Detoxing From Alcohol
On the list of drugs that come with the most uncomfortable and dangerous detox process, alcohol detox is considered one of the worst. In severe cases, detoxing from alcohol can be fatal, but even in mild forms it is a difficult and unpleasant experience, best done under the supervision of rehab/medical staff. Heavy alcohol use changes the way the brain functions, leading to both physical and psychological symptoms when going through alcohol withdrawal.
The detox process will be different for individuals based on how much and for how long they have been drinking. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as binge drinking for 5 or more days in the past month. A person’s genetic predisposition may also play in a role in the severity of withdrawal symptoms. Alcohol is a central nervous system depressant, which increases the effects of the neurotransmitter Gamma-aminobutyric acid (GABA) and decreases the neurotransmitter glutamate. GABA creates calm feelings, while glutamate creates excitability. When someone is dependent on alcohol, their brain is only in homeostasis when ethanol, the chemical compound for alcohol, is present in their system. When alcohol is removed from the system, this results in overactivity of the central nervous system. This state is responsible for withdrawal symptoms.
The mild symptoms of alcohol withdrawal typically begin 6 to 8 hours after the last drink. This may include headaches, nausea and vomiting, anxiety, hand tremors, sweating, and insomnia. Patients may still have a significant blood alcohol concentration (BAC) while experiencing these symptoms. In some mild cases, withdrawal may not progress past this point and their symptoms will resolve in 24 to 48 hours. The more serious withdrawal symptoms typically begin 12 to 24 hours after the last drink of alcohol. These include fever, heavy sweating, high blood pressure, confusion, rapid heartbeat, strokes, and seizures. Withdrawal seizures are usually tonic-clonic convulsions: seizures that involve a loss of consciousness and violent muscle contractions. These are most common in patients that have long-term chronic alcohol dependence. Untreated, these seizures can lead to delirium tremens (DT) in about one third of patients.
Delirium tremens begin 48 to 96 hours after the last drink. The symptoms include hallucinations, fast heart rate, disorientation, high blood pressure, agitation, high body temperature, and sweating. DT can last 1 to 5 days. DT can result in death, especially if left untreated. Death is usually due to arrhythmia or underlying health conditions. Detoxing from alcohol should be done under the supervision of a medical professional for safety reasons, as well as making it the least uncomfortable process as possible.
What Is Alcohol Detox Like?
Treatment centers can provide patients with a safe place to detox from alcohol and help them develop a recovery plan. Because of the length of time it takes to detox from alcohol, an inpatient treatment center may be the best option. Upon arrival, any co-occurring conditions will be identified and treated if necessary. Next, a plan will be created to alleviate withdrawal symptoms with medications, intravenous (IV) fluids, clinical assessment of vital signs, and nutritional support. Patients should be a in a quiet and protective environment, with soft lighting, limited contact with people, and positive support from those who are around. People with a severe alcohol use disorder are often malnourished so they may need an IV infusion of multivitamins.
Another benefit of detoxing in an inpatient treatment facility is the access to 24/7 care. Patients, especially those with a severe alcohol use disorder, should be constantly monitored during detoxification. High risk patients, like older adults and those at risk for DT, may need to be transported to an intensive care unit (ICU) if symptoms escalate. Staff will monitor patients through their oxygen levels, fluid and electrolyte status, vital signs, and neurologic function which includes coordination and reflexes. There are several options for medications to be used during alcohol detox that clinicians can provide depending on what is appropriate for each patient.
Alcohol Detox Medications
There are a variety of medications that are used during the alcohol detox process, such as benzodiazepines and barbiturates. Benzodiazepines, often referred to “benzos,” are drugs typically used to treat epileptic seizures, anxiety, panic attacks, and withdrawal symptoms from central nervous system depressants. When used as treatment during alcohol detox, they are used to keep minor symptoms from progressing into major ones, as well as helping with psychomotor agitation. Some common benzodiazepines used are diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium), but other long-acting options are also used. Typically, this medication is given orally but can also initially be given via IV. Benzos cause a level of sedation that is helpful during detox, and the dosing depends on the patient. For example, diazepam is usually given in 5 to 10 mg doses every 5 to 10 minutes until the required level of sedation is reached.
Barbiturates are central nervous depressant drugs such as Amobarbital (Amytal), Butabarbital (Butisol), and Secobarbital (Seconal). They are used for treating headaches, seizures, insomnia, and are sometimes used to help with alcohol withdrawal symptoms. When used during alcohol detox, barbiturates can treat seizures caused by alcohol withdrawal and are appropriate for severe withdrawal. Disulfiram is a drug that is used to treat alcoholism by causing an adverse reaction when someone drinks alcohol, so it is usually used after detox and as part of a patient’s treatment plan. Vivitrol is a one time a month intravenous drug that decreases cravings and compulsions to drink alcohol. Clonodine is typically prescribed during detox to manage blood pressure. Medications for alcohol detox will be selected and administered by a medical professional during detox to make the process as safe and comfortable as possible. Drugs should never be taken other than how they are prescribed, as some of them may lead to addiction.
Do I Need To Detox From Alcohol?
If you have been drinking heavily for an extended period of time, you will likely need to go through the detox process. While it may seem daunting, this is the first step in starting a life where you are not dependent on alcohol. Because of the potentially life-threatening withdrawal symptoms, it is not recommended to abruptly quit drinking. Going “cold-turkey” may also be dangerous. Once you have made the decision to detox, contact a treatment provider so you can undergo a safe detox. The staff at an inpatient rehabilitation facility can help ease the painful symptoms that come with detox, which can lead to a higher success rate.
Author: Hayley Hudson | Last Edited: August 5, 2021
Medical Reviewer: Dayna Smith-Slade