What is alcohol withdrawal?
If you've ever struggled with alcoholism in the past, you've probably heard a thing or two about this uncomfortable and life-threatening step in recovery.
Maybe you've heard about the long list of withdrawal symptoms that might happen during detox. Or perhaps you know about how getting clean from alcohol can actually end up being deadly.
No matter where you're at in your understanding of alcohol withdrawal, it's important that you understand some of the fundamentals behind alcohol withdrawal: why this process happens, what are the symptoms, what are the risks, and how can you get through it in the end.
This comprehensive guide to withdrawal from alcohol will take you through the answers to these questions and more.
Because after all, understanding a problem is the first step to overcoming it.
As you know, alcohol withdrawals are the set of symptoms an addict suffers when they haven't had as much to drink as usual.
But why do these symptoms occur in the first place? And what's going on inside both your body and your mind when you go through alcohol withdrawals?
Let's dig a bit deeper.
Addiction to any substance is usually accompanied by a physical dependency. It's possible only to be psychologically addicted to a drug, but in most cases, the two often go hand in hand.
Now, when the body becomes physically dependent, it develops what's known as tolerance. The National Institute on Drug Abuse defines tolerance as:
when the person no longer responds to the drug in the way that person initially responded. Stated another way, it takes a higher dose of the drug to achieve the same level of response achieved initially.
The same thing happens with alcoholism. The more addicted to booze you become, the more you have to drink to get that same buzz.
This tolerance is caused by a host of physical changes in the body. Certain chemicals become stronger, neural pathways end up being used more often, and numerous other changes occur along the way.
Essentially, the body adapts to alcohol being in the bloodstream more frequently.
But when an alcoholic stops using alcohol abruptly, it can take some work for the body to readjust to functioning without the help of booze.
And as the body goes through this period of readjustment, those physical changes that required alcohol can cause all sorts of problems now that the substance is no longer in your blood.
Withdrawal symptoms are the embodiment of those problems. And they can be uncomfortable, overwhelming, and (at times) incredibly dangerous.
It may surprise you to learn that alcohol addiction is actually one of the harder drugs to detox from. Some former addicts have even described such heavy hitters like cocaine and crack as having more forgiving symptoms of withdrawal.
Physical symptoms can be brutal, psychological ones can be haunting, and without the proper support during your withdrawal, you can end up suffering from a range of troublesome complications.
However, others with a longer history of alcohol dependency may develop acute alcohol withdrawal. This condition comes with a long list of side effects that can be particularly brutal to get through on your own.
Beyond these symptoms, it's also possible for detoxing alcoholics to experience a variety of complications. Dehydration, malnutrition, and the threat of self-harm are all very real possibilities without proper clinical care.
As such, partnering with a professional treatment center is critical to your safety during this dangerous time.
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It might surprise you to learn that in the realm of addictive substances, alcohol actually has one of the deadliest withdrawal syndromes you can experience.
That's right - deadlier than crystal meth, deadlier than crack/cocaine, and deadlier than PCP.
In fact, there are only three drugs that have directly life-threatening withdrawal symptoms: alcohol, benzodiazepines, and opioids (to a certain extent).
But how is this drug (which is 100% legal, used by more than 86% of the U.S. population, and can even be bought in gas stations) more dangerous to detox from than other drugs which are actually illegal?
It all comes down to how alcohol interacts with a chemical in the brain called GABA. More technically known as gamma-aminobutyric acid, GABA is the mind's main inhibitory neurotransmitter and is responsible for calming down activity.
However, since our bodies prefer to be in a state of balance and alcohol throws that balance off, our mind counteracts the stronger GABA by making its excitatory chemicals even stronger.
This increase in strength of excitatory chemicals is one of the reasons why you develop tolerance over time.
The problem during alcohol withdrawal comes from the fact that when you stop drinking, your GABA quickly returns to normal - but the excitatory chemicals stay just as strong. And since GABA is so much weaker than it was, these excitatory chemicals set off a flurry of electrical activity in the brain.
And if the withdrawal is particularly severe, it can cause deadly reactions like grand mal seizures, delirium tremens, and other terrifying symptoms.
As you can see, then, going through withdrawal from alcohol without proper care can end up costing you your life.
One of the most frightening symptoms of alcoholism detox is the risk of developing seizures.
As we saw, seizures are caused by an overpowered excitatory chemical and a particularly weakened inhibitory chemical called GABA.
With a stronger excitatory system, the brain becomes extremely overactive and electrical signals spread through your neural pathways irregularly.
Think of it as a short circuit in the brain - just like how a short can cause a current to run along an unintended path, a seizure involves the disorganized spread of electricity to nerves that control muscles, breathing, and a variety of other functions.
As a result of this electrical chaos, you may experience the following symptoms as provided by the Mayo Clinic:
Grand mal seizures may also result in coma, respiratory failure, and even death.
According to the NIAAA, such seizures may occur in more than 5% of patients who don't receive professional-grade treatment.
What's more, over 90% of these seizures occur within the first 48 hours after your last drink. And that means it's vital to your safety that you find professional detox to get you through the withdrawal process.
That being said, some seizures can actually occur as far out as 20 days after quitting. Continuing your recovery after detox with a rehabilitation program, then, will not only help reduce the risk of relapse, it may even save your life!
Also known as delirium tremens, the DTs is a clinical syndrome that may occur during alcohol withdrawal. It's brought on by the same imbalance in excitatory and inhibitory chemicals that may end up causing seizures.
According to MedlinePlus, delirium tremens occurs:
most often in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 to 5 pints (1.8 to 2.4 liters) of wine, 7 to 8 pints (3.3 to 3.8 liters) of beer, or 1 pint (1/2 liter) of "hard" alcohol every day for several months. Delirium tremens also commonly affects people who have used alcohol for more than 10 years
This serious complication of alcohol withdrawal is characterized by a range of symptoms, some of which can be quite terrifying to witness firsthand. These symptoms include:
Seizures are also common in patients who fall prey to delirium tremens. As such, the mortality rate of alcoholics who develop the DTs can be quite high - at around 5% to 25% according to some estimates.
The video below demonstrates just how disorienting the DTs can be. Luckily, he had the proper medical help to ensure his safety throughout the process.
As you can see, the patient seems almost completely debilitated and is in a state of stupor. What the video doesn't show, however, is the extent of the hallucinations and restlessness that are so common during this syndrome.
Another aspect of withdrawal from alcohol that makes it particularly dangerous is what's known as the Kindling Effect.
A phenomenon first documented in the late 60s, the Kindling Effect refers to the tendency for alcohol withdrawals to become increasingly severe after each detoxification.
For example, if an alcoholic goes through withdrawal for the first time, they may experience relatively mild symptoms - maybe tremors, slight anxiety, some nausea, etc.
However, if that same person has gone through several attempts at quitting already and they try to detox, they have a significantly higher risk of developing more severe symptoms of acute alcohol withdrawal like delirium tremens or deadly grand mal seizures.
Much of the Kindling Effect has to do with alcohol's effect on GABA and the excitatory neurotransmitters in the brain. Over time, the neural systems that are activated by these chemicals become more vulnerable to their influence.
And as a result, the imbalance between these two chemicals leads to even more severe effects.
In addition to the heightened risk of developing delirium tremens or seizures, the Kindling Effect may also apply to certain types of brain damage. According to the NIAAA, the Kindling Effect may play a role in reducing cognitive performance and even damaging hormonal systems over time.
More research needs to be done on the impacts of kindling when it comes to alcohol withdrawal, but there's one thing that remains quite clear today - you should always try to get sober using only evidence-based treatment methods that are proven to work.
With each and every relapse, you're only putting your safety more at risk than before.
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Also known as "wet brain," Wernicke-Korsakoff syndrome is just one of the numerous health problems that alcoholism and unsupervised detox can cause.
This condition isn't a direct alcohol withdrawal symptom but rather is a thiamine nutritional deficiency caused by alcoholism. In fact, as many as 8 out of 10 alcoholics are deficient in thiamine.
You may be tempted to believe that a disease caused simply by a poor diet and nutritional deficiency would be a minor problem. However, Wernicke-Korsakoff syndrome can end up being quite debilitating.
Besides the risk of death and coma during the earlier stages, the severe memory impairment can make it almost impossible to live a normal life.
For a great demonstration of just what this disease is really like, have a look at this documentary segment on Wernicke-Korsakoff syndrome showing an interview with a sufferer of this disorder (happens at around 2:25 minutes in).
Once again, with proper medical treatment during detoxification, you may be able to avoid developing this tragic disorder.
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One of the most common questions among recovering alcoholics is how long does alcohol withdrawal last? And the short answer is - it depends.
Just like how addiction, in general, affects everyone on a different level, your unique withdrawal process isn't going to be the same as everyone else's. Maybe you'll start feeling back to your old self within just a few days. Or perhaps it will take you weeks of treatment to get over the symptoms.
It's different for everyone.
That being said, acute alcohol withdrawal generally lasts around 5 to 7 days total. During that time, you'll go through a range of symptoms.
When it comes to the risk of seizures, the first 48 hours after your last drink (Stages 1 and 2) are the most dangerous (though they can still occur as far out as 20 days later).
Added to that, the overactivity, confusion, and altered sense perceptions of delirium tremens will generally begin 2 to 5 days into your detoxification.
Generally, withdrawal from alcohol only lasts around 5 to 7 days. However, some individuals may experience especially protracted symptoms that can end up lasting for weeks, months, and even years.
This condition is what's known as Post-Acute Withdrawal Syndrome, better known as PAWS. For patients that suffer from PAWS, they may experience a wide range of symptoms for significantly longer than most recovering alcoholics.
Researchers are still trying to understand this unique disorder, but with proper treatment from a professional addiction treatment center, it is possible to recover.
The short answer here is YES - it most certainly is.
And unfortunately, many people think that they can get clean from their alcoholism on their own. However, the truth is that professional alcohol detox and rehabilitation are by far the best ways to ensure your long-term sobriety.
As you move through the alcoholism recovery process, you'll likely be given a number of medications to help manage your symptoms of withdrawal and keep you from relapsing.
Many of these medications will be used to treat specific symptoms like anxiety, tremors, insomnia, and more.
Below are some of the most common ones you'll likely encounter during your alcohol detoxification program. It's worth noting, however, that some of these medications can be quite addictive on their own when used improperly.
Consequently, it's important that you take these medications with caution. You just may end up developing a new addiction in place of your old one if you aren't careful.
Benzodiazepines - This class of drug includes anti-anxiety medications like Xanax and Ativan. They can end up reducing the severity of tremors, confusion, anxiety, and more. Added to that, these drugs enhance the effectiveness of GABA just like alcohol. And that means with benzodiazepines, you'll be less likely to experience severe complications like seizures and delirium tremens.
However, these drugs are notoriously addictive, so they should only be taken for a short duration. Plus, benzos actually have what is considered to be the most painful withdrawal syndrome out of any other drug including illicit substances like heroin!
Tegretol - Like benzodiazepines, Tegretol can also be quite beneficial when it comes to treating the harmful withdrawal symptoms associated with alcohol withdrawal. This drug is powerful anticonvulsant that can make alcohol detox much safer, but it also isn't as addictive as benzodiazepines.
Antipsychotics - For especially severe cases of alcohol withdrawal, you may be prescribed a variety of antipsychotics to help cut down on hallucinations and general anxiety as well. These psychological symptoms can not only be particularly disturbing, but they can also make it much harder to keep the benefits of sobriety in perspective as well.
Beta-blockers - A safe and effective go-to for treating the high blood pressure that comes with alcohol withdrawal, beta blockers are a common addition to almost any alcohol withdrawal medication regimen.
Clonidine - Used for controlling both blood pressure and the symptoms of attention deficit hyperactivity disorder (ADHD), Clonidine is particularly useful in reducing the risk of complications during alcohol withdrawal caused by irregular blood pressure.
Like many of the other drugs used in treating alcohol withdrawal, though, clonidine can be addictive.
Dilantin - Like other anticonvulsants, Dilantin works by decreasing the amount of abnormal electrical activity going on in the brain during detoxification - and that makes it quite useful when it comes to getting through withdrawal from alcohol.
Gabapentin - Used primarily to treat seizures during alcohol withdrawal, gabapentin (sold under the brand name Neurontin) can also help reduce the severity of other symptoms as well. That's because gabapentin actually decreases the release of excitatory neurotransmitters. And since most alcohol withdrawals are caused by an abundance of these neurotransmitters, these symptoms become much more manageable.
Like benzodiazepines, though, gabapentin can be quite addictive on its own. So, use it with care.
While the drugs above are effective at helping addicts overcome the uncomfortable symptoms of withdrawal, they don't necessarily treat the symptoms of alcohol dependency itself.
However, there are a number of FDA-approved medications that can make it easier to withstand the lure of alcohol during recovery. And when they're combined with a comprehensive relapse prevention plan, your chances at achieving long-term sobriety will be much higher than trying to abstain on your own.
Disulfiram (Antabuse) - One of the oldest treatments for alcoholism (approved by the FDA in 1951), Antabuse is a psychological deterrent from returning to alcohol during recovery.
This unique compound actually inhibits your metabolism of alcohol. As a result, someone on Antabuse who consumes alcohol quickly becomes quite ill.
Severely uncomfortable symptoms can appear in just a few minutes and in many cases, the discomfort that results are enough to keep alcoholics from drinking at all.
Some of these symptoms include:
Antabuse is widely available and is also one of the cheapest alcohol dependency medications available.
While it's important to discuss with a doctor whether or not Antabuse is right for you, many people have found that it's incredibly helpful in limiting their compulsions to drink. Below is a testimonial from just one problem drinker that turned their life around with the help of disulfiram.
"This drug literally saved my life. I had a routine where after work every day I would go to the liquor store, get a 40oz and knock it back, before heading to the bar. I did this for years. When I finally hit a wall (it's a long story) I saw a few different healthcare professionals, one of whom was a psychiatrist and he prescribed me Antabuse. He explained it to me very well, and asked me if I would try it and I agreed. The thing about it is, this drug forces you to change your habits. It gives you the time you need to think things through and make different decisions. While I was taking Antabuse I had to take the time and thought required to figure out other things to do with my time. It was a process. IT WORKED. Sober 9yrs."
- Chris S. via Drugs.com
Acamprosate (Campral) - Much of the cravings and withdrawal symptoms that come from alcohol cessation have to do with an imbalance of the neurotransmitters GABA and glutamate.
In some patients, taking Acamprosate can help restore that balance so that your cravings, your withdrawals, and your drive to consume alcohol at all may be able to disappear completely.
While this drug certainly sounds like a cure for alcoholism, this certainly is not a miracle drug. Just like most other medications for addiction, Acamprosate is only effective when it's used as part of a complete recovery program. And that means maintaining psychosocial support and active avoidance of alcohol consumption.
That being said, Acamprosate can be a real life changer for some people.
Below is a success story of an Acamprosate user who used this medication to overcome their long-term alcoholism.
"I had been a heavy drinker ever since I was about 19 or 20. I would drink pretty much any alcohol - to extreme every day. In the end I was drinking around 2 litres of port each day. Sometimes also wine, champagne, beer and/or spirits. Anything really, to excess. I'm now 59 & have been alcohol-free for almost 2 years & no longer have any desire whatsoever to drink, thanks to Campralů I honestly can't recommend it highly enough. I am no longer a dying alcoholic. My liver has returned from being just pre-cirrhosis and inches away from liver failure back to completely 100% healthy and normal. Good luck & I hope this helps others who are caught up in that alcohol-dependent nightmare. :) xxx"
- RettySwee via Drugs.com
This unique compound actually binds to opioid receptors and blocks any other chemicals from activating them. And that means getting buzzed off of opioids or alcohol is incredibly hard to do.
As a result, alcoholics and opioid addicts can abuse their drug of choice all they want - they still won't be able to get high.
And like the other medications used for treating alcohol dependence, naltrexone is not addictive at all.
It comes in pill form as well as a once-a-month injection, though it can be quite expensive.
With proper use of naltrexone, it is possible to make alcohol seem far less appealing and thus reduce the risk of relapsing back into alcoholism. Just have a look at the testimonial below of one patient who was driven to tears of joy thanks to naltrexone.
"I have only had this drug for a few weeks now. I cannot even believe the difference it made the very first time I took it. I took about an hour before I went down for a happy hour event. I grabbed a glass of wine and fully expected it to feel the same way it always does which is a nice warm glowy feeling as I drink it. Instead it tasted like cardboard and suddenly I didn't want it. I was so floored and amazed at the difference it made I had tears of joy! Tears!! I have never in all of my life felt like that... This medication has made it possible for me to have control finally over something I never thought I would have control over !!!"
- Alaskanbabe via Drugs.com
Medications like those above can be hugely beneficial for addicts and may even end up changing their lives forever.
The video below shows how one of these drugs, naltrexone, saved the life of successful actress Claudia Christian. This event was filmed at TEDx in London and is an inspiring tale of overcoming one of the most powerful addictions.
This might sound surprising, but alcoholism treatment is cheaper than it's ever been.
In fact, according to data collected by SAMHSA, out of pocket costs for addiction treatment have actually shrunk over time. In 1986, 13% of all substance use disorder treatment spending came from out-of-pocket payments. And in 2020, those same payments are predicted to make up 9% of all expenditures.
The takeaway here is that out-of-pocket costs are actually going down relative to total costs. And that's good news for anyone struggling with alcohol addiction.
But even more surprising is the fact that federally-funded insurance programs are covering more and more of total treatment costs.
The same SAMHSA data shows that just 9% of treatment spending came from Medicaid in 1986. But with all the changes in healthcare legislature happening today, a whopping 28% of treatment spending is expected to come from such government programs.
It isn't just federal health insurance that's covering more either. In fact, the changes dictated by the Affordable Care Act now actually require health insurance providers to cover some form of addiction treatment.
Whether it's inpatient, outpatient, or hospital treatment that's covered depends on the individual providers. That's why it's important to verify your insurance before partnering with any treatment center.
And don't forget to make sure you have an in-network insurance provider as well.
Ultimately, though, many recovering addicts end up being charged little more than a copay and may not even be left with a bill at all!
And this is especially welcome news given that almost 1 out of 3 people who felt they needed treatment didn't get it due to costs alone according to the 2016 National Survey on Drug Use and Health from SAMHSA.
Beyond that, you'll also need to take into account how much your insurance provider is willing to contribute to your final treatment costs.
As such, accurately estimating your particular expenses for treatment can be tough, if not impossible, to do.
Withdrawal from alcohol can be a tough phase of recovery to get through on your own. Even if you can withstand the pain of the physical symptoms and the anguish of the psychological ones, you still have to deal with the potentially deadly complications.
But with professional help from an alcoholism treatment center on your side, you can be sure that your withdrawals will be far easier to bear. And beyond that, you'll never have to worry about whether or not your safety is at risk.
At Northpoint Recovery, we take great pride in offering the best detox and rehabilitation services in the area. Our Boise, Idaho facility is clean, comfortable, and offers every amenity you'll need to make your recovery at seamless as possible.
And with a high staff-to-patient ratio and nationally accredited programs, you can rest assured you'll be in caring and qualified hands.
You don't have to suffer through alcohol withdrawals in order to attain sobriety. We can help.