Alcoholism is a disease characterised by continuous heavy drinking. Until people with alcohol use disorder admit to problems with alcohol and stop drinking, the risk of alcohol use disorder continues which affects both physical and mental health.
Alcohol starts to injure the brain once it reaches the bloodstream.
Excessive consumption can lead to Alcohol-Related Brain Damage, or ARBD, which is a type of brain disorder caused by alcohol consumption. Brain shrinkage caused by alcohol abuse is permanent, as alcohol kills brain cells and grey matter.
For more information and effects click ‘Learn More’.
Every month, we bring you an unfiltered recovery conversation with someone who’s either experienced addiction firsthand, or works closely with those in recovery.
No sanitised success stories – just practical insights on what actually works in recovery, that you can apply, in your life too.
Recovery capital is the internal and external resource used to begin the recovery process and maintain sobriety. This combines personal, social, and community support to provide a joined-up approach that supports the addict through recovery.
Do you or a loved one need addiction treatment for alcohol or drugs? Thousands blindly walk into addiction treatment in expensive rehab centres and find that the reality doesn’t meet expectations.
If you’re considering rehab treatment, first check our ultimate guide for complete instructions on how to find the right rehab centre for you.
Take-home Naloxone kits help families and loved ones respond quickly in an opioid overdose emergency, until emergency services arrive. Kits contain nasal or injectable forms of Naloxone.
Changes in legislation mean Naloxone kits are now more widely available from pharmacies and drug services, including Abbeycare.
For additional information, click ‘Learn More’ below.
Overcoming alcohol addiction means first ceasing alcohol intake, and taking care of physical and chemical withdrawal symptoms.
Detoxing from alcohol means undergoing withdrawal from alcohol, but with the assistance of prescribed medication and detox phase, to substitute in place of the alcohol itself.
Alcohol rehab focuses on tackling the problems underneath alcoholism, such as grief, trauma, depression, and emotional difficulties, in order to reduce continuing drinking after treatment.
Inpatient services at an alcohol rehab programme provides 24 hour access to specialist care.
Alcohol home detox provides a means of semi-supervised addiction treatment in the comfort of your home. It’s often suitable for those with inescapable practical commitments, or where a reduced budget for treatment is available.
An at-home detox is the most basic detox option available from Abbeycare, and assumes you have support available, post-detox, for the other important elements of long-term addiction recovery.
The term alcoholism refers to the consumption of alcohol to the extent that the person is unable to manage their own drinking habits or patterns, resulting in side-effects that are detrimental to the quality of life and health of the alcoholic, or those around them.
An alcoholic is someone who continues to compulsively abuse alcohol in this way, despite the negative consequences to their lives and health.
Immediately following treatment, the early stages of recovery and abstinence are most vulnerable to lapses.
At Abbeycare, a structured and peer-reviewed aftercare plan is usually prepared whilst still in treatment. This comprises social, peer, and therapeutic resources individuals draw upon, following a residential treatment programme for drug or alcohol misuse.
Cognitive Behavioural Therapy is a well-known therapy option used by doctors at drug and alcohol treatment facilities for the treatment of substance use disorders.
It is a form of talking therapy that helps one mange their problems by changing how they think and behave. This form of therapy is used to treat depression and anxiety and is useful for physical health problems as well as one’s mental health.
Family Therapy at Abbeycare Scotland or Gloucester is realistic, compassionate, and appropriate for families and loved ones of addicts.
Family therapeutic interventions in residential rehabilitation have been designed to support those living with or caring for participants entering the Abbeycare Programme.
Support for families in a group setting allows for a safe, constructive, and confidential place to listen and share common experiences.
Inpatient rehab is drug and/ or alcohol treatment in a rehab centre, where patients remain on-site for the duration of inpatient rehabilitation.
It includes detoxification from drugs, therapy (group work and 1-2-1 sessions), and aftercare planning. Inpatient rehabs typically last 28 days, but this varies on an individual basis.
Long-term treatment at Abbeycare has been developed for those suffering from alcohol or drug addiction. Completing a long-term drug and alcohol inpatient programme may be the solution to problematic substance use.
Motivational Enhancement Therapy can be used by trained addiction recovery therapists to elicit internal changes within and promote long-term recovery from substance use disorder.
All the answers to addiction can be found within with this comprehensive and successful therapy concept leads to behavioural changes, reflective listening, self-motivational statements, and a comprehensive recovery process.
Outpatient drug or alcohol rehab is daytime treatment as opposed to living in a treatment facility.
Outpatient treatment is similar to inpatient in terms of the methods used to treat substance abuse. Where they differ is in their approach to recovery.
Abbeycare’s prison to rehab is a 12-week structured rehab programme which involves direct transfer from prison. The suitability of the candidate is decided by prison staff.
Short-term residential treatment programmes are the chance to press the reset button and access a therapeutic programme designed to create recovery from the use of alcohol and drugs.
Feeling stuck in a rut. Want to stop but can’t seem to achieve sobriety?
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The 12-step programme was created by alcoholics anonymous (AA), and is specifically designed to aid addicts in achieving and maintaining abstinence.
The central ethos behind the programme is that participants must admit and surrender to a divine power to live happy lives. Ideas and experiences are shared in meetings, and help is sought in an attempt to achieve abstinence.
Abbeycare’s policy to respect your privacy and comply with any applicable law and regulation regarding any personal information we may collect about you, including across our website and other sites we own and operate.
Alcohol withdrawal is process of cutting down on alcohol or stopping drinking altogether.
The central nervous system adjusts to deal with the amount of alcohol in the body (tolerance), and compensates for the depressive effects alcohol has on brain function and nerve communication.
Alcohol is a depressant. When consumption is reduced, the brain transitions into a hyperactive state, causing risk of convulsion.
Alcohol Withdrawal Symptoms To Expect
Mild Drinking
Symptoms following mild or episodic drinking include:
Headaches
Sweating
Hand Tremors
Nausea and vomiting
Heart palpitations
Increased anger and anxiety - initially alcohol causes users to feel relaxed and more confident, but later emotions change to anger and anxiety
Mild or casual drinkers consume low amounts of alcohol on rare occasions, using alcohol no more than once per week or a few times per month.
Moderate Drinking
Symptoms experienced following moderate drinking are:
Feeling anxious and irritable
Tiredness
Nightmares and disturbed sleep
Depression
Anxiety
Mood swings
Difficulty concentrating
High temperature or chills
Moderate drinking means 2 drinks per day for men, and 1 drink per day for women, with several drink-free days in the week [2].
Heavy Drinking
Those ceasing intake from a pattern of drinking heavily, may experience both physical and psychological side effects:
Delirium tremens (DTs) - occurs in between 3-5% of those experiencing acute symptoms [3]
Severe disorientation
Visual delusions - affect 0.6-0.7% of those withdrawing from severe alcohol abuse [4]
Neurological fits/spasms
High blood pressure
Depression
Anxiety
Heavy drinking is classed as more than 15 drinks per week for men, and more than 8 drinks per week for women [5].
When Do Alcohol Withdrawal Symptoms Start
Symptoms from ceasing low levels of intake begin from 5-10 hours after the last alcoholic drink.
Symptoms from ceasing moderate drinking occur from 12-24 hours after the last alcoholic drink.
Symptoms when ceasing drinking heavily for a long time occur 48 hours after the last alcoholic drink, with some experiencing symptoms for weeks.
Tolerance levels in those with a long-term drinking pattern are higher than moderate drinkers, meaning they require more alcohol to counteract cessation side effects.
When Is Alcohol Withdrawal The Worst
Symptoms tend to peak 48 hours after the last alcoholic drink, when the alcoholic is at greatest risk of suffering fits.
Physical urges for alcohol typically peak 5-7 days from the time of your last drink, and may last up to 2 weeks.
Abbeycare's clinical experience indicates that psychological cravings last for months or years after beginning recovery, as memories and associations to alcohol take time to extinguish long after removing alcohol from your system.
How Long Does It Take
Drinking Pattern
Intake Level
Duration Of Withdrawal
Casual Drinking
1 drink per week for women 2 drinks per week for men [6]
Non; potential for feeling unwell as will have a low tolerance [7]
Moderate Drinking
4 drinks per week for women 5 drinks per week for men
Moderate symptoms stopping after 48 hours
Heavy Drinking
8 drinks per week for women 15 drinks per week for men [8]
Developing a pattern of a healthy diet and good sleep schedule - focusing on short-term goals can help alleviate overwhelm in recovery
Cut down the amount of alcohol you drink very gradually instead of going cold turkey - especially if withdrawing at home
Maintain regular contact with medical staff - medications may require different dosages for each alcoholic, with incorrect dosages leading to overdose, cross-addiction, or symptoms not being treated
Selective extinction - after alcoholics cease intake, the endorphin receptors become more sensitive, using this time for endorphin-releasing activities allows the brain to learn more healthy habits
Reading - books that discuss recovery, family relationships, anxiety and depression help the user to understand symptoms and focus on recovery
If you or a loved one is struggling with alcohol cessation, seek professional medical advice.
It is important to respond dynamically for each individual's circumstances such as:
Utilising a good support network - inform family and friends of expected timeline and create a visiting schedule to maximise support
If there is a lack of a support network - contact a GP, local support services and helplines
Reducing caring responsibilities - 34.1% of those with caring responsibilities reported an increase in alcohol use disorder, so alleviating these responsibilities assists in working towards sobriety [10]
Adapting to changes in care plans - the first form of treatment is not always successful, and changes may need to be made to the treatment plan to allow for costs and time spent on treatment
Reducing Symptoms
Ways to anticipate and prevent complications when you quit drinking are:
Medication - naltrexone, acamprosate and tiapride reduce urges for alcohol
Speaking to a supportive family doctor if possible - the alcoholic being comfortable and the doctor having previous medical knowledge assists in predicting and reducing symptoms
Slowly decreasing alcohol over time to slow down symptoms, especially if consumption of alcohol has been heavy and over a number of years
With less severe intake, mild symptoms may begin to disappear
Fever
Sweating
Confusion
Increased blood pressure
7 days after the last alcoholic drink
The effects of ceasing intake usually disappear between 4-7 days
Those with long term severe alcohol dependency may go through adverse effects for several weeks
Irritability
Depression
Unstable mood
Withdrawal vs Hangover
75% of those who drink high amounts will experience a hangover, whereas withdrawal will only occur in those who have become physically dependent on alcohol [11].
Whilst initial symptoms are similar, hangover symptoms typically stop after 24 hours after your last drink, whereas signs and symptoms of withdrawal may last for several weeks.
Alcohol withdrawal syndrome may result in life threatening symptoms like convulsions and DTs, that do not occur during a regular hangover.
Alcohol Detox
Alcohol detox is the process of withdrawing from alcohol in a controlled way, supported by medical professionals, and using prescription medication to help you overcome serious side effects of stopping drinking.
Medication For Alcohol Detox
The alcohol detoxification process is controlled by medications:
Benzodiazepines - e.g. Chlordiazepoxide (Librium), Diazepam (Valium), or Oxazepam (Serax) - used to treat symptoms such as disrupted sleep, anxiety and muscle spasms, reduces risk of convulsions.
Anticonvulsants - e.g. Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), or Gabapentin (Neurotonin) - secondary drugs used to control acute symptoms.
This stage takes place on an inpatient basis in a clinic, or on an at home basis assisted by a professional alcohol treatment nurse.
Detoxing from alcohol at home without medical professionals is not advised as symptoms you experience may become severe, developing into neurological fits that result in death.
Detoxing An Alcoholic
The primary concerns when treating a chronic alcoholic, as compared to a casual drinker, are:
Higher tolerance - people with unhealthy alcohol patterns are unable to quit drinking cold turkey due to the level of alcohol they consume
DTs, convulsions, or hallucinations
Possibility of relapse - based on our first-hand experience, the fear of severe adverse effects contributes to restarting drinking
Overcoming emotions - without alcohol to numb emotions, feelings such as guilt (realising the negative impact drinking has had on others), and the emotions that caused addiction originally, may lead to anxiety and depression
Further alcohol treatment is more important when it comes to chronic alcohol disorders, as the medical phase only cures the physical dependence on alcohol, not the emotional causes and triggers of addiction, including:
External triggers - places, people and situations where previous drinking habits occurred
Anxiety - addiction may have started as a means to cope in social environments
PTSD and trauma - men with PTSD run a 2-fold increased risk of becoming alcoholics than men without PTSD [12]
Those with chronic alcohol addiction require the therapy aspect of the programme to treat emotional triggers and continue in recovery.
What Is The Alcohol Detox Process
Medical assessment
Patients will meet with medical staff to assess the right treatment for alcohol addiction and create a treatment timeline.
Withdrawal
Alcohol intake is stopped or gradually reduced, based on individual need, and side effects begin.
Treatment continues until symptoms start to subside; this is different for each patient but typically happens within 1-2 weeks.
In a residential facility, medication and 24 hour professional care are provided to manage side effects.
The next stage
After you have completed your treatment, you are ready to complete the rest of the residential programme, including intensive psychological therapy, this is not available at home.
Treatment For Alcohol Detox vs Alcohol Withdrawal
Medically assisted detox is the safe and controlled process of reducing the amount you drink or stopping drinking whilst managing symptoms with medication.
Alcohol withdrawal attempted without medical assistance and supervision does not manage the severity of symptoms, as well as creating the potential for alcoholics to relapse without support.
Remission rates for those who undergo unassisted alcohol withdrawal are 50-80%, whereas rates for those who have assistance are between 20-50% [13].
Long term, heavy drinkers may require medical assistance, as they are at risk of developing life threatening symptoms like severe vomiting, and DTs.
Undergoing withdrawal instead of detox may occur when:
The NHS cannot afford the cost of residential treatment
There have been frequent early discharges from treatment by the patient
Patients are triggered by aspects of treatment itself - such as staff or other clients
In these circumstances, the care plan is managed by an ADP team, preparing for access to services and support through treatment [14].
Alcohol Detox Symptoms
Physical symptoms
Rapid heartbeat
Raised blood pressure
Seizures
DTs - only affecting long term excessive abuse of alcohol
Fever - Fevers during the process typically range from 99.5°F (37.5°C) to 100.3°F (38.3°C), but temperatures above 100.4°F (38°C) require medical attention.
Fatigue
75% of alcoholics report inability to sleep during alcohol detox [15], because:
Cognitive dysfunction in 80% of alcoholics after detoxification makes fatigue 79% more likely [16] [17]
Depression occurs in 40.65% of people during the process, resulting in a 50% higher chance of experiencing fatigue [18] [19].
The ratio of glutamate to GABA decreases by 17.66%, and cortisol levels rise by 20% during the process, both resulting in fatigue [20] [21].
Headache
Headaches occur as a result of:
20-30% reduction in GABA levels at the start of the process [22]
Dehydration and Pressurenatriuresis: blood pressure rises of 20-30mmHg followed quickly by blood pressure reductions during detox trigger Pressurenatriuresis and increased urination (3-4 litres per day) [23]
Increased Corticotrophin Releasing factor (CRF) released when intake ceases activates mast cells, signals vasodilation, and results in headache [24]
Psychological and emotional symptoms
Fear of addiction treatment - previous negative experiences may lead to a fear of repeating symptoms, causing continued alcohol abuse
Depression and anxiety - 63.8% of those detoxing are suffering from depression, particularly drinking to cope patterns have been used [25]
Guilt - for past behaviour and actions towards family and friends
Symptoms - How Long?
Factors that lengthen the duration, and increase the severity of symptoms are:
How many years drinking has been occurring - 50% of those with a history of long term heavy alcohol consumption experience side effects [26]
How much alcohol is consumed whilst drinking
How often drinking is occurring
Co-occurring mental health disorders
Co-occurring substance abuse - 6.4% of those suffering with co-occurring substance abuse, or mental health disorders, experience symptoms following alcohol cessation [27]
Alcohol Detox Timeline - Day By Day
Timeline of Symptoms
Alcoholism
Eating Disorders
6-12 Hours
Headaches, sleeplessness, stomach pains and hand tremors [28]
Headaches, insomnia, stomach pains and hand tremors- symptoms are observed and medication is provided
Detox at home is when a specialist nurse visits 4 times a day for 15 minutes to check vital signs, but the rest of the process is completed with friends and family support.
Reasons why this may be successful include:
No prior history of convulsions
A strong pre-existing support system that is available to visit frequently
Not consuming more than 30 units daily
At Home
In A Clinic
Care from a nurse specialist 4 times per day
Care provided 24 hours a day
Symptoms treated with medication - may take time for nurse to arrive to administer dosage [32]
Symptoms treated with medication immediately
Nurse specialists look for how patient is reacting, breathing, heart rate and blood pressure
Medical staff look for physical symptoms as well as psychological reactions to discuss during further treatment
Support is required from friends and family during
Support from friends and family assists in recovery but is also provided by clinic staff [33]
Detox In A Clinic
Detoxing from alcohol in a residential clinic becomes necessary when:
There is evidence of drinking alcohol excessively over a long period of time
Co-occurring mental health disorders - those with bipolar disorder, depression or anxiety have difficulty maintaining sobriety without support, need supervision due to potential suicide attempts and benefit from the mental health services provided in a residential setting
Denial about how the effects of alcohol - during treatment, the patient has the opportunity to accept the level of their addiction and how it has affected work, relationships and overall health
Negative impact on family - neglecting the needs of children and causing partners to feel ashamed and overwhelmed with extra responsibilities create a difficult environment
A breaking point that causes the alcoholic to consider their behaviour - including a hospital admission, an accident, drink driving or a nervous breakdown
Detox In Hospital
Completing the process in a hospital setting is required when there is:
Previous or current seizures
Co- occurring substance abuse disorder
Suffering from schizophrenia or psychosis - 4% of alcoholics in recovery develop psychosis, may be due to infection, trauma, liver disease or electrolyte abnormalities that require hospital care [34]
Suspected to suffer from Wernicke's encephalopathy, fits, or DTs
Hospital vs Clinic vs Home
At Home
In A Clinic
In A Hospital
Must not have severe AUD
May have mild to severe AUD
Must have severe AUD and be at risk of severe side effects
Assessments of treatment completed by nurse, no approval needed
Assessments done by clinic staff, approval for suitability for treatment needed
Assessments performed by hospital staff
Dangers of less medical care and being around triggers
Less dangers due to 24 hour care
Less dangers due to 24 hour care
Around 7 days - longer if patient is distracted by triggers
Around 7 days - longer if patient has severe alcohol use disorder
Around 7 days - potentially longer as patients are experiencing severe side effects
Suitable for mild to moderate symptoms
Suitable for moderate to serious symptoms
Suitable for severe symptoms
Not suitable for patients with liver cirrhosis or disease
Suitable for patients with liver cirrhosis or disease
Suitable for patients with liver cirrhosis or disease
Liver cirrhosis and disease - causing further damage to what has already been done by alcoholism
Wider Addiction Treatment
A bigger drug treatment plan is necessary to achieve and maintain sobriety, which includes therapy in order to identify and resolve the causes of alcohol addiction and aftercare to assist in readjusting to life without alcohol and avoiding relapse.
Removing the physical dependency for alcohol does not solve:
Triggers for using alcohol
Enablers and social groups that encourage drinking habits
Co-occurring mental health disorders that may be causing alcohol dependency
Detoxification alone has a success rate of between 20-50%, whereas a full treatment plan has a success rate of 60%, meaning those who are not successful initially may have to complete the process again and have to pay for both sets of treatment [38].
Medical Detox Is Not Rehab
Alcohol rehab provides:
24 hour care from treatment providers
Support from staff as well as other clients
Removal from home environment and causes of addiction
Different forms of therapy such as grief and trauma counselling, anger management and family therapy
Studies show that inpatient rehabilitation lowers the chance of relapse, increases social functioning, and decreases criminal activity [39].
Ideal Candidate
Not bingeing on alcohol but not attempting to go cold turkey and risk extreme side effects
No preconceptions about sobriety - even if they have previously attended treatment
Realistic about the difficulties of recovery - being aware that potential obstacles and slips may occur and this does not mean failure
Perhaps struggling with finances due to costs of alcohol habit - but with supportive friends and family members offering to finance treatment
Receiving external support from friends and family - by creating boundaries, asking the alcoholic to seek treatment and stating the negative consequences of not getting help
Support from employers - an employer that is concerned about the consequences of the alcoholic arriving late, being drunk and underperforming so is encouraging the alcoholic to take time from work to seek help for alcohol addiction
Changes in appearance - gaining or losing weight, lack of hygiene and not caring about their appearance demonstrates how much alcohol addiction has taken over
Experiencing negative emotions as a result of worsening drinking - no longer experiencing increased confidence or reduced social anxiety, but depression and anxiety
Being Prepared
Being aware of what to expect, such as the overall process, the treatment options available and the length of the programme reduce anxiety and create a positive mindset for treatment.
The ideal mental and emotional state of an alcoholic entering treatment is one that is prepared to confront and deal with emotions that may arise during treatment, such as shame, guilt, anger and trauma.
Difficult family relationships, stress, grief and trauma may also cause the alcoholic to do better in treatment, as they have the opportunity to face the emotions that caused addiction and the consequences of their actions, causing more motivation towards recovery.
Whether or not this is the first stay in an alcohol facility, an alcoholic who is entering treatment will have begun to accept the addiction and take accountability for their actions as part of their recovery journey.
Only essential items are required to be brought into an alcohol facility, including:
1 weeks worth of clothing
Stationary and notepads for writing
Hygiene products - toothbrush and toothpaste, deodorant and feminine hygiene products
Contact information of loved ones
Although it varies between clinics, items that are not allowed in facilities include mobile phones, items containing alcohol such as mouthwash and expensive items such as jewellery.
Risks
8% of patients die after experiencing convulsions or fits during the process [40].
If round-the-clock medical assistance is unavailable, or there are no NHS resources available, it may be safer for the alcoholic to keep drinking instead of attempting to cease drinking alone.
48% of patients who experienced convulsions during treatment had attempted detox five or more times previously, meaning repeated attempts are to be avoided [41].
Reasons alcoholics repeatedly go through the process that lead it to being contra-indicated are:
Social groups - alcoholics that immediately return to the same groups of other users and enablers
Being willing to be treated for physical addiction but not wanting to change behaviour or addictive pattern
About the author
Harriet Garfoot
Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).
