Alcohol Detox

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KEY TAKEAWAYS

Alcohol detox is withdrawing from alcohol with medication and support from medical professionals and is considered safer than withdrawing unassisted.

Withdrawal symptoms alter based on alcohol intake levels and previous experiences under withdrawal.

The process of alcohol cessation and withdrawal is completed in a hospital, clinic or at home (medically-assisted) [1].

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Alcohol Withdrawal

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 alcohol intake is reduced, the brain transitions into a hyperactive state, causing risk of seizure.

Alcohol Withdrawal Symptoms

Mild Drinking

Symptoms experienced 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.

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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 severe alcohol withdrawal symptoms [3]
  • Severe disorientation
  • Hallucinations - affect 0.6-0.7% of those withdrawing from severe alcohol abuse [4]
  • Seizures
  • 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 Does Alcohol Withdrawal 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 seizure.

Physical cravings 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 For Alcohol Withdrawal

Drinking Pattern

Intake Level

Duration Of Withdrawal

Casual Drinking

1 drink per week for women 2 drinks per week for men [6]

No withdrawal, 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 withdrawal
symptoms stopping after 48 hours

Heavy Drinking

8 drinks per week for women 15 drinks per week for men [8]

Withdrawal symptoms from 48 hours to several weeks [9]

How To Cope With Alcohol Withdrawal

  • 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 stop drinking, 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 stop drinking are:

  • Medication for alcohol cravings - naltrexone, acamprosate and tiapride reduce cravings
  • 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 reducing alcoholic intake over time to slow down symptoms, especially if consumption of alcohol has been heavy and over a number of years
  • Holistic methods such as acupuncture and massage therapy - reduces both the physical pain and emotional stress of the withdrawal process

Alcohol Withdrawal Timeline Day By Day

6-12 hours after the last alcoholic drink

  • Headaches
  • Hand tremors
  • Cravings
  • Beginning to feel depressed
  • Anxiety
  • Stomach pains
  • Insomnia
  • Poor appetite

12-24 hours after the last alcoholic drink

  • With severe alcohol withdrawal, DTs
  • Hallucinations
  • Seizures

48 hours after the last alcoholic drink

  • With less severe alcohol withdrawal, mild symptoms may begin to disappear
  • Fever
  • Sweating
  • Confusion
  • High 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 seizures 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

The alcohol detoxification process is controlled by drugs such as:

  • Benzodiazepines - used to treat symptoms such as insomnia, anxiety and muscle spasms
  • Naltrexone - reduces alcohol cravings
  • Acamprosate - helps the brain function without alcohol and reduces cravings

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 experienced may become severe, developing into seizures 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, seizures 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 alcoholism 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 - alcoholism 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 alcoholism 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 professionals to assess the right treatment for alcohol addiction and create a treatment timeline.

Withdrawal

Alcohol will be stopped or gradually reduced, based on individual need, and side effects will begin.

Treatment continues until symptoms start to subside; this is different for each patient but typically happens within 1-2 weeks.

Unlike withdrawal without assistance, in a residential facility medication and 24 hour professional care are provided to manage your withdrawal.

The next stage

After you have completed your detox programme, 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

Detoxification 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 have gone through 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, seizures 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].

Detox Symptoms

Physical symptoms

  • Rapid heartbeat
  • High blood pressure
  • Seizures
  • Delirium tremens - only affecting long term excessive abuse of alcohol
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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 [15]
  • 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 withdrawal [16]
  • 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 [17]

Alcohol Detox Timeline - Day By Day

Timeline of Symptoms

Alcoholism

Eating Disorders

6-12 Hours

Headaches, insomnia,
stomach pains and hand
tremors [18]

Headaches, insomnia,
stomach pains and hand
tremors- symptoms are
observed and medication is
provided

12-24 Hours

Delirium tremens,
hallucinations and seizures
[19]

Potential for oversedation,
ataxia, high blood pressure
and respiratory issues

48 Hours

Fever, sweating and high
blood pressure

Potential for delirium
tremens, hallucinations and seizures if tapering dose is done too quickly

7 Days

Easing of symptoms -
continuing in some severe
cases

Easing or removal of
symptoms [20] [21]

At Home

Detox at home is when a specialised 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 seizures
  • A strong pre-existing support system that is available to visit frequently
  • Not consuming more than 30 units daily

Alcohol Detox At Home

Alcohol Detox In A Clinic

Care from a detox nurse 4 times per day

Care provided 24 hours a day

Symptoms treated with medication - may take time for nurse to arrive to administer dosage [22]

Symptoms treated with medication
immediately

Detox nurses look for how patient is reacting
to withdrawal, breathing, heart rate and blood pressure

Medical professionals look for physical
symptoms as well as psychological reactions
to discuss during further treatment

Support is required from friends and family
during detox

Support from friends and family assists in
recovery but is also provided by clinic staff
[23]

In A Clinic

Detoxing from alcohol in a residential clinic becomes necessary when:

  • There is evidence of heavy alcohol misuse over a long period of time
  • Enabling friends or family members - those who make excuses and take responsibility for the alcoholic hinder recovery
  • 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
  • Severe symptoms of liver cirrhosis or disease
  • 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
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In Hospital

Detoxification in a hospital is required when there is:

  • Previous or current experience of 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 from alcoholism that require hospital care [24]
  • Suspected to suffer from Wernicke's encephalopathy, seizures or DTs

Hospital vs Clinic vs Home

Alcohol Detox At Home

Alcohol Detox In A Clinic

Alcohol Detox In A Hospital

Must not have severe alcohol use disorder

May have mild to severe
alcohol use disorder

Must have severe alcohol use disorder and be at risk of severe side effects

Assessments of treatment
done by detox 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 alcohol dependency

Suitable for moderate to
severe alcohol dependency

Suitable for severe alcohol
dependency and side effects

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

No support after detox [25]

Support provided after detox [26]

No support after detox [27]

Is It Bad To Drink Alcohol While Detoxing?

It is bad to drink alcohol while detoxing because the medication enhances the effects of GABA to reduce side effects, with excess GABA from alcohol use causing a lack of brain activity.

Benzodiazepines, commonly prescribed during treatment, cause dangers when combined with alcohol such as:

  • Increased risk of overdose
  • Physical side effects - nausea, vomiting, lethargy, allergic reactions, heart attacks, strokes and seizures
  • 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 alcoholism

Detox 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 [28].

Medical Detox Is Not Rehab

Alcohol rehab provides:

  • 24 hour care from treatment providers
  • Support from staff as well as other people with alcohol use disorder
  • 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 not only does inpatient rehabilitation lower the chance of relapse, it also increases social functioning and decreases criminal activity [29].

Ideal Candidate For Alcohol Detox

  • Not bingeing on alcohol but not attempting to go cold turkey and risk severe symptoms of cessation
  • 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 alcoholism - no longer experiencing increased confidence or reduced social anxiety, but depression and anxiety

Being Prepared To Detox From Alcohol

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.

When Alcohol Detox Is NOT Appropriate

8% of patients die after experiencing seizures during withdrawal [30].

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 seizures during treatment had attempted detox five or more times previously, meaning repeated detox is to be avoided as there is a greater risk of developing severe withdrawal [31].

Reasons why alcoholics repeatedly detox that lead it to not be recommended include:

  • 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
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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).

Last Updated: February 28, 2024