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’.
Family Recovery Compass is a newsletter for friends and family members who feel trapped between supporting a loved one in addiction, and protecting their own wellbeing.
Every week, we tackle one specific situation in addiction family dynamics, and deliver practical decision-making frameworks and exact dialogue scripts – that help you respond with confidence instead of reaction.
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.
Clinically managed residential detoxification is:
– A structured detox that uses medication-assisted treatment and regular physical health observations
– Takes place in an inpatient rehabilitation unit or hospital
– Typically lasts from 7-10 days, but in Abbeycare, it is incorporated into a 28-day rehab programme
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?
Click below.
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.
A 7-day process that uses 2/0.5 - 32/8mg Suboxone to mitigate abdominal pain, hand tremors, and diarrhoea high-level use (≥30 tablets daily) of codeine [1]
Symptomatically treated with 50 -150 µg clonidine to manage restlessness, lacrimation, and irritability by minimising sympathetic outflow within 48 hours of detoxing [1]
How Is Detox For Codeine Done In A Controlled Setting?
A detox for codeine is done in a controlled setting by:
Administering standardised assessment tools (e.g. SDS, ASI) to predict the severity of withdrawal based on the amount of codeine taken daily (e.g. high-level use > 16 tablets daily = severe withdrawal expected) [1]
Conducting 6-hourly evaluations using The Clinical Opiate Withdrawal Scale, to develop an appropriate medication regimen after establishing the level (e.g. COWS: 13 – 24 = moderate) of joint pain, abdominal cramps/spasms, and restlessness [2]
Providing up to 8/2mg of Suboxone with 2-hourly monitoring 12 – 24 hours after the last dose of codeine and stabilising patients on a maximum daily dose of 32/8mg for around 1 week to mitigate severe withdrawal (e.g. COWS > 36) [3]
Symptomatically treating agitation, muscle/joint, and abdominal pain developing within 6 - 24 hours of cessation using 50 - 150 µg clonidine, 400mg ibuprofen, or 20mg Hyoscine butylbromide as needed for 5 - 10 days [1][2]
Physical Symptoms Of Codeine Detox
Muscle Aches And Joint Pain
Body aches are a physical symptom of codeine detoxification experienced by 98% of patients who withdraw after prolonged use (e.g. 14 years) as the body struggles to naturally produce endorphins due to the loss of mu (μ) receptor stimulation after abstaining [4]:
Diffuse body pain typically develops within 4 – 48 hours of codeine cessation and lasts for an average of 4 – 5 days in patients who previously abused 60 – 500ml of codeine-containing cough syrup daily for 4 years [4]
Aches and pains usually peak during days 2 - 4 and are exacerbated by disruptions in pain signalling and perception caused by imbalances in excitatory (+22% glutamate) and inhibitory (-24% GABA) neurotransmission after 5 years of codeine abuse [2][5]
Joint pain is less severe (e.g. 1 = mild diffuse pain vs 4 = unable to sit still due to discomfort) during a detox from codeine compared to other opiates, i.e. morphine, due to a weaker analgesic effect and Ki nM (734.2 vs 1.168) at the μ-receptor [6]
Nilsen et al. (2010) found that a 39-year-old female's musculoskeletal pain was 40% less intense within 8 weeks of receiving a codeine taper during detox after previously abusing 210mg daily for 3 years [7].
Restlessness And Hand Tremors
Psychomotor agitation is a physical symptom of codeine detoxification because autonomic and motor signalling is no longer suppressed by taking 100mg of codeine daily, resulting in fidgeting, an inability to sit still, or finger tapping due to CNS excitation [8].
Restlessness may present as anxiousness in up to 83% of patients who previously abused up to 500 mL of codeine-based cough syrup (e.g. Phensedyl) daily for a minimum of 5+ months, developing within 12 hours of discontinuation and lasting for around 5 days [4].
Tremors during withdrawal from codeine are typically localised (e.g. hands) rather than systemic (e.g. full body) as codeine is 10 times less potent than morphine compared to other opioids (e.g. fentanyl), which is 100 times more potent than morphine [9].
Clinicians administer COWS to evaluate the intensity of restlessness (e.g. 3 = frequent shifting or extraneous movements of the legs/ arms) and tremors (e.g. 4 = gross tremor or muscular twitching during observations of outstretched hands) during a detox from codeine.
50 - 150 µg of clonidine is administered every 6 hours as needed for up to 5 days during detox to manage restlessness and hand tremors developing within 4 - 48 hours of codeine cessation [1][4].
Abdominal Cramps
Abdominal cramps/spasms are a physical symptom of codeine detoxification because the enteric nervous system (ENS) becomes overactive and gut motility accelerates after being suppressed during active use, leading to vomiting and diarrhoea in up to 85% [10].
78% of daily codeine users have loose bowel movements within 2 days of detoxing due to the loss of μ receptor stimulation in the gastrointestinal tract, typically easing within 5 days as phasic contractions are stabilised by the recovery of the ENS after abstaining [4].
Clinicians use the Clinical Opiate Withdrawal Scale to gauge the intensity of gastrointestinal upset experienced within the past 30 minutes (2 = nausea or loose stool vs 5 = multiple episodes of vomiting or diarrhoea) in patients detoxing from codeine.
20mg Hyoscine butylbromide is provided every 6 hours to manage abdominal cramps/spasms as needed, alongside 2mg loperamide and 10mg metoclopramide to control diarrhoea, vomiting, and nausea developing within 48 hours of abstaining from codeine [2][4].
Lacrimation
Lacrimation is a physical symptom of codeine detoxification that occurs in 98% of patients, as the lacrimal glands become overstimulated within 2 days of cessation due to the rebound of parasympathetic activity after being inhibited during active use [4].
Lacrimation typically peaks during days 2 – 4 of codeine cessation and lasts an average of 5 – 10 days, and assessment tools (e.g. SOWS, COWS) are used to distinguish between “normal” and “abnormal” tearing during detox by [2]:
Asking patients to rate the statement “My eyes are tearing” using a 0 – 4 rating scale where 0 = not at all, 1 = a little, 2 = moderately, 3 = quite a bit, and 4 = extremely
Conducting physical observations to evaluate the production of tears not accounted for by a cold/flu or allergies, and establishing whether patients have unusually moist eyes or tears streaming down the cheeks using a 4-point scoring system [2]
Psychological Symptoms Of Codeine Detox
Depression
Depression is a psychological withdrawal symptom of codeine detoxification due to the rebound of low mood, energy, and motivation; and a 35% reduction in the availability of dopamine transporters in the striatum after 12+ months of codeine misuse because [11][12]:
45% of users take around 240mg of codeine daily to “feel better when down or depressed” due to the drug’s ability to enhance mood for around 4 hours at a time, and some patients claim, “It gave me direct depression ... from coming off.” [13][14]
Abusing prescription analgesics for ≥ 6 months increases the risk of depression by 50% due to disruptions in dopaminergic signalling, and codeine patients have abused the drug for an average of 4 years before entering treatment [4][15]
Nilsen et al. (2010) found that 18% of patients experienced depression during detox after abusing codeine for 1 – 3 years, although the intensity decreased from 2 (moderate) to 0 (none) within 3 months of treatment after previously taking 210 - 240mg daily [7].
Irritability
Irritability is a psychological withdrawal symptom of codeine detoxification caused by μ-receptor deactivation and neurochemical imbalances (e.g. a 35% decrease in dopamine) in brain regions responsible for mood regulation (e.g. striatum) after 1 year of use [11].
Irritability typically develops within 24 hours of codeine cessation and peaks during days 2 – 3, as some users claim “I’d get very, very agitated” for around 5 - 10 days after abstaining because misusing codeine for ≥ 3 months increases mood swings by 2-fold [2][14][16].
Irritability is typically assessed on a 6-hourly basis using the Clinical Opiate Withdrawal Scale, where a score of 4 is assigned to patients who appear so irritable that participation in the assessment is difficult, compared to a score of 0 if no irritability is present [2].
Emotional Restlessness
Emotional restlessness occurs during codeine detoxification due to excitatory-inhibitory imbalances (e.g. a 24% reduction in GABA + a 22% increase in glutamate) in brain regions involved in emotional processing (e.g. medial prefrontal cortex) after 5 years of use [5].
Emotional restlessness typically develops within 2 days of withdrawing from codeine and is exacerbated by insomnia and anxiety in 83 – 100% of patients who abstain after heavy use (e.g. 60 - 500ml of codeine-containing cough syrup daily) [4].
Slight (1935) studied a 44-year-old man who became nervous within 7 hours of last taking codeine that was initially prescribed for “foot pain”, although emotional symptoms (e.g. irritability) resolved within 1 week after previously injecting 80mg of codeine per day [17].
SOWS is used to assess signs of emotional restlessness by asking patients to rate statements such as “I feel anxious” and “I feel restless” from 0 – 4 to describe the current intensity (e.g. 0 = not at all vs 4 = extremely) during each day of codeine detoxification.
Positive Benchmarks Of Codeine Detox
Return Of Normal Bowel Function
Complete resolution of diarrhoea within 5 days is a positive benchmark of codeine detoxification as intestinal contractions are inhibited by taking 2-16mg/d of loperamide to manage loose bowel movements experienced by 78% of patients within 2 days of cessation [2][4].
Stiles et al. (2010) found that the intensity of diarrhoea decreased by 3-fold at the 12-week follow-up in 5 patients who received an 8-week codeine taper after abusing high doses (e.g. 420mg/d) that were initially prescribed for neuropathic or musculoskeletal pain [7].
Patients typically have healthy bowel movements (1-2 daily) within 10 days of abstaining from codeine after having ≥ 3 loose stools daily during the first 5 days, and constipation (< 3 stools p/wk) with related symptoms (e.g. abdominal bloating) during active use [2][4].
Reduced Cravings
Cravings/urges to use codeine mid-detox are rated 2 (moderate) on a 0 - 3 intensity scale, compared to a 1 (small) post-detox and a 0 (none) at the 3-month follow-up in patients who previously abused 180mg of codeine daily for 1 year [7].
Mattoo et al. (1997) found that the urge to use codeine subsided within 4 - 5 days of detoxing after 100% of patients with a long-term codeine addiction (e.g. 14 years of daily use) felt the desire to take the drug within 4 - 48 hours of abstaining [4].
Fors et al. (2010) found that cravings/urges to take codeine completely subsided by the end of treatment in 70% of patients who previously abused up to 420mg of prescribed codeine daily before receiving an 8-week taper during detox [7].
Fors et al. (2010) found that cravings/urges to take codeine completely subsided by the end of treatment in 70% of patients who previously abused up to 420mg of prescribed codeine daily before receiving an 8-week taper during detox [7].
Improved Mood Stability
A 50% decrease in anxiousness is a positive benchmark of codeine detoxification because patients no longer feel “very agitated and in complete shutdown” within 12 weeks of abstaining after previously abusing 240mg of codeine daily for 10 years [7][14].
Nilsen et al. (2010) found that a 29-year-old female's scores on the mental health subscale of the SF-36 HRQL increased by 67% within 3 months of detoxing after previously taking 240mg of codeine daily for 1 year and experiencing moderate depression mid-detox [7].
Slight (1935) studied a 44-year-old man whose nervousness, sweating, and irritability subsided within 1 week of receiving a medically supervised detox after previously abusing 80mg of codeine daily, alongside heroin and morphine for around 9 years [17].
How Does Dehydration Alter Codeine Detox Protocols?
Being dehydrated alters codeine detoxification protocols because 78% have loose bowel movements during the first 5 days, and patients who pass ≥8 loose or watery stools within 24 hours are 9 times more likely to become severely dehydrated, requiring [4][18]:
Regular encouragement to consume “light” balanced meals with protein (e.g. meat), complex carbohydrates (e.g. wholegrain bread), and dietary fibre (e.g. berries) alongside 2 – 3L of liquid (e.g. water) daily throughout the withdrawal period [2]
Nutritional/fluid intake and output, urea electrolytes, creatinine, liver function, and acid-base balance evaluations and monitoring with 2 – 5L of intravenous rehydration with potassium or magnesium salts if needed when COWS > 36 [2]
Higher doses of loperamide (e.g. 16mg vs 2mg) to inhibit peristalsis and electrolyte loss with ongoing monitoring to assess the number of loose stools after each dose and general gastrointestinal functioning [2]
Providing suboxone around 12 – 24 hours after the last use of codeine and symptomatically treating joint pain or abdominal/bowel spasms with ibuprofen or hyoscine butylbromide as needed after being examined by the medical team
Assigning each patient with a key worker during the first 7 days to ease nervousness and apprehension by providing 1-1 support and developing a personalised care plan in a calm and relaxed environment
Using assessment tools (e.g. COWS) and regular supervision to evaluate changes in gastrointestinal functioning (e.g. number of vomiting/diarrhoea episodes), mood, and perspiration (e.g. sweat streaming off face) during the first week of treatment
About the author
Mischa Ezekpo
Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).
