Alcohol Addiction & Rehab

The Stages Of Alcohol Withdrawal And Detox

The Stages Of Alcohol Withdrawal And Detox

Alcohol is a socially acceptable and readily available drug. As a result, almost everybody drinks or has tried an alcoholic drink at some point in their lives. This is confirmed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime.”

Alcohol is legally available to anyone over 21 in this country and the vast majority of people are able to consume it regularly and never experience any issues. In fact, some health professionals state that there could be some health benefits associated with drinking in moderation (one drink daily for women, two for men).

“It sounds like a mixed message: Drinking alcohol may offer some health benefits, especially for your heart. On the other hand, too much alcohol may increase your risk of health problems and damage your heart.”

The statistics on alcohol abuse, however, are quite shocking. They include the fact that:

• In 2013, some 16.6 million adults in this country had Alcohol Use Disorder (AUD).
• Around 33% of all emergency room visits are related to alcohol in some way.
• 10% of deaths between the ages of 20 and 64 are related to excess alcohol consumption.
• Alcohol is the 3rd leading preventable death cause in this country, with 88,000 fatalities each year.

What Happens When People Drink?

Alcohol increases dopamine levels in the brain so that people feel very nice. Mood is elevated, self-confidence increases, and inhibitions decrease. However, when the alcohol leaves the bloodstream, this stops. These alterations in the levels of dopamine can lead to the brain expecting alcohol to be present, which means it will stop producing its own dopamine unless the individual consumes alcohol. Over time, these individuals will develop a tolerance to alcohol and the brain will start to depend on it even more. When alcohol’s effects wear off, the individual may start to experience withdrawal symptoms that, in extreme cases, can be life-threatening.

The Side Effects of Alcohol Withdrawal

Withdrawal usually starts between six and 24 hours after a final drink, according to the American Family Physician.

“Approximately 2% to 9% of patients seen in a family physician’s office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of alcohol.”

Once they start to withdraw, there are three stages that someone can go through. Not everybody will experience each stage, as this depends on the level of abuse, the individual’s physiology, and various other external factors. The three stages are:

1. Mild, leading to heart palpitations, mood swings, foggy thinking, depression, tremors, fatigue, loss of appetite, abdominal pain, nausea and vomiting, insomnia, and anxiety.
2. Moderate, leading to increased mood swings, irritability, sweating, confusion, irregular heartbeat, and increased breathing, body temperature, and blood pressure.
3. Severe, which is known as delirium tremens (DT), leading to agitation, severe confusion, seizures, fever, hallucinations, and possibly coma and even death.

The way someone experiences withdrawal is unique for each person. There are many factors coming into play, including levels of stress, whether that individual used other substances, whether there are co-occurring disorders, and so on. However, because there is a possibility that individual can go through the most severe stage, which is DT that can be fatal, it is vital that proper support is offered and the individual does not go about it alone.

“Approximately 1 to 4% of hospitalized patients who have withdrawal delirium die; this rate could be reduced if an appropriate and timely diagnosis were made and symptoms were adequately treated.”

It is common for DT to start several days after detox and it can happen at any time. This is why close medical supervision is vital to recovery. Going “cold turkey” is therefore never recommended by the treatment community, as it can be life-threatening.

A Timeline of Detox

Just as there are different stages to detox and everybody experiences them in different ways, the timeline is different for everybody as well. However, the National Library of Medicine (NLM) has created an approximate timeline that most people will go through.

“Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 to 72 hours, but may go on for weeks.”

The timeline is as follows:

• Eight hours after final drink – withdrawal symptoms may start.
• 24 to 72 hours after final drink – the peak of withdrawal symptoms, with patients rapidly going through the second and third stage of withdrawal.
• Five to seven days after final drink – withdrawal symptoms become less intense.
• After one week – some side effects will continue, particularly psychological symptoms.

Under treatment, patients will be monitored during detox to make sure they are safe and stable. Medication may be provided to treat the symptoms, including benzodiazepines that help the body to relax. Medical professionals will monitor all vital signs, intervening when these drop below safe levels.

Sometimes, it is recommended that people slowly reduce their alcohol consumption rather than stopping all of a sudden. This must also be done in a medically supervised manner. This is generally recommended for those at increased risk of DT.

People with alcoholism are often malnourished and they have disrupted sleep patterns. Hence, a strong focus of detox will be on restoring appropriate nutritional levels. Many alcoholics have a vitamin B12 deficiency, which must be addressed.

“Some alcohol-dependent patients with megaloblastic anemia may respond to vitamin B12 treatment despite normal cobalamin serum levels; therefore in alcoholics caution is urged in the interpretation of these vitamin assays, because of possible functional vitamin B12 deficiency.”

It is also very important that those who have gone through detox are provided with proper support and aftercare. Due to the readily available and socially acceptable nature of their chosen drug, it is incredibly easy and common for people to relapse.

About the author

Dr. Michael Carlton, MD.

Leading addictionologist, Michael Carlton, M.D. has over 25 years of experience as a medical practitioner. He earned a bachelor’s degree in Mechanical Engineering and returned for his MD from the College of Medicine at the University of Arizona in 1990. He completed his dual residency in Internal Medicine and Pediatrics and his Fellowship in Toxicology at Good Samaritan Regional Medical Center and Phoenix Children’s Hospital.

He has published articles in the fields of toxicology and biomedicine, crafted articles for WebMD, and lectured to his peers on medication-assisted treatment. Dr. Carlton was a medical director of Community Bridges and medically supervised the medical detoxification of over 30,000 chemically dependent patients annually.

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