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].
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:
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:
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:
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 |
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
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:
Reducing Symptoms
Ways to anticipate and prevent complications when you stop drinking are:
Alcohol Withdrawal Timeline Day By Day
6-12 hours after the last alcoholic drink
12-24 hours after the last alcoholic drink
48 hours after the last alcoholic drink
7 days after the last alcoholic drink
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 For Alcohol Detox
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:
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:
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:
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
Psychological and emotional symptoms
Symptoms - How Long?
Factors that lengthen the duration, and increase the severity of symptoms are:
Alcohol Detox Timeline - Day By Day
Timeline of Symptoms | Alcoholism | Eating Disorders |
---|---|---|
6-12 Hours | Headaches, insomnia, | Headaches, insomnia, |
12-24 Hours | Delirium tremens, | Potential for oversedation, |
48 Hours | Fever, sweating and high | Potential for delirium |
7 Days | Easing of symptoms - |
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:
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 |
Detox nurses look for how patient is reacting | Medical professionals look for physical |
Support is required from friends and family | Support from friends and family assists in |
Detox In A Clinic
Detoxing from alcohol in a residential clinic becomes necessary when:
Detox In Hospital
Detoxification in a hospital setting is required when there is:
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 | Must have severe alcohol use disorder and be at risk of severe side effects |
Assessments of treatment | Assessments done by clinic | Assessments performed by |
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 | Around 7 days - longer if | Around 7 days - potentially |
Suitable for mild to moderate alcohol dependency | Suitable for moderate to | Suitable for severe alcohol |
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:
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:
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:
Studies show that inpatient rehabilitation lowers the chance of relapse, increases social functioning, and decreases criminal activity [29].
Ideal Candidate For Alcohol Detox
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:
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: