Substance Use

Alcohol Withdrawal

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Alcohol Withdrawal Symptoms, Timeline & Detox Treatment Options

According to the National Institute on Alcohol Abuse and Alcoholism, in 2019, nearly 15 million people ages 12 and older had alcohol use disorder.

If you or your loved one struggles with alcohol, the recovery process can be daunting. However, not seeking the treatment you need could be dangerous. Approximately 18.5% of emergency department visits are related to alcohol, making alcohol the third-leading preventable cause of death in the United States. 

If you would like help to overcome your struggles with alcohol use disorder, alcohol withdrawal and detox is the first step. Following a period of excessive alcohol use, users often experience alcohol withdrawal syndrome. This process can be uncomfortable, but it can also cause potentially life-threatening complications. That’s why it’s not recommended to go through the withdrawal process without medical supervision. 

What Are the Symptoms of Alcohol Withdrawal?

The symptoms of alcohol withdrawal were studied as early as 400 B.C. Hippocrates recorded the first known clinical picture of alcohol withdrawal. He wrote that if a patient is “in the prime of life and if from drinking he has trembling hands,” it may well be the case that the patient is showing withdrawal signs and symptoms.

Although the symptoms are well-established, alcohol withdrawal remains underrecognized and undertreated to this day. Symptoms can begin even if an individual still has significant blood alcohol concentrations. 

Withdrawal symptoms are uncomfortable. However, high intoxication levels increase your risk of early death, which is a daily occurrence for many. These are the symptoms of intoxication that develop based on blood alcohol concentrations, although this can vary greatly depending on tolerance level. The Substance Abuse and Mental Health Services Administration reports that blood alcohol concentrations correspond with clinical signs. 

  • 20-100 mg – Reduced coordination, mood changes, impairment
  • 101-200 mg – Speech impairment, reduced coordination, impaired thinking 
  • 201-300 mg – Memory blackouts, vomiting, impaired thinking and memory, reduced alertness 
  • 301-400 mg – Excessive sleepiness, amnesia, worsening of symptoms above 
  • 401-800 mg – Dangerous decreases in temperature, blood pressure, and pulse, increasing the risk of death or coma

The symptoms of alcohol withdrawal can cause significant illness and death, including delirium tremens (DTs) and seizures. 

The entire cluster of symptoms is known as acute alcohol withdrawal (AW). Although some individuals experience mild symptoms, the events and disease processes that accompany AW can be life-threatening. 

The symptoms associated with alcohol withdrawal can begin as early as six hours following the initial decline from peak intoxication.

The initial symptoms include:

  • Tremors 
  • Insomnia 
  • Anxiety 
  • Nausea 
  • Restlessness

Approximately 10% of patients will experience serious symptoms, including:

  • Rapid breathing 
  • Fever 
  • Severe tremors
  • Profuse sweating
  • Seizures in approximately 5% of untreated individuals 
  • Delirium tremens, characterized by confusion, disorientation, and hallucinations 

More on Seizures and Delirium Tremens 

For those who experience alcohol-related seizures, over 90% occur within 48 hours after the individual stops drinking. The likelihood of these seizures and their severity increase with the number of past withdrawals based on cumulative long-term changes in brain excitability. Medications can be given in a medical detoxification setting to target this dangerous symptom. 

Delirium tremens typically develop 1 to 4 days after the onset of alcohol withdrawal. These symptoms develop among those who have been drinking excessively for years. Warning signs include hallucinations and extreme hyperactivity. Sadly, the mortality rate among those suffering from delirium tremens is around 5%, but it may be as high as 25%. However, this risk drops significantly when the individual receives medical support. 

Research shows that approximately 50% of patients who experience a withdrawal seizure will progress to have delirium tremens. 

What Causes Alcohol Withdrawal?

Alcohol withdrawal is a clinical syndrome that has serious potential consequences. 

This syndrome is caused by prolonged, excessive alcohol use, which leads to tolerance and physical dependence. Following long-term exposure, if a person discontinues alcohol use, the central nervous system becomes hyper-excitable. Without alcohol, there is a lack of the sedative effect your brain is used to, which causes the symptoms discussed above. 

There are some predictors concerning alcohol withdrawal including:

  • Men who consume more than eight standard drinks daily and women who have more than six standard drinks daily 
  • Individuals who drink daily, at this level, for at least two weeks (withdrawal is unlikely among binge drinkers)
  • If a person’s last drink was consumed in the past six to 24 hours 
  • If a person has experienced a withdrawal syndrome in the past 
  • If the person has their first drink in the morning 

To better understand alcohol withdrawal, you must consider this substance’s mechanism of action. 

Alcohol is a central nervous system depressant. When you consume alcohol, it affects your brain and body in several ways. Within the brain, it targets specific brain chemicals. For example, it inhibits glutamate while enhancing GABA. Normally, these two chemicals are balanced. 

Since GABA increases, alcohol reduces feelings of fear and anxiety. It has a calming effect. However, when individuals drink alcohol regularly long-term and then suddenly stop, the central nervous system experiences an excitement overload. Long-term, alcohol decreases the number of GABA receptors, which means users have to drink larger doses of alcohol to achieve the same effect. This effect is known as tolerance and acts as the first major stepping stone towards dependence. When you’re physically dependent on alcohol, discontinuing use means withdrawal syndrome will surface. 

With chronic alcohol use, users experience increases in glutamate to maintain balance with increasing GABA levels. When alcohol use is stopped, this results in high levels of glutamate, resulting in tremors, sweating, neuropsychiatric complications, seizures, etc. 

This complex process involves several brain regions and other brain chemicals, including dopamine. 

How Long Does Alcohol Withdrawal Take?

Alcohol withdrawal happens in several stages. How these stages unravel depends on variables such as the level of dependence. You may only experience stage one, whereas someone else will experience all three stages. 

These stages include stage one (mild), stage two (moderate), and stage three (severe). 

If you drink daily and then discontinue use, you’ll likely experience first-stage symptoms such as tremors, sleep disturbances, and headaches. These are the physical symptoms of withdrawal. You’ll also experience psychological symptoms like anxiety and intense cravings. 

Next, you’ll enter a second stage, and symptoms will worsen. You may experience abnormal breathing, increased blood pressure, and confusion. At this point, the thought of alcohol will likely consume you. If you can have a drink or two, everything will be better. This is the vicious cycle of addiction. You continue drinking to avoid withdrawal symptoms. However, this doesn’t allow you to overcome the urge to drink and the consequences that come with that. 

Last, you’ll enter stage three. With each stage, you experience the symptoms associated with previous stages. So, at this point, symptoms are incredibly overwhelming. Plus, more severe and even dangerous symptoms can surface including hallucinations, disorientation, and seizures.

If you’re not in the care of healthcare professionals, you may progress from stage two to stage three very quickly. 

Overall, this timeline will vary. However, most people will experience stage one symptoms 6-12 hours after their last drink. At this point, symptoms are mild and, although uncomfortable, they’re manageable. Within 24 hours, symptoms are significant enough to impair function and may be severe enough to require medical attention. Most symptoms will peak by 24 hours. For the next 48 hours, symptoms will slowly level off, but this timeframe is not easy. As discussed above, many people experience seizures within the first 48 hours. 

The key is to seek professional assistance. When symptoms are properly managed under clinical supervision, the vast majority of people fully recover. At this point, they can begin their journey towards long-term sobriety, which will require an individualized treatment plan. 

How to Safely Manage Alcohol Detox

The alcohol detoxification process should not be attempted without medical supervision. 

Alcohol is one of the most dangerous substances to withdraw from because of the way it influences the central nervous system. 

Appropriate alcohol withdrawal treatment can effectively relieve your discomfort, keep you safe, and help reduce the risk of cumulative effects that may worsen in the future. Although many individuals experiencing mild symptoms can be treated via outpatient services, the safest setting is a medical detox facility. 

One of the primary concerns of alcohol detox is the medical disorders that often co-occur with alcoholism. These disorders can exacerbate symptoms. For example, patients may have an irregular heartbeat or inadequate heart function, liver disease, infectious diseases, gastrointestinal bleeding, or nervous system impairment. These disorders need to be considered when monitoring vital signs and administering medications. 

Co-occurring mental health conditions are also a cause for concern. However, these disorders are addressed in more detail following the detoxification period. There is a strong relationship between mental health conditions and substance use disorders. In many cases, mental health symptoms lead to excessive drinking or drug use to help mask what the individual is feeling. It is a form of self-medication that creates a dangerous cycle. 

Data shows that one in four adults living with a serious mental health condition also has a substance abuse problem. Common co-occurring conditions include anxiety disorders, schizophrenia, depression, and personality disorders. To ensure long-term success, this will be addressed within your personalized treatment plan. Therapy will be recommended as well as other holistic, evidence-based approaches. However, to get to this point, you must first successfully detox.

The setting in which you withdraw from alcohol will make a significant difference. For example, you should seek a low-lighting room with minimal stimulation. Of course, this can be challenging, as there is nothing to distract you. To help you through the most uncomfortable symptoms, medications may be required. 

Several types of medications may be administered throughout the detoxification period, depending on your symptoms and any pre-existing medical conditions. These medications will often target specific symptoms, helping individuals remain as comfortable and safe as possible. For example, individuals at risk of seizures may be given lorazepam. To prevent Werknicke’s encephalopathy (WE), induced by a vitamin B1 deficiency, supplementation may be required. 

Today, benzodiazepines are commonly administered to help prevent alcohol withdrawal symptoms such as seizures. Again, this is only given in select situations. For mild cases, medications may not be required. Sometimes, individuals simply need a quiet, supportive environment that is calm and understanding. The key is to be in a place where you’re monitored so that further action can be taken if need be. 

Can You Withdrawal From Alcohol Without Medications?

People do successfully detox from alcohol without the use of medication. However, management of alcohol withdrawal without medication can be dangerous. There are currently no screening techniques to predict with confidence that someone will not experience life-threatening complications during this process. The risk of a seizure is fairly high, especially among those with a history of alcohol withdrawal seizures. 

As discussed, individuals with mild symptoms do not typically require medication-assisted treatment. When symptoms are moderate to severe, however, a higher level of care is highly recommended. Some options for those who do not receive medication include adequate fluids, adequate sleep, maintenance of an alcohol-free environment, and ongoing interpersonal support. 

When to Contact a Medical Professional

There is no need to fear alcohol withdrawal when you have the support of a professional clinical team. Not taking this critical step can increase your risk of the dangerous, potentially deadly complications that come with alcoholism. You can overcome your alcohol addiction and then address any underlying conditions that trigger your urge to drink. Building a life that’s fulfilling and free from the grip of alcohol is possible — but first, you’ll need to complete the alcohol withdrawal process. 

Support is available to help you do just that. With professional care, you’ll remain safe and comfortable. Take back control of your health, life, and future. Call Zinnia Healing today at (855) 430-9439.

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