It may be difficult to remember that while alcohol is widely available, celebrated, and legal, it is still a potent substance that can cause many problems when misused and abused.
As the U.S. Centers for Disease Control and Prevention (CDC) warns, ethyl alcohol, or ethanol, affects every organ in the body. Those who continue to drink beer, wine, and liquor in heavy amounts are risking their health and their futures.
Drinking too much alcohol can and often does lead to an alcohol use disorder (AUD), or alcoholism. The CDC says excessive alcohol use includes:
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- Binge drinking (five or more drinks for men on a single occasion and four or more drinks on a single occasion for women within a two-hour period)
- Heavy drinking (15 drinks or more per week for men; eight drinks or more per week for women)
- Any alcohol use by people under age 21, the minimum drinking age
- Any alcohol use by pregnant women.
As the National Council on Alcoholism and Drug Dependence, Inc., notes, some common signs and symptoms of alcohol addiction include:
- Blackouts and memory loss
- Broken capillaries on the skin
- Deterioration of appearance
- Loss of control or judgment
- Insomnia, headaches, and nausea
Not everyone who drinks excessively will become dependent on alcohol. The CDC says about 90 percent of people in this group would not be expected to meet the diagnostic criteria for having a severe AUD. Signs of an AUD include:
- Being unable to limit or stop drinking
- Drinking more to achieve a high
- Continuing to drink despite any negative consequences that result
- Being preoccupied with alcohol
People who overindulge in drinking alcohol on a regular basis risk developing a dependence on it that will make it hard to quit alcohol. Quitting comes with a heavy price—alcohol withdrawal. If the drinker already has other health problems, drinking will only worsen the toll alcohol takes on the body, mind, and spirit.
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What Are the Symptoms of Alcohol Withdrawal?
Alcohol depresses the central nervous system and slows down the brain. Many drinkers feel relaxed and happy when alcohol’s effects hit the brain. That’s because the substance suppresses certain brain chemicals, called neurotransmitters, which allow relaxation to take place.
Some of the alcohol will be broken down by enzymes in the liver, but any alcohol that’s leftover after that process takes place will be absorbed by the brain and other parts of the body. When too much alcohol is consumed, people may start to slur their speech, lose their balance, and have a hard time remembering things.
For some drinkers, pleasurable feelings associated with drinking are a green light to keep going just to experience these feelings again and again. They may think all they’re doing is drinking, but what they’re really doing is building up a tolerance to alcohol over time that a) makes it difficult to stop drinking and b) makes them feel worse and puts them at risk of serious complications if or when they do decide to quit alcohol.
If there are any noticeable physical, mental, or emotional changes when drinking alcohol is stopped, and all traces of alcohol are out of the body’s system, then that’s a sign that alcohol dependence has set in, and that withdrawal is taking place. Not everyone will have the same alcohol withdrawal symptoms, but these are common:
- Loss of appetite
- Light sensitivity
- Nausea, diarrhea, vomiting
- Shakiness (including shaky hands)
- Sweating, clammy skin
- Foggy thinking
- Rapid heartbeat
- Sleep disturbances
- Delirium tremens (DTs)
Excessive drinking that is suddenly stopped results in uncomfortable withdrawal symptoms for many people. This is one reason frequent drinkers keep drinking; they want to avoid these physical and psychological complications.
However, excessive drinking can result in many health problems, including alcohol poisoning, overdose, and death. Hallucinations are symptoms of serious alcohol withdrawal that occurs anywhere from 12 to 24 hours after the last drink. Seizures can also occur within the first two days after alcohol use is stopped.
A person also can also experience Delirium tremens (DT), which begins 48 to 72 hours after the last drink. Only about five percent of people in alcohol withdrawal experience this condition, according to WebMD, which is characterized by confusion, a racing heart, high blood pressure, fever, and heavy sweating. People with DTs also have vivid hallucinations and delusions.
Alcohol withdrawal goes far beyond just being drunk or hungover. It is a serious matter and can result in death. If you or your loved one is having hallucinations, delusions, or seizures, get professional help immediately.
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What Are the Stages of Alcohol Withdrawal?
An alcohol withdrawal timeline will look different depending on the person. Alcohol affects people differently. Several factors come into play when determining a timeline. Among them are:
- Age, sex, health, medical history, and lifestyle
- Your weight and body fat percentage
- Duration of alcohol use
- How much alcohol consumed and frequency of consumption
- Your alcohol tolerance
- The manner in which alcohol has been used
- If alcohol has been used or cut with other drugs and substances
- Co-occurring disorders
A person can experience withdrawal symptoms within a few hours after the last drink or several days. It really just depends. However, be aware that a person’s physical or psychological condition can worsen as the alcohol withdrawal period unfolds.
The following is a general overview of the three stages that follow when an alcohol-dependent person stops drinking. Experiences will vary by the person, so it’s best to consult with a doctor to get the clearest understanding of what’s going on in your situation.
Phase 1 | 8-24 hours: During this period, alcohol users can experience milder symptoms that appear very early on in the alcohol withdrawal timeline. For those that cannot go very long without a drink, these symptoms may manifest in the first eight hours of their last drink. These symptoms are similar to a hangover. There’s sensitivity to light and sound. There also are headaches, nausea, irritability, and anxiety that stem from the blood-alcohol level being high. Even though symptoms may be mild at this stage, alcohol poisoning is still a possibility. Mild symptoms also leave after a day or two. If not, consider that the person could be in the second stage of alcohol withdrawal.
Phase 2 | 1-3 Days: Moderate symptoms appear and typically peak in this period. High blood pressure, tremors, hypothermia, and confusion are usually present at this stage sometime within 24 to 72 hours. The vital organs most affected by alcohol—the liver and kidneys—should be monitored throughout this phase.
Phase 3 | 3-7+ days: The 72-hour and beyond mark is the most severe stage of alcohol withdrawal, and it can last a week or longer. During this time, recovering alcohol users will need around-the-clock medical care as they may be disoriented or agitated. They also may be experiencing seizures, Delirium tremens and hallucinations. Medical professionals administering detox will likely prescribe medications to help treat these dangerous symptoms and keep conditions from worsening.
Post-Acute Withdrawal Symptoms
Alcohol-dependent users who get through their first week of withdrawal are still not out of the woods. They may experience lingering symptoms from their alcohol use for weeks or months after alcohol was used. These symptoms are collectively known as Post-Acute Withdrawal Syndrome (PAWS).
Symptoms of PAWS symptoms include:
- Changes in appetite and sleeping schedules
- Feeling more tired than usual, fatigue
PAWS symptoms do not have to be handled on your own. Professional treatment is recommended to manage this period and recover from it. Adequate rest, practicing habits that promote health and wellness, and a supportive network of people are effective ways to manage PAWS. Consult with your physician to come up with the best plan for you.
What Happens If I Quit Cold Turkey?
If you’ve developed a chemical dependency after frequent drinking, it may be dangerous for you to stop suddenly. Alcohol and other central nervous system depressants work by limiting excitability in the brain. Alcohol is GABAergic, which means that it works by increasing the efficiency of a natural chemical messenger in the brain called gamma-aminobutyric acid (GABA). It’s GABA’s responsibility to regulate excitability, and when alcohol binds to receptors, it causes GABA to become more effective.
These effects can be more powerful than they would without alcohol’s influence, leading to the sedative and euphoric effects. When alcohol is used consistently, your brain will start to get used to the substance. It may attempt to counteract the drug and balance brain chemistry by decreasing its own inhibiting and depressing chemicals and increasing excitatory chemicals. This can cause your tolerance and your dependency to grow.
If you stop using suddenly, you will experience the consequences of a chemical imbalance. The excitatory chemicals that were being suppressed by alcohol are uninhibited. The result may be an overexcited nervous system which leads to withdrawal symptoms like insomnia, anxiety, and irritability. If you stopped abruptly after drinking heavily for multiple days a week, you might experience more severe symptoms like tremors, panic, seizures, and a condition called delirium tremens.
You are also more likely to experience severe, life-threatening symptoms if you have gone through central nervous system depressant withdrawal before. A neurological process called kindling causes long-lasting changes in the brain after you go through withdrawal. If you go through withdrawal a second or third time, kindling can make it more likely for you to experience seizures and other dangerous symptoms.
Seizures aren’t always life-threatening, but they can be if they cause injuries or happen when you are in a dangerous position or situation. Seizures can come on suddenly, so if you are standing, walking around or driving, they can cause potentially fatal accidents. Seizures are also more dangerous if you are on your own with no one able to call for emergency services if you are injured. Alcohol withdrawal causes tonic-clonic seizures, similar to the seizure that are caused by epilepsy.
Tonic-clonic seizures happen in two main phases and then a post-phase. First, the tonic stage causes your muscles to stiffen, and your limbs may snap in close to the body. You also lose consciousness in this phase. The clonic phase is characterized by convulsions and rapid muscle contractions. Seizures typically last up to three minutes. If they last more than five minutes, you need immediate medical attention.
Delirium tremens is life-threatening on its own and requires medical treatment and supervision. It’s characterized by sudden confusion, terror, tremors, seizures, and catatonia. Without medical treatment, delirium tremens can lead to coma and death. With medical treatment, this condition is usually avoided, and medical intervention can prevent it from becoming life-threatening.
The safest way to go through alcohol withdrawal is in medical detox. If necessary, medical professionals can help you taper off the drug.
Why Should I Detox from Alcohol?
The decision to seek professional medical detox for an alcohol problem is personal. In some cases, it’s necessary. Either way, a medically assisted detox offers multiple benefits. It ensures that all traces of alcohol (and other drugs if used) are removed from the body to bring about physical and psychological stability, and it ensures that the process is done safely. It helps ease and prevent the complications that arise with withdrawal and excessive alcohol use.
If anything unexpected happens, medical professionals are on-site to address the issue right away. Also, it connects alcohol-dependent users with the therapies and treatments needed to help end alcohol abuse and prevent relapse.
If someone has resorted to frequently drinking alcohol, it will take more than just detox to stay away from this addictive substance. It will take a change in behavior and support to stay true to achieving and maintaining sobriety.
Medical detox can last anywhere from three to seven days or longer, depending on how severe the situation is. Mild situations may be managed outside of a rehab center, but even in that case, a physician’s assessment should be sought to determine what at-home treatment and medications are needed for a recovery taking place at home. As mentioned earlier, serious alcohol withdrawal symptoms that last longer than a week should be treated by professional health care providers.
During a health examination, the client performs a physical exam that will check for things such as a rapid heart rate, shaky hands, dehydration, fever, abnormal eye movements, abnormal heart rhythms, and other things.
What Comes After Medical Detox from Alcohol?
Medical detox is the first in a series of steps to alcohol abuse recovery. After this process takes place, entering a licensed alcohol or drug treatment center is ideal. Such a place promotes ending problematic alcohol use and alcohol addiction by beginning to understand and address the underlying reasons for their dependence. According to the National Institute on Drug Abuse, addiction is treatable, and research shows that at least three months or more are needed to treat drug addiction.
Before a treatment center is chosen, the needs and preferences of the person enrolling must be assessed. Therapeutic approaches to addiction don’t look the same for everyone, so this is an important step.
After it is determined what kind of arrangement is beneficial, recovering drinkers can choose from:
Residential (or inpatient) programs. Rehabs that offer residential or inpatient programs provide clients with a safe, supportive, and supervised environment that allows problem drinkers to focus on their addiction with minimal distractions. Clients may stay on-site for anywhere from 30 days to three months or longer, depending on their needs and severity of their situation. Clients are typically supervised around the clock to ensure they get the care they need on all levels. Research supports that the longer someone stays in treatment, the better their chances are of achieving long-term recovery.
Intensive outpatient programs. Intensive outpatient programs (IOP) provide strong support for recovering alcohol drinkers without requiring them to stay overnight or at a rehab facility for extended periods. IOPs are viewed as an affordable option for people who are recovering from substance addiction. The length of an IOP depends on the individual, but the program can run at least up to three months. Clients can receive intensive therapies for a set number of hours each week.
Partial hospitalization programs.Partial hospitalization programs (PHP) provide services that are similar to those of inpatient or outpatient programs. In a partial hospitalization program, individuals struggling with addiction must meet certain criteria to successfully complete the program. PHPs can be used for people who need a place to live as they step down from a higher level of care and transition back into society. Partial hospitalization can serve as a substitute for inpatient care or be a form of intensive outpatient treatment.
Outpatient patient treatment offers the most flexibility, while inpatient and residential likely requires a 30-day or longer stay at the treatment facility. During your time in any of these programs, you will have various therapies and counseling opportunities to help you put your life back together after addiction.
These include behavior therapy, trauma therapy, holistic therapy, and others. There’s also individual, group, and family counseling, 12-step programs such as Alcoholics Anonymous, life skills management, relapse prevention training, and a great deal more.
Start Your Journey to Recovery Today
The cycle of addiction is familiar to many people who can’t seem to escape its clutches. They use, quit their drug of choice cold turkey (which is not recommended), go through withdrawal, and then relapse just to avoid feeling lousy from withdrawal. This cycle can only continue so many times before death is a real possibility. There is a way to end this cycle and that’s to get assistance from people who can actually help end your dependence on alcohol.
If you or someone you know has tried everything to curb problematic drinking or end alcohol addiction but can’t seem to stop, Pathway to Hope can help you find the peace you’re seeking.
Centers for Disease Control and Prevention. (2018, March 29). CDC - Frequently Asked Questions - Alcohol. from https://www.cdc.gov/alcohol/faqs.htm
Hart, T. (2017, March 20). Generalized Tonic-Clonic Seizure (Grand Mal): What to Know. from https://www.healthline.com/health/generalized-tonic-clonic-seizure
National Institute on Drug Abuse. (2018, January). Principles of Effective Treatment. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
U.S. National Library of Medicine. (2019, July 22). Gamma-Aminobutyric acid. from https://pubchem.ncbi.nlm.nih.gov/compound/gamma-Aminobutyric-acid
U.S. National Library of Medicine. (2019, July 10). Delirium tremens: MedlinePlus Medical Encyclopedia. from https://medlineplus.gov/ency/article/000766.htm