Detoxing from excessive alcohol use is dangerous and shouldn’t be attempted without medical supervision.
Alcohol withdrawal happens when someone abruptly stops or significantly reduces their alcohol consumption.
Symptoms of alcohol withdrawal can vary widely from mild anxiety and shakiness to severe complications, like seizures and delirium tremens. Delirium tremens can be life threatening and are characterized by confusion, rapid heartbeat, and fever.
Because of the severe effects of alcohol withdrawal, it’s important to seek medical attention even if symptoms are mild. Alcohol detoxes can effectively reduce the risk of developing withdrawal seizures and delirium tremens.
Causes of Alcohol Withdrawal
Excessive daily drinking disrupts the brain’s neurotransmitters.
An example of daily drinking affecting the brain’s neurotransmitters– alcohol at first enhances GABA (GABA is a neurotransmitter that produces feelings of relaxation), but after a while the same alcohol use that helped GABA no longer does, requiring you to drink more alcohol to get the same relaxed feeling you did at first.
Heavy alcohol intake also suppresses glutamate, the neurotransmitter which produces feelings of excitement. To maintain balance, the glutamate system responds by functioning at a higher level than it does in moderate drinkers and nondrinkers.
When chronic drinkers stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability. So, the effects related with alcohol withdrawal– anxiety, irritability, agitation, tremors, seizures and delirium tremens– are the opposite of those related with alcohol consumption.
Symptoms of Alcohol Withdrawal
Generally the severity of someone’s alcohol withdrawal symptoms depends on how much and for how long a person has been drinking.
Alcohol withdrawal symptoms usually show up 6 to 12 hours after a person stops drinking. Symptoms include:
- Shaky hands
- Mild anxiety
12-24 hours after they stop drinking, some people may experience visual, auditory, or tactile hallucinations. These normally end within 48 hours.
Withdrawal seizures normally appear between 24 to 48 hours after someone stops drinking, though they can appear as early as 2 hours after drinking stops. The chances of seizures are significantly higher in people who have previously detoxed multiple times.
Treatment of Alcohol Withdrawal Syndrome
If you have moderate withdrawal symptoms, your doctor may choose to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detox is safe, effective, and less costly than inpatient detox.
However, you may require inpatient treatment if you don’t have a reliable social network, are pregnant, or have a history of any of the following:
- Severe withdrawal symptoms
- Withdrawal seizures or DTs
- Multiple previous detoxifications
- Certain medical or psychiatric illnesses
- The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.
Prescription drugs of choice include benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine (Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.
To help withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen. These may include:
-An antipsychotic drug, which can help relieve agitation and hallucinations
-A beta-blocker, which may help curb a fast heart rate and elevated blood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
-Clonidine (Catapres), another blood pressure drug
-Phenytoin (Dilantin), an anticonvulsant which doesn’t treat withdrawal seizures but may be useful in people with an underlying seizure disorder
Preventing Future Alcohol Withdrawal Episodes
Because successful treatment of alcohol withdrawal syndrome doesn’t address the underlying disease of addiction, it should be followed by treatment for alcohol abuse or alcohol dependence.
Relatively brief outpatient interventions can be effective for alcohol abuse, but more intensive therapy may be required for alcohol dependence. If you have alcohol dependence, your doctor may prescribe other medications to help you stop drinking. He or she also may recommend joining a 12-step group — such as Alcoholics Anonymous and Narcotics Anonymous — or staying at a comprehensive treatment facility that offers a combination of a 12-step model, cognitive-behavioral therapy, and family therapy.