Before anyone can recover from substance use disorder, they must go through detox or withdrawal, meaning they have to stop using the substance until it has left their system.
Unfortunately, one of the main reasons that people with substance use disorders might avoid seeking alcohol rehab, or even just stop trying to stop on their own, is that detox or withdrawal can be painful. Fortunately, that pain can be managed.
What Is Detox?
Detoxification is a natural process by which the liver removes impurities from the body. At its simplest, all it takes is to stop using the substance plus time.
That’s sometimes easier said than done. Severe substance use disorder (SUD) can overtax the system, making detox painful due to cravings and other symptoms caused by withdrawal.
According to the American Society of Addiction Medicine, detox should be safe and humane, allowing clients to become drug-free while maintaining their dignity and preparing them for ongoing rehab treatment.
Alcohol is one of the most commonly used substances and is legal in most places for those aged 21 and older. One might conclude then that it is the safest or least harmful substance to abuse. However, alcohol is one of the few substances that can be as dangerous to quit as it is to continue using.
Detoxing is even potentially deadly, particularly with benzodiazepines (benzos) and alcohol. Managed withdrawal under medical observation or assistance (medication-assisted treatment or MAT) is safer, though not always necessary.
Actor Nelsan Ellis, best known for his role as Lafayette on HBO’s True Blood, died in 2017 of heart failure brought on by attempting to manage alcohol withdrawal on his own without medical assistance or monitoring.
What Is Alcohol Use Disorder?
Alcohol use disorder (AUD) encompasses what used to be called alcoholism.
One way to determine if someone has an AUD is to examine how many symptoms in a list of 11 symptoms they have experienced in the past year. Experiencing six or more of the symptoms is severe, but as few as two might mean that someone has a mild disorder.
The symptoms include being unable to control how much or how often one drinks, despite the negative consequences to one’s personal life or health. They also include feeling horrible when one is not drinking.
Not all drinking means that someone has an alcohol use disorder. One drink per day for women and two drinks per day for men is usually considered safe. Drinking more — eight drinks or more within a week for women, 15 or more for men — is considered drinking to excess and may mean an individual has a problem with alcohol.
Consuming several drinks in a short time — four or more in two hours for women, five for men — is called binge drinking, which can still be dangerous, but not necessarily a sign of an AUD.
What Is a Drink?
It’s worth reviewing what qualifies as a single drink. Size and what type of alcohol matters. Basically, it’s one ounce of alcohol, but different beverages possess different amounts of alcohol. The standard measure is:
- 1.5 ounces of distilled spirits or liquor such as gin, rum, or whiskey
- 5 ounces of wine
- 12 ounces of beer
If your drinks are substantially larger or smaller, take that into consideration.
Some people may be able to handle more alcohol or at least appear to handle it better, but the problem is that the human body develops tolerance.
The body becomes used to the effects of a certain level of alcohol and no longer feels the pleasant effects of euphoria. More drinks become necessary to feel the same buzz.
Worse, over time, the body comes to depend on that level of alcohol. That amount of alcohol becomes the new normal.
Without the accustomed amount of alcohol, the body will no longer function normally, which can affect the mind as well the body. To stop drinking alcohol abruptly (a practice known as going cold turkey) can throw the body into detox or withdrawal suddenly.
How Long Do Alcohol Detox Symptoms Last?
While sobriety is to be desired, sudden sobriety can be very painful, physically and psychologically.
The good news is that cold turkey detox only takes a few days or a couple of weeks at most. The bad news is that even that short period of time is long enough to kill you if you don’t take precautions. Different symptoms of alcohol withdrawal syndrome may begin at different stages of detox. Some may debut later, continue, or intensify: Two-to-six hours. These are mostly mild symptoms, though they may still be of concern and should not be ignored, such as: 12-to-24 hours. Hallucinations are some of the scariest symptoms because individuals cannot trust what they see, hear, or even touch. 48-to-72 hours. Delirium tremens (DTs). Not the experience of seeing pink elephants depicted in popular culture, delirium tremens or withdrawal delirium is a life-threatening medical emergency. In addition to hallucinations, there may be general confusion and fever. It affects those who drink very heavily — people who drink more than 10 standard drinks per day, every day for months or people who drink heavily for 10 years or more. Although the symptoms typically manifest within three days, they can take up to 10 days.
Alcohol Withdrawal Timeline
Different symptoms of alcohol withdrawal syndrome may begin at different stages of detox. Some may debut later, continue, or intensify:
Two-to-six hours. These are mostly mild symptoms, though they may still be of concern and should not be ignored, such as:
12-to-24 hours. Hallucinations are some of the scariest symptoms because individuals cannot trust what they see, hear, or even touch.
48-to-72 hours. Delirium tremens (DTs). Not the experience of seeing pink elephants depicted in popular culture, delirium tremens or withdrawal delirium is a life-threatening medical emergency. In addition to hallucinations, there may be general confusion and fever. It affects those who drink very heavily — people who drink more than 10 standard drinks per day, every day for months or people who drink heavily for 10 years or more. Although the symptoms typically manifest within three days, they can take up to 10 days.
Because of the symptoms and risks of detox for individuals who have been heavily drinking for a long time, sometimes addiction treatment professionals use medication-assisted treatment (MAT). In the past, professionals used alcohol during the detox process, gradually diminishing the amount the clients used until they were weaned off of the substance.
Now, prescriptions known as benzodiazepines (benzos) are the treatment of choice. Such medications include diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax).
While such drugs can be addictive in the long run, for the duration of MAT they are safe. They prevent the most serious symptoms of withdrawal such as seizures and delirium tremens as well as milder ones such as anxiety and insomnia.
In general, a regimen of benzodiazepines only lasts five days.
Other drugs may be helpful with alcohol withdrawal symptoms, but only as adjuncts to benzos. The antipsychotic drug haloperidol (Haldol), the beta blocker atenolol (Tenormin), the high blood pressure treatment clonidine (Catapres), and the anticonvulsant phenytoin (Dilantin) all have complications or are less effective at preventing seizures.
Remember, detox is only the first step towards recovery. If individuals stop there, there is a high probability that they will resume their alcohol use disorder.
Treatment for alcohol abuse must include behavioral therapy, group therapy, developing a non-enabling support structure, learning new habits, and an aftercare plan.
Detox is an important start. Just remember to follow through.
- aafp.org – Alcohol Withdrawal Syndrome
- washingtonpost.com – Nelsan Ellis Died of Alcohol Withdrawal
- niaaa.nih.gov – Alcohol Use Disorder
- webmd.com – Physical Signs and Other Symptoms of Alcoholism and Alcohol Abuse
- cdc.gov – Binge Drinking Is a Serious but Preventable Problem of Excess Alcohol Use
- niaaa.nih.gov – What Is a Standard Drink?
- webmd.com – What Is Alcohol Withdrawal?
- webmd.com – Hallucinations
- webmd.com – What Are Seizures? What Causes Them?
- ncbi.nlm.nih.gov– Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond
- medlineplus.gov– Delirium Tremens
- aafp.org – Outpatient Management of Alcohol Withdrawal Syndrome
Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.
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