrawal symptoms, but alcohol is the most dangerous substance from which to detox. It is the only one that could have fatal consequences. Therefore, when someone detoxifies from alcohol, especially after many years of heavy drinking, he or she should do so at a professional detox facility to ensure his or her overall health and well being during the process. There are several options for types of detox, including the type of facility providing the treatment.
Statistics of Alcohol Detox
About 8.6 million people in America meet the criteria for alcohol dependency, which is about 3.3 percent of the population, according to the latest data based on the Results from the 2012 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA). However, an even greater number of people, about 18 million, need treatment for alcohol abuse or dependency problems. Unfortunately, only 8.2 percent, or 1.5 million, actually received it. Reports estimate that only 10 to 20 percent of people experiencing withdrawal from alcohol are treated in hospitals. Based on these figures, it is estimated that 2 million Americans may go through some form of alcohol withdrawal or detox, many without any help.
Going through medically assisted detox for alcohol abuse or dependency provides a 20 percent increase in the likelihood of successfully completing treatment, compared to those who do not. One of the biggest reasons going through detox improves one's chances of a full recovery is because many people turn back to alcohol when the symptoms of withdrawal become too strong. Professional detox services help to reduce these symptoms, making it easier for people to abstain from drinking. Another reason for relapsing is not receiving help for the underlying conditions fueling the alcohol abuse or addiction, and many professional detox facilities also provide psychological support.
Alcohol Withdrawal Symptoms
Alcohol withdrawal can last as little as two days to as long as two weeks, and in rare cases even longer. The severity of withdrawal depends on several factors, including the length of alcohol dependency, the typical amount of alcohol consumed, the age and the overall health of the person. The onset of symptoms begins within 8 hours of the last drink of alcohol. Most people who detox from alcohol only experience mild to moderate symptoms for a period that lasts between 24 and 72 hours, although it may last for longer. These include:
- Nausea and vomiting
- Depression or anxiety
- Sweating or chills
- Mood Swings
- Difficulty thinking clearly
- Loss of appetite
- Clammy skin or a loss of pallor
- Rapid heart rate
These symptoms often do not lead to dangerous health consequences, and can be appeased with medication. However, there are some symptoms of alcohol withdrawal that can lead to serious medical complications. These more serious cases can come on suddenly, which is why it is important to have medical supervision during detox, especially for those with a long history of alcohol abuse or addiction.
More severe cases of alcohol withdrawal could lead to delusions, hallucinations, and seizures. The most dangerous complication of withdrawal is a condition known as delirium tremens (DT), which involves severe mental or nervous system changes that occur suddenly. If not treated correctly, it can lead to death.
Alcohol detox is the most dangerous substance for the body from which to withdrawal. Most cases do not have any serious medical complications. However, severe cases can lead to delirium tremens (DT), which can cause death. Even milder cases can become dangerous to a person's health in some circumstances. A person can become extremely dehydrated, especially if he or she vomits a lot and/or sweats profusely. In these cases, a person often will need to have an IV drip to rehydrate. If a person's health is already compromised, due to alcoholism or other medical conditions, withdrawal can also lead to serious medical complications. To be safe, it is recommended that a person detoxifies from alcohol under some form of medical supervision, which could include an outpatient clinic.
DT most commonly occurs in those with heavy drinking habits and those who already have a history of alcohol withdrawal. Only about 5 percent of people develop DT, but anyone at risk should be very careful during detox and have more comprehensive medical supervision. DT is most common in drinkers who have consumed 4-5 pints of wine, 7-8 pints of beer, or 1 pint of hard alcohol daily over a period of several months. Additionally, those who have abused alcohol or had alcoholism for more than 10 years also have a high risk of developing DT. The initial symptoms of DT typically arise around 48 to 96 hours after the last alcoholic drink, but it could occur as late as 7 to 10 days after the final drink. The symptoms can quickly worsen, so it is important to seek treatment right away. The symptoms include:
- Tremors in the hands or body
- Mental or cognitive function changes
- Irritability or agitation
- Disorientation or confusion
- A decrease in the attention span
- Delirium or hallucinations
- Excitement, restlessness, or fear
- Sleeping deeply, especially for more than a day
- Sudden changes in mood
- An increase in activity
- Fatigue or sleepiness
- Sensitivity to touch, sound or light
These symptoms may appear even if a person does not have DT. However, it is best to seek medical attention just in case.
The most dangerous consequence of DT is seizures. These typically occur within the first 12 to 48 hours after the last drink. They are typically grand mal seizure, also known as tonic-clonic seizures, which involve the whole body. These seizures can be dangerous, and may lead to injury and other serious consequences.
It is not known exactly what contributes to the development of DT, but experts speculate that alcohol's effect on the GABA receptors in the brain leads to a counterregulatory response when the body struggles to retain homeostasis. The receptors are down-regulated, and many excitatory neurotransmitters, such as glutamate, norepinephrine, dopamine, epinephrine and serotonin are up-regulated. This increases the tolerance to alcohol.
When alcohol is removed from the system, the down-regulated GABA receptors are insensitive to the normal amount of GABA, making it have no effect. This means that the sympathetic activation of GABA is unopposed, causing an adrenergic storm that can lead to many life-threatening effects including cardiac arrhythmia and stroke. Additionally, the up-regulated excitatory neurotransmitters create a sympathetic nervous system that is over-active and unopposed by GABA, and there are more of these neurotransmitters than normal. This causes the NMDA receptors to be up-regulated, which can lead to delirium and neurotoxicity.
Types of Alcohol Detox
There are two general categories of alcohol detox: natural and medical. Many people think of natural detox as cold turkey. In a natural withdrawal, a person stops drinking alcohol and allows the body to overcome the dependency on its own. This can be difficult, especially if a person experiences severe withdrawal symptoms. Those who undergo natural detox are at a higher risk of relapse, due to the strong temptation to drink in order to appease the symptoms. Natural detox also needs to be medically supervised to ensure no serious complications develop. A person with a long history of alcohol abuse, especially previous history of withdrawal, should discuss the potential consequences of natural detox with a medical professional prior to starting to ensure that all precautions are taken into account.
Some detox centers now use a natural IV detox, known as neurotransmitter restoration, that uses high quantities of vitamins and minerals to assist the body in overcoming its dependency upon alcohol and other substances. The main component of this therapy is NAD (nicotinamide adenine dinucleotide), a coenzyme necessary for cell metabolism. NAD is also transformed into vitamin B3, which stimulates the cells to be more active and helps with the recovery process. This helps to restore the neurotransmitters and detox the body, without medication and with minimal withdrawal symptoms. This form of treatment is relatively new, and only select detox facilities provide it.
Medical Detox uses medicine to appease the symptoms and slowly wean a person off of the alcohol dependency.
Medically assisted alcohol detox relies upon medications that have similar effects as alcohol, which prevents the withdrawal symptoms from appearing. The person takes the medication in increasingly lower doses to slowly wean off the medication, and alcohol, until finally the body no longer has a dependency upon alcohol. Other medications may also be used to treat certain symptoms that appear, such as nausea or headaches, as needed. The exact treatment protocol depends upon the patient, the history of withdrawal, the history of alcohol abuse, and the exhibiting symptoms.
The most common medication used for alcohol withdrawal is benzodiazepines. Common benzodiazepines include chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax). Benzodiazepines have been shown to prevent or treat the seizures and delirium associated with severe alcohol withdrawal, including DT. These agents work on the body similarly to alcohol, but they have a longer half-life. This provides a step-down process that allows a patient's body to overcome the effects of alcohol with minimal symptoms. One criticism of this method is that benzodiazepines are at risk of abuse as well, so a patient may be swapping one addiction for another. However, the doses tend to be low, and as long as a patient follows the prescription, the risk of abuse is minimal.
Another option for medication is carbamazepine, which is typically used only in those who have a history of withdrawal seizures. Clomethiazole also may be used to prevent delirium, but it has more side effects and a higher risk of abuse.
If there are complications of withdrawal, then the doctor may also prescribe beta blockers, clonidine, haloperidol, and phenytoin. These drugs treat the symptoms themselves, such as seizures, nausea, and headaches. Patients may also experience severe dehydration or nutritional losses, so they will be given an IV to restore their fluids.
Many people with alcohol problems suffer from a lack of B vitamins, especially thiamine (B1). Therefore, many detox centers will also provide patients with supplements to restore their B vitamins. Thiamine is an essential vitamin, which means that it must be obtained from the diet. It plays a role in the energy metabolism of the body and is essential to all the cells of the body. The B-vitamins are essential for a healthy brain, and the nervous system is especially dependent upon the vitamin, and sensitive to any deficiency. Deficiency can cause serious health problems.
Typically, a thiamine deficiency occurs in alcoholics due to poor nutrition and gastritis, two conditions for which alcoholics are at risk. Another reason alcoholics are deficient is that thiamine is used as a coenzyme during the metabolism of alcohol. A severe deficiency can cause Wernicke's encephalopathy and Karsakoff's syndrome. The symptoms of these disorders include ocular disturbances, unsteady stance and gait, and changes in mental state including dementia.
Oral supplements of thiamine are poorly absorbed, so the best way to treat a serious thiamine deficiency is to provide prophylactic treatment of high-potency B complex vitamins. There is a risk of anaphylaxis, so it should be administered under medical supervision with resuscitation facilities. In those who are generally healthy and well-nourished, an oral supplement can be taken.
In addition to the medication used to reduce the symptoms of withdrawal, some doctors prescribe certain medication to help a person abstain from drinking alcohol. The most common of this type of medication, and the oldest, is known as disulfiram (Antabuse). This medication interferes with the body's metabolism of alcohol. This causes the body to create a metabolite that causes nausea when alcohol is consumed, which deters people from consuming alcohol. It does have potentially severe side effects, including neurological conditions. Critics also complain that alcoholics merely stop taking the medication in order to consume alcohol.
Another medication typically used to help with alcohol addition is naltrexone (ReVia, Vivitrol). Naltrexone interferes with the pleasurable experience of drinking alcohol. A person can drink alcohol, but he or she will not receive the pleasurable effects. This has been shown to reduce the temptation or desire to drink alcohol, and even stop a person from drinking all together. It is also used in the treatment for other addictive substances, especially opiates.
Another option is acamprosate (Campral), which reduces the cravings for alcohol. The exact science behind it is unclear, but experts believe it balances the neurotransmitters, which reduces the cravings. It can also help with some symptoms of withdrawal, including mood swings, anxiety and sleep problems.
Some limited success has also been seen using some antidepressants for the treatment of alcohol addiction.
Where to go for Alcohol Detox
Alcohol detox is the first step in treatment for alcohol addiction. Most facilities will not accept patients to undergo psychotherapy and other treatment programs without having first undergone some type of detox. Some treatment facilities offer detox as the initial phase of their programs, while others refer prospective patients to nearby facilities to undergo detox and then enroll the patients in their treatment programs once the detox is complete.
There are several options for alcohol detox programs, including hospitalization, residential or outpatient facilities. Some facilities are dedicated detox programs, while other offer comprehensive treatment programs for alcohol addiction. Hospitalization or partial hospitalization takes place in a facility that has medical monitoring, often a hospital or other medical center. A patient might stay in the hospital full time, or might come in for intensive treatment during the day but spend nights in his or her own home. Those at a high risk of medical complications, especially DT, should undergo detox in a hospital setting.
Residential facilities do not have as much medical monitoring as a hospital. They often have doctors and nurses on staff who monitor a patient's detox, but the monitoring of the patient and the medical equipment on site will not be as extensive as in a hospital setting. The patient remains at the facility full time, undergoing intensive treatment during the day.
Outpatient detox is when a patient comes to a facility for the medication or other elements of the detox program, but undergoes the majority of the process at home. A doctor will still monitor the patient, but he or she will not have as much oversight as the other detox options.
Many facilities that offer detox in addition to other treatment methods will allow detox patients to take part in all treatment programs, once he or she is stable enough.
Detox is merely the first step in overcoming alcohol addiction or abuse. Once a person completes detox, it is important to undergo additional treatment. A person can choose to enter a rehab facility, undergo private counseling, or attend support groups, such as Alcoholics Anonymous. Extended medical care may also be necessary, depending on the health and well being of the person. Many programs combine detox with an extended care program. However, if the detox program only includes detox services, it is essential to search for additional support.
Even if the facility claims to treat alcoholism with a rapid detox cure, this is not the case. Alcoholism is a complex disease that involves various factors, including genetics, environment, psychological, emotional, and social. It takes more than just removing the alcohol out of the system and bringing the body back to homeostasis to overcome the disease. It takes lifelong maintenance to remain sober, so a person needs to have the knowledge of how to withstand cravings and temptation.
Detox is an essential first step in treatment; however, it must be followed by some form of additional treatment. Treatment for substance abuse typically includes psychotherapy and education.
By enrolling in a comprehensive treatment program after going through detox, a person has a much higher chance of remaining sober. The best programs have a holistic approach, teaching a patient healthy lifestyle approaches, stress relief techniques, coping mechanisms, emotional management, and psychotherapy for underlying and co-occurring conditions.
Alcohol abuse and addiction has a high risk of co-occurring with mental health conditions, especially depression and anxiety. If these conditions are not treated at the same time as the alcoholism, a person has a high risk of relapsing. Many people turn to alcohol to self-medicate mental health problems, or just numb strong emotions. They also use alcohol as a form of stress relief. If they do not learn healthy ways to manage emotions and stress, then they will have a harder time abstaining from drinking. A treatment program teaches coping mechanisms, healthy behavior patterns, and healthy stress relief.
Like detox, these programs are offered in various facilities and situations, including residential or intensive outpatient. Some people find the best support through a continuum of care, beginning with residential treatment, moving to intensive outpatient and then a sober living facility with aftercare support and support group meetings such as Alcoholics Anonymous.
The optimum treatment program depends on the individual situation; however, a combination of detox and some form of additional treatment is necessary to overcome alcohol abuse or addiction.