Alcohol Detox

Drinking large quantities of alcohol over long periods of time can lead to critical, and even life-threatening, health issues, chronic disease and other serious problems including alcohol use disorder. Between the years 2011 to 2015, excessive alcohol consumption caused nearly 95,000 deaths annually in the U.S., shortening their lives by an average of 29 years.1 These deaths, which were caused by excessive alcohol consumption over a long period of time, resulted from issues such as liver disease, heart disease and breast cancer.2 Even today among working-age adults 20 – 64 years of age, excessive alcohol use is responsible for 1 in 10 deaths.2

Approximately 70% of all U.S. citizens have consumed alcohol within the past year and nearly 55% in the past month.3 Among these individuals, more than 65 million currently take part in binge drinking behavior.4 An estimated 17 million Americans struggle with problematic alcohol use which is also referred to as alcohol use disorder (AUD).

Alcohol abuse, however, is not limited to adults; teenagers abuse alcohol as well. Teen statistics5 in the U.S. show that:

  • By the age of 15, almost 30% have had at least one alcoholic beverage
  • By the age of 18, the percentage increases to 58%
  • More than four million teens admitted to binge drinking during the previous month

Problematic and excessive alcohol use often leads to alcohol dependence. When someone who is alcohol dependent significantly reduces their intake or suddenly stops drinking altogether, withdrawal — also referred to as alcohol withdrawal syndrome (AWS) – begins to take place. With AWS, a potentially distressing combination of emotional and physical symptoms may happen. Some AWS symptoms can be life-threatening.  AWS is one of several criteria used to diagnose AUD.6

At Harmony Place, you’ll receive the support and medical expertise you need to safely and successfully navigate alcohol withdrawal and detoxification. Whether you’re looking for treatment options for yourself or someone you care about, we’re here for you. To learn more about our holistic treatment options or to enter our treatment program, communicate with us via email or call us at 1 (855) 652-9048 to speak with an admissions counselor.

Alcohol Withdrawal Syndrome (AWS)

Someone who drinks excessively and for long periods of time often becomes alcohol dependent. A diagnosis of alcohol dependence is given when one or more of the following criteria is met within a one-year time period: 6

  • Increased tolerance
  • Presence of withdrawal symptoms
  • Alcohol consumption that takes place over longer periods of time and in greater amounts than intended
  • Large amounts of time and effort are spent ensuring alcohol availability, in the act of consuming alcohol, and overcoming/recovering from the negative effects of alcohol use (e.g. hangover)
  • Alcohol dependence/use leads to reduced participation in or abstinence from social, recreational and occupational activities
  • Persistent desire and/or attempts to decrease or stop drinking are unsuccessful
  • Despite the awareness that alcohol consumption causes or intensifies persistent physical or psychological problems, alcohol use continues

When someone who is dependent on alcohol significantly decreases the amount of alcohol they consume or suddenly quits consuming alcohol altogether, AWS may develop within a few hours to several days following the cessation of consumption.7

Although the extent of symptoms varies from one individual to the next, more than 80% of AUD patients experience withdrawal following hospitalization.7

The brain has a precise and delicate balance of chemicals called neurotransmitters. Experts believe AWS results when large quantities of alcohol trigger changes in brain chemistry.8 Alcohol consumption disrupts this balance; and with long-term heavy drinking, the brain begins to compensate for these changes, leading to long-term chemical alterations that allow the brain to function normally even in the presence of alcohol.9

When someone with substantial alcohol dependence abruptly stops drinking, the brain and nervous system experience fluctuations which may lead to:8,10

  • Irritability
  • Agitation
  • Anxiety
  • Nausea/vomiting
  • Upset stomach
  • Insomnia
  • Tremors
  • Seizures

Some individuals experience more serious symptoms which may include:10

  • Severe mental confusion
  • Hallucinations
  • High fevers
  • Grand mal seizures

Alcohol withdrawal accompanied by severe and/or complicated symptoms can quickly become life-threatening, requiring close medical supervision to monitor symptoms and to administer medications (e.g. benzodiazepines) to reduce seizures.10 Medical detox, such as that offered at Harmony Place, ensures that alcohol-dependent patients are as comfortable and safe as possible during detox and withdrawal. Medical detox also prepares an individual for recovery work and rehabilitation.8

The heavier the consumption of alcohol, the more likely alcohol withdrawal will occur. Adolescents and teenagers, as well as adults, are at risk of alcohol withdrawal.5 Withdrawal symptoms can range from mild insomnia to severe and life-threatening symptoms such as delirium tremens (DTs).11 Certain factors affect the severity and character of alcohol withdrawal. These include:8

  • Underlying psychiatric and/or medical conditions
  • Duration of alcohol abuse
  • Consumption amounts/quantities
  • Time since the last consumption of alcohol
  • Previous alcohol withdrawal complications (e.g. seizures)

Stages of Alcohol Withdrawal

Alcohol withdrawal symptoms will vary from one individual to the next. The level of physiological alcohol dependence determines the severity of alcohol withdrawal.

The three potential stages of alcohol withdrawal are:12

  • During stage 1, symptoms are generally mild and may include insomnia, heart palpitations, anxiety, headache, gastrointestinal disturbances and hand tremors.
  • During stage 2, symptoms become moderate. In addition to stage 1 symptoms, additional symptoms may occur including confusion, increased heart rate, increased blood pressure, rapid abnormal breathing and mild hyperthermia.
  • During stage 3, withdrawal symptoms become severe. In addition to the symptoms experienced during stages 1 and 2, the patient may also experience impaired attention, auditory and visual hallucinations, disorientation and seizures. Without healthcare intervention, the progression between stages 2 and 3 can occur rapidly.12

Although many physical symptoms and signs of withdrawal generally subside within a few days, psychological symptoms (e.g. depression, anxiety and agitation) may continue for long periods of time after alcohol consumption has ceased.13 The length of time it takes for someone to progress through these stages varies from person to person and is based on multiple factors which include:8

  • Underlying psychiatric and/or medical conditions
  • Duration of alcohol abuse
  • Consumption amounts/quantities
  • Time since the last consumption of alcohol
  • Previous alcohol withdrawal complications (e.g. seizures)

A generic alcohol detox timeline would look something like this:8,14

  • Approximately 6-12 hours after the last consumption of alcohol, mild early withdrawal symptoms may ensue. These symptoms can include stomach upset, mild anxiety, headache, small tremors and insomnia.
  • By the 24-hour mark, some individuals begin to experience hallucinations – auditory, visual and tactile.
  • Somewhere between 24 and 72 hours, many withdrawal symptoms have climaxed and begin to level off. Some symptoms, however, typically psychological, may continue for weeks or longer. The risk of seizure is the greatest beginning 24 hours after the last consumption of alcohol and lasting for the next 24 hours. During this period, close monitoring and seizure prophylaxis is important. Between 48 and 72 hours following the last alcohol consumption, withdrawal delirium (i.e. delirium tremens) may be experienced.

On occasion, although rarely, some individuals experience a more arduous time with withdrawal, having long-lasting withdrawal-related symptoms such as fatigue, mood changes and sleep disturbances which may continue for months.8 It should be noted, however, most individuals who receive proper withdrawal management services and medical detox generally experience a full recovery.14

Delirium Tremens

Someone who is alcohol-dependent may develop delirium tremens (DTs), also referred to as the “shakes,” within 96 hours of the last consumption of alcohol; however, DTs may also occur later. Left untreated, symptoms of DTs can escalate quickly. Symptoms include:15

  • Severe and sudden onset confusion (i.e. delirium)
  • Hallucinations
  • Agitation
  • Irritability
  • Sudden mood changes
  • Body tremors
  • Fatigue/stupor
  • Increased sensitivity to stimuli (e.g. touch, sound, light)
  • Increased fear or excitement
  • Seizures

It should be noted that seizures may develop in the absence of any other symptoms associated with DTs.15

Delirium tremens is a very severe complication of alcohol withdrawal and can become life-threatening.15 DTs can be fatal, especially when unmanaged; therefore immediate medical treatment should be sought if you or someone you know is experiencing symptoms of DTs.15

Medically supervised treatment and supportive care during withdrawal may involve:10

  • Medications to control seizures and reduce the risk of additional complications (e.g. benzodiazepines)
  • Comprehensive laboratory evaluation
  • IV fluids
  • Vigilant mental status evaluations
  • Frequent checks of vital signs
  • Adequate nutrition

Even with appropriate treatment, DTs can be fatal in 5-15% of cases. The percentages are closer to 5% with modern ICU management.16 The two most common causes of death in patients experiencing DTs are cardiac arrhythmias and respiratory failure.16 Before modern treatments, which include pharmacotherapy and ICU care, the mortality rate for patients experiencing DTs was as high as 35%.16

Medically Supervised Alcohol Withdrawal and Detoxification

For those with a significant dependence on alcohol, quitting can be a challenge. Not only is it difficult to change the habits and compulsive patterns of alcohol use/abuse caused by cravings, but the detox cycle also causes withdrawal symptoms that are unpleasant and can be life-threatening. 

This is where medical detox comes in. Medical detox that takes place before treatment or rehabilitation minimizes the most severe and life-threatening complications of alcohol withdrawal (e.g. DTs and seizures). Due to the risks associated with alcohol detoxification, someone should never attempt to undergo alcohol detox on their own. Supervised medical detox is advised, where a doctor and healthcare professionals create a customized plan of treatment and prescribe/monitor any medical interventions required for appropriate withdrawal management.12 A medical detox program, such as the one offered at Harmony Place, provides supportive care, close monitoring, and, if needed, medical intervention to reduce the risk of painful or life-threatening withdrawal symptoms.

At the beginning of the detox treatment, patients are fully evaluated to determine the presence of any other medical and/or mental health conditions. To minimize the risks of certain complications such as DTs and seizures, patients receive continual supervision throughout their stay to ensure adequate management of withdrawal symptoms.8 During medical detox, the emotional and medical needs of patients are continually monitored and corresponding adjustments are made to manage symptoms. Medications — benzodiazepines such as chlordiazepoxide or diazepam — may be prescribed for seizure prevention and to manage other alcohol detox symptoms.7,17

The length of detox varies from person to person, depending on the quantity, frequency and duration of previous alcohol use/abuse.

For individuals with co-occurring medical and/or psychological disorders, effectual withdrawal management is of particular importance.17 If you or someone you care about requires alcohol withdrawal treatment, Harmony Place has state-of-the-art medical detox and alcohol withdrawal treatment programs, as well as the ability to provide treatment for co-occurring substance abuse and mental health conditions.

Ongoing Support and Treatment after Detox

Detoxification is only the first step in the rehabilitation process and does not negate the need for comprehensive rehabilitation services. Ongoing recovery support is essential to achieve long-term recovery.8 Options for ongoing recovery support include: 8

The level of involvement in ongoing recovery support to successfully maintain sobriety varies from one individual to the next. For example, some individuals require daily attendance to AA meetings, whereas others can maintain sobriety with weekly attendance. Some may even need to attend multiple meetings daily, especially during the early days of sobriety or when going through difficult times. Some individuals can maintain their sobriety utilizing one of the above options, while others may need to take advantage of several of them to maintain sobriety.

At Harmony Place, we offer holistic treatment options to help you or someone you care about overcome alcohol dependence and addiction. We provide the support and medical expertise needed to safely and successfully navigate alcohol withdrawal/detoxification. Using holistic treatments like yoga and acupuncture, we work with you to customize a plan of care that fits your specific needs and goals, helping you to make positive changes and achieve long-term abstinence. To learn more about our holistic treatment options or to enter our treatment program, email us or call us at 1 (855) 652-9048 to speak with an admissions counselor.

Sources:

1Centers for Disease Control and Prevention. Alcohol Use and Your Health.

2Centers for Disease Control and Prevention. One in 10 deaths among working-age adults due to excessive drinking.

3National Institute on Alcohol Abuse and Alcoholism. Alcohol Facts and Statistics.

4Substance Abuse and Mental Health Services Administration. (2019). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.

5National Institute on Alcohol Abuse and Alcoholism. Underage Drinking.

6Diagnostic and Statistical Manual, 4th Edition, of the American Psychiatric Association, (DSM-IV, 1994).

7American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

8Bayard M, McIntyre J, Hill KR, Woodside J Jr. (2004) Alcohol withdrawal syndromeAm Fam Physician. 69(6):1443-1450.

9National Institute on Alcohol Abuse and Alcoholism. Neuroscience: Pathways to Alcohol Dependence

10Patel, P. (2016). Alcohol withdrawal syndrome in medical patientsCleveland Clinic Journal of Medicine83(1), 67.

11National Institute on Alcohol Abuse and Alcoholism. Introduction to Alcohol Withdrawal

12Muncie Jr., H. L., Yasinian, Y., & Oge, L. K. (2013). Outpatient management of alcohol withdrawal syndrome. American Family Physician, 88(9), 589-595.

13National Institute on Alcohol Abuse and Alcoholism. Alcohol Dependence, Withdrawal and Relapse

14National Library of Medicine. (2020). Alcohol withdrawal.

15National Library of Medicine. (2019). Delirium tremens.

Medscape. What is the mortality rate for delirium tremens (DTs)?

PsychCentral. Alcohol Use Disorder: Medical Treatment

Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.