Ethyl alcohol, or ethanol, is an intoxicating agent produced from the fermentation of yeast, sugars, and starches. Alcohol is the most widely consumed psychoactive substance in the world. While alcohol can be consumed safely and responsibly, excessive alcohol use can quickly lead to abuse and dependence.
A recent survey from the Substance Abuse and Mental Health Services Administration (SAMHSA) found that 140 million Americans, 12 or older, use alcohol. Of these people, 23% are considered binge drinkers. Roughly 6% were considered heavy drinkers, and another 6% met the criteria for an alcohol use disorder. Unfortunately, only a very small percentage of those with an alcohol use disorder seek treatment, according to these recent findings.
Alcohol exerts a pervasively negative physical influence throughout the body, and sustained heavy use can cause significant damage to the brain, liver, and heart. If you or someone you know abuses alcohol, it’s essential to seek help. There are many treatment options available, many of which start with formal detoxification.
Alcohol Withdrawal Symptoms
What is Delirium Tremens?
In rare cases, some patients may experience a specific, severe set of alcohol withdrawal symptoms referred to as delirium tremens (DT).
DT is characterized by profound confusion/delirium and may be accompanied by symptoms like:
- Increased heart rate.
- Increased blood pressure.
Withdrawal from alcohol use produces a number of distressing symptoms. The full spectrum of withdrawal symptoms spans from the mildly troublesome to quite severe, if not life-threatening. Symptoms can include:
- Tremors (whole body or parts of the body).
- Quick mood changes.
- Heart palpitations.
- Hallucinations (alcoholic hallucinosis).
- Seizures (commonly occur in the first 48 hours).
Factors Affecting the Severity
Withdrawals from alcohol are complex, and the severity of symptoms depends on a number of factors, including:
- Alcohol use (level of consumption, frequency, length of use).
- Use of additional substances.
- Past withdrawal history.
- Peak blood alcohol levels.
Past withdrawal history is another important factor in alcohol withdrawal. Three or more past withdrawal periods – especially if any one period was severe – can serve as a potential risk for severe withdrawal episodes in the future.
Any longstanding abuse of alcohol places you at risk of experiencing the significant adverse effects of alcohol withdrawal.
An assessment from a physician or alcohol addiction specialist will help determine what method of detoxification is right for you, whether you need to attend an inpatient program, and what additional treatment options might be appropriate.
What Happens During Alcohol Detox?
Upon receiving an assessment for alcohol abuse, you will be advised of the appropriate steps for treatment, if it is needed. During an assessment, a doctor or addiction specialist will attempt to determine:
- The extent of your alcohol use.
- The presence of any psychiatric disorders, including additional substance use disorders.
These and other questions should help determine what method of detoxification, if any, is appropriate.
If you have a long history of alcohol abuse, including multiple withdrawal periods, you may be advised to enter a medically monitored detoxification program.
These assessments and determinations can be made at a detox center or an outside clinic. Routine questionnaires at the doctor’s office often screen for physical conditions and mental illness, including substance use disorders. Because of the potentially dangerous consequences that may arise during detox and withdrawal, it’s extremely important to be honest you’re your doctor about your alcohol consumption.
If you’ve been diagnosed with an alcohol use disorder and have enrolled in a detox program, you’ll receive an evaluation during intake. Your clinician will also discuss the detoxification process and post-detox treatment options, including medication and counseling. Lying or trying to downplay your use can result in inappropriate treatment recommendations and severe or fatal consequences, so it’s extremely important to be honest.
Before any medication is administered, blood is drawn and other screening medical tests are conducted to determine potential biological indications of severe alcohol abuse (e.g. vitamin deficiencies), as well as to detect the presence of concurrent substance abuse or physical issues that might complicate the treatment process.
During the actual detoxification process, patients are monitored closely to ensure safety and relative comfort.
In some cases, benzodiazepines may be administered to reduce anxiety, agitation, and to prevent tremors and/or seizures. Benzodiazepines are central nervous system depressants that calm the body down. As substances with marked dependency potential, the benzodiazepines will only be utilized in the short withdrawal interim for seizure prophylaxis; their use will be quickly tapered off and discontinued as detox concludes.
What Happens After the Process
SAMHSA encourages the practice of medication-assisted treatment (MAT) for alcohol use disorders. MAT is the combination of approved medications with behavioral therapies to treat addiction.
Medications approved by the FDA to treat alcohol abuse and dependence include:
- Disulfiram (Antabuse) — When taken with alcohol, this medication causes a significant physical reaction that may include nausea/vomiting, heart palpitations, and flushing. These act as a deterrent to continued drinking. As a once-per-day pill, the effectiveness of this therapy relies on the diligence and dedication of the recovering individual.
- Naltrexone — This drug blocks opioid receptors involved in the rewarding effects of drinking or craving alcohol, discouraging abuse.
- Acamprosate (Campral) — This is thought to reduce symptoms the protracted (long-lasting) symptoms of alcohol withdrawal by normalizing levels of neurotransmitter activity affected by alcohol use and withdrawal.
It’s important to note that while medications can be extremely useful tools in the maintenance of recovery from alcoholism, treatment is not complete without other interventions like therapy. Medications will help to curb cravings and prevent relapse so that the recovering user can focus on treating the reasons behind the disorder and learning new skills that will aid long-term recovery efforts.
A comprehensive addiction treatment program that combines therapy and medications can occur on an inpatient or outpatient basis. If you have a history of alcohol abuse and feel that relapse is imminent, consider inpatient treatment. You’ll be in a supportive and monitored environment where your normal environmental triggers will be lessened or absent.
If you have a strong motivation to stay sober and a lot of support at home, you may wish to attend an outpatient program. Outpatient treatment involves visits to a clinic to receive counseling or medication. Outpatient programs are a great option for someone with personal or professional responsibilities that require them to live at home during the duration of treatment.
Why Should I Enter a Program?
While you can detox alone from alcohol, it is not advised because of the potential dangers. The greatest danger of detoxing alone is life-threatening seizures. It is very difficult to assess at intake who might have this experience, which can be fatal. However rare these dangers might be, it is surely not worth the risk.
Even if you are unlikely to experience dangerous withdrawal symptoms, detoxing at home might present the temptation to start using again. Inpatient detox and treatment will provide a wall between temptation and relapse, allowing you to fully recover, however long that might take.
Treatment plans are tailored to each individual and their needs. Any medical issues found at intake, such as blood pressure, heart disease, vitamin deficiencies, etc. will also be addressed.
Treatment of Mental Health Disorders
Additional psychiatric illness is common in cases of alcohol use disorder. Successful addiction treatment will incorporate the treatment of any mental health issues as well.
The treatment of co-occurring disorders is called dual diagnosis treatment. Self-medication of the symptoms associated with various mental health issues may be a contributing factor towards sustained alcohol and drug abuse. This is among the various reasons that the treatment of both issues simultaneously may increase the likelihood of sustained success.
How to Find Alcohol Withdrawal Treatment?
When choosing a detox and treatment program, you should also consider the following:
- Does the treatment center I’m considering offer medication-assisted treatment (MAT)? Is the staff there highly trained?
- Do I need treatment beyond detoxification? (For most people, detox is only the first step in treatment – not the only step.)
- Do I want inpatient or outpatient treatment?
- Can I take time off work to attend treatment? (NOTE: Many employers allow for leave to get addiction treatment. If you’re not sure about your company’s policy, ask your HR manager.)
- If choosing inpatient treatment, what kind of services would be best for me?
- How long can I stay in treatment?
- What amenities or activities are most important to me?
- Does the treatment center have a high rate of success?
- If choosing inpatient treatment, should I find somewhere close or further away from home? (How much support you have at home from friends and family may help you make this decision. If, for example, you have friends or family members that contribute to your substance use in any way, you might consider a treatment center further away.)
- Centers for Disease Control. (2015, November 16). Alcohol and Public Health: Frequently Asked Questions. Retrieved March 10, 2016, from http://www.cdc.gov/alcohol/faqs.htm
- Substance Abuse and Mental Health Services Administration. (2015, October 30). Alcohol. Retrieved March 10, 2016, from http://www.samhsa.gov/atod/alcohol
- S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, & Division of Pharmacologic Therapies. (2015). Medication for the Treatment of Alcohol Use Disorder: A Brief Guide. 5-15. Retrieved March 10, 2016, from http://store.samhsa.gov/shin/content//SMA15-4907/SMA15-4907.pdf
- Raistrick, D. (2000). Management of alcohol detoxification. Advances in Psychiatric Treatment, 6(5), 348-355.
- Office of Applied Studies. Results From the 2013 National Survey on Drug Use and Health: Summary of National Findings. Section 7.3, Alcohol Use Treatment and Treatment Need. NSDUH Series H-48. (HHS Publication No. [SMA] 14-4863.) Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
- Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Brit J Addiction. 1989; 84(11):1353 1357.
- Center for Substance Abuse Treatment. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Treatment Improvement Protocol 49. (HHS Publication No. [SMA] 12-4389.) Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009.