Stop Drinking FAQ

What Happens When You Stop Drinking?

When you stop drinking, most will likely experience withdrawal symptoms, including sweating, tremor, headache, blood pressure fluctuations, and sleeplessness.

Generally speaking, withdrawal symptoms can be unpleasant.

The most severe withdrawal symptoms usually occur in the first few days after drinking has stopped.

 

Here is the typical timeline for alcohol withdrawal symptoms [1]:

Days 0 to 1

  • >> Anxious feelings
  • >> Irritability
  • >> Sleeplessness
  • >> Headaches/Migraines
  • >> Stomach upsets
  • >> Excessive sweating
  • >> Loss of appetite
  • >> Insomnia

 

Days 1 to 2

  • >> Shakes/ Tremors/ Muscle spasms
  • >> Fever
  • >> Stomach upsets
  • >> Nausea/Vomiting
  • >> Continued Insomnia

 

Days 2 to 3

  • >> Shakes/ Tremors/ Muscle spasms
  • >> Delirium Tremens (a form of seizure)
  • >> Blood pressure may rise
  • >> Heart can beat faster than usual
  • >> Excessive sweating
  • >> Continued Insomnia
  • >> Some individuals experience hallucinations

 

Symptoms in days 2 to 3 can last up to 5 days, especially without professional help.

Experts believe, that if symptoms do not get worse 24 to 48 hours after the last drink, there is a better chance of recovery [2].

Alcohol Withdrawal Syndrome (AWS) is the formal name given to the collection of symptoms felt during alcohol withdrawal [1].

 

AWS can range from Mild, Moderate to Severe.

In a rehab clinic, health care workers determine how serious AWS is by conducting an assessment process.

 

The AWS assessment process can include [3]:

Using a scale called CIWA-Ar:

  • >> Using a scale called CIWA-Ar:
  • >> Blood tests
  • >> Alcohol and/or toxicology screen

 

 

The assessment process will help to: [3]

  • >> Monitor a person’s progress during treatment
  • >> Determine instances when it is appropriate to give medication
  • >> Give an indication when treatment can be stopped
  • >> Help health care workers know when the person can be referred to outpatient care

 

 

Severe cases of AWS can result in death, due to Delirium Tremens.

This is especially true if a severe case is not immediately treated [2].

 

Why Alcohol Withdrawal Syndrome (AWS) happens [4]:

  • >> The brain maintains balance by maintaining the levels of inhibitory (“stoppers”) and excitatory (“go-ers”) neurotransmitters.
  • >> One of the major excitatory neurotransmitters (or brain chemical) is glutamate, which acts through the N-methyl-D-aspartate (NMDA) neuroreceptor.

 

  • >> Alcohol stops the action of the NMDA neuroreceptors, when this happens, the brain becomes over-excited.
  • >> Continuous, regular use of alcohol makes this over-excitement a regular action for the brain (this is called hyperexcitability).

 

  • >>Hyperexcitability accounts for AWS symptoms such as anxiety, insomnia and tremors.
  • >> As for the brain’s inhibitory (“stopper”) neurotransmitter, it is called γ-amino-butyric acid (GABA).

 

  • >> GABA acts through (GABA-A) neuroreceptor.
  • >> When the brain acts in a normal way, GABA prevents a person’s brain from becoming overly excited.
  • >> Alcohol enhances the effect of GABA by making the GABA-A neuroreceptors over-eager

 

  • >> The “over-eagerness” is why a person feels relaxed after drinking an alcoholic beverage.
  • >> But when alcohol is consumed too much and too often, the brain gets used to this over-eagerness of the receptors.

 

  • >> The person’s brain becomes used to this high level of GABA-A neuroreceptor activity.
  • >> To maintain this unusual level, the person tends to want more alcohol in order to relax or just feel normal (not agitated)

 

An important concept in both alcohol craving and alcohol withdrawal is the “kindling”

With repeated attempts at alcohol withdrawal, a person may experience “kindling”.

Kindling means, that brain cells experience long-term changes and worsening of alcohol withdrawal symptoms every time an attempt to quit is performed.

When a person seeks professional help for detox, for instance in a clinic like Abbeycare, there is a better chance of preventing relapse [5].

 

What Defines An Alcoholic?

An alcoholic is defined as a person who exhibits problematic drinking behaviour, which affects the individual’s mental and physical health. [6]

The person’s social life, family life, and activities at work also tend to be affected.

For the person to be officially diagnosed as “alcoholic”, the problems (called impairments) should last for at least a week.

 

The term “alcoholic” is sometimes considered derogatory or insulting.

The terms “problematic drinking” and “Alcohol Use Disorder (AUD)” have largely replaced “alcoholic”.

Persons who have AUD are also classified as having a mild, moderate or severe case of AUD, depending on the number of symptoms they exhibit.

Experts say that AUD is best approached undergoing a structured rehab program such as one offered by Abbeycare Gloucester Clinic.

 

In recent years, the term “grey area drinker” has become buzz word [7].

A grey area drinker can be described as a person who does not strictly meet the criteria for Alcohol Use Disorder.

A grey area drinker may not have work, family or job impairments that make the problematic drinking easy to spot.

Grey area drinkers may not hit rock bottom like persons who have a more serious case of AUD.

But they can also benefit from professional care in an alcohol rehab clinic.

 

 

What Is The Best Way To Stop Drinking?

The best way to stop drinking is to reduce intake levels over time, gradually [8].

A cold-turkey approach increases the chance of relapse.

Relapse is linked to a phenomenon called “kindling”.

Kindling is a tendency for withdrawal symptoms to get worse every time there is another attempt to quit alcohol.

Individuals who quit drinking all of a sudden are prone to experience the most negative effects of alcohol withdrawal.

 

In serious cases, some individuals can be hospitalised due to Delirium Tremens or seizures connected with alcohol, withdrawal.

Less serious cases of Alcohol Withdrawal Syndrome can be successfully treated on an out-patient basis.

Overall, finding professional help is also a good idea so that the negative experiences associated with alcohol withdrawal can be minimised.

 

Here are some tips to quit alcohol adapted from the National Institute on Alcohol Abuse and Alcoholism (US): [9]

  • >> Gradually decrease alcohol consumed to the recommended levels
  • >> Identify and avoid alcohol triggers
  • >> Talk through urges to drink with an accountability partner or a professional (counsellor, therapist, etc.)
  • >> Develop the habit to say “no, thanks” convincingly and readily.
  • >> Seek other healthier ways to cope with stress, manage moods, and feel more relaxed around other people.

 

 

Professionals who can help with quitting alcohol include:

  • >> Addiction counsellor
  • >> Local health care workers
  • >> Therapists who use Cognitive Behavioural Therapy and 12 Step facilitation

 

 

A rehab clinic well-equipped to provide professional help will also:

  • >> Be able to handle withdrawal complications
  • >> Have qualified staff to administer treatments
  • >> Check an individual’s progress during alcohol withdrawal
  • >> Look after overall health
  • >> Personalise a treatment plan
  • >> Recommend support so the person can be supported after therapy

How Do You Know If Alcohol Is Affecting Your Health?

Signs that a person’s health is being affected by alcohol, can include memory loss, and early symptoms of liver damage.

In addition, alcohol dependency is another warning sign [4].

Memory loss is seen when: [10]

  • >> A person becomes increasingly forgetful of recent events
  • >> Appointments are forgotten
  • >> Some daily tasks are overlooked
  • >> Things become lost or misplaced more often
  • >> Usual activities take more time than usual because the person got confused about the next step
  • >> Other persons have remarked about the memory loss

 

Loss of memory is associated with problematic alcohol use because alcohol affects the hippocampus, the part f the brain responsible for memories. [11]

 

Early signs of liver damage

Whereas, memory loss is quite obvious, are less easy to spot.

The first stage of liver disease associated with heavy use of alcohol is alcoholic fatty liver disease. [12]

The symptoms of alcoholic fatty liver disease are:

  • >> stomach upsets/ nausea
  • >> abdominal pain
  • >> diarrhoea
  • >> lessened appetite
  • >> feeling weak
  • >> itchy skin

 

If there is blood in the vomit or stools, it is a sign to seek professional help.

 

Indicators of alcohol dependency [2]

  • >> morning drinking (with or without vomiting)
  • >> unable to feel “normal” without drinking
  • >> tremors and muscle spasms
  • >> the person plans the day around drinking
  • >> skipping meals
  • >> cannot sleep without drinking
  • >> being unable to keep a self-imposed drink limit

 

Defining “normal drinking” is useful when a person wants to know if his or her behaviour conforms to what is considered acceptable.

With this line of reasoning, the NHS guidelines can be consulted.

 

The NHS recommends drinking only 14 units of alcohol a week [13].

  • >> One unit of alcohol is equivalent to:
  • >> half a pint of regular beer
  • >> half a glass of red wine
  • >> one single measure of spirits or aperitifs

 

The NHS also suggests refraining from binge drinking.

 

Binge drinking means:

  • >> Male – 8 units of alcohol in a single session
  • >> Female – 6 units of alcohol in a single session

 

This definition is different because male and female bodies process alcohol differently in terms of metabolism, pharmacokinetics, and pharmacodynamics [14].

It is also recommended to evenly spread the 14 units recommended throughout the week.

Whenever possible, alcohol-free days should be practiced

 

Individuals who are concerned about alcohol use can benefit from detoxing safely in a structured program [15].

A rehab clinic such as Abbeycare Scotland can also offer a home detox option for a mild case of alcohol dependency.

Since alcohol dependence can be a sign of a deeper problem, some mental health workers also recommend psychotherapy.

 

Psychotherapeutic approaches most often used with problem drinking include:

  • >> 12 Step Facilitation
  • >> Cognitive Behavioural Therapy
  • >> Dialectical Behaviour therapy

 

An individual who undergoes detox and therapeutic work is likely to have a better grasp of the issues causing alcohol addiction.

This understanding can help sustain a sober living lifestyle.

 

References

  1.   Muncie, H. Jr., Yasinian, Y. & Oge’ L. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. Available at: https://www.aafp.org/afp/2013/1101/p589.html
  2.   Richard K. Newman; Megan A. Stobart Gallagher; Anna E. Gomez. (2019). Alcohol Withdrawal. Available at: https://www.ncbi.nlm.nih.gov/books/NBK441882/
  3.   Gortney, et. al. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine. Available at: https://www.mdedge.com/ccjm/article/105413/critical-care/alcohol-withdrawal-syndrome-medical-patients
  4.   Bayard, M., Mcintyre, J., Hill, K. & Woodside, J. (2004). Alcohol Withdrawal Syndrome. Am Fam Physician. 69(6), 1443-1450. Available at: https://www.aafp.org/afp/2004/0315/p1443.html
  5.   National Institute on Alcohol Abuse and Alcoholism (2017). Understanding Relapse. Available at: https://alcoholtreatment.niaaa.nih.gov/support-through-the-process/understanding-relapse
  6.   Phillips, M. (1990). Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Available at: https://www.ncbi.nlm.nih.gov/books/NBK418/
  7.  Scott, C. (2017, November 16). ‘I belonged to the grey area between normal drinker and alcoholic’. Available at: https://www.yorkshirepost.co.uk/news/latest-news/i-belonged-to-the-grey-area-between-normal-drinker-and-alcoholic-says-leeds-woman-who-is-now-helping-growing-number-of-problem-drinkers-1-8860147
  8.  Chernyak, P. (2019). How to Quit Drinking Alcohol. Available at: https://www.wikihow.com/Quit-Drinking-Alcohol
  9.  National Institute on Alcohol Abuse and Alcoholism. (2015). Self-help strategies for quitting drinking. Available at: https://www.rethinkingdrinking.niaaa.nih.gov/Thinking-about-a-change/support-for-quitting/Self-Help-Strategies-For-Quitting.aspx
  10.  Braun, M. (2018). 3 Warning Signs of a Potential Memory Problem. Available at: https://www.psychologytoday.com/us/blog/high-octane-brain/201807/3-warning-signs-potential-memory-problem
  11.  National Institute on Alcohol Abuse and Alcoholism. (2004). Alcohol Alert. Available at: https://pubs.niaaa.nih.gov/publications/aa63/aa63.htm
  12.  Felman, A. (2018). What’s to know about alcoholic liver disease? Medical News Today. Available at: https://www.medicalnewstoday.com/articles/215638.php
  13.  NHS. (2016). New alcohol advice issued. Available at: https://www.nhs.uk/news/food-and-diet/new-alcohol-advice-issued/
  14.  Whitley, H. & Lindsey, W. (2009). Sex-Based Differences in Drug Activity. American Family Physician, 80(11), 1254-1258. Available at: https://www.aafp.org/afp/2009/1201/p1254.html
  15.  National Institute on Alcohol Abuse and Alcoholism. (2019). Available at: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help

 

Author: Melany Heger

Registered Psychologist and Freelance Writer, Jinjin Melany passionately writes about mental health issues, addiction, eating disorders and parenting since 2015. Read more about Melany on LinkedIn.