Alcohol Detox: Timeline and Symptoms

Alcohol Addiction

Alcohol addiction – or alcohol use disorder – is a chronic relapsing disorder associated with compulsive drinking, even when the person may want to stop. There are varying severities of the disorder, ranging from mild to severe. Some signs and symptoms of this condition include:

  • Not being able to stop or cut down on drinking, despite wanting to stop
  • Continuing drinking despite its damage to a person’s health, relationships, and career
  • Unsuccessful attempts to stop drinking
  • Intense cravings for alcohol
  • Experiencing withdrawal symptoms if not drinking regularly
  • Failure to meet obligations in personal relationships, at work, or at school
  • Partaking in risky behaviour, e.g. drink driving
  • New financial issues
  • Getting in trouble with the law

Over the past few years in the UK, alcohol use disorder has been a growing issue due to poor mental health caused by the pandemic progressing people’s drinking habits. In 2020, there was a 20% increase in the number of alcohol specific deaths compared to 2019, with the people in higher levels of poverty disproportionately affected. This disorder does not have to be a death sentence, with three-quarters of people living with it eventually overcoming their alcohol addiction.

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Alcohol Dependency

When someone starts to consume alcohol regularly, chemical and physical changes in the brain and body occur which make it extremely difficult to stop. Addiction influences the decision making and reward centres of the brain via directly changing levels of neurotransmitters being released – such as dopamine. This results in individuals not being able to control their drug taking behaviour, even when they may want to.

Ethanol is the key ingredient in most alcoholic beverages which acts as a central nervous system (CNS) depressant. Repeated exposure to ethanol reduces the activity of glutamate receptors which are the excitatory portion of the CNS, while increasing the activity of the inhibitory part called gamma-aminobutyric acid receptors. Overtime, this causes the addicted individual’s body to become dependent on the substance.

Alcohol Withdrawal Timeline

Each individual’s alcohol withdrawal syndrome will present itself slightly differently due to the severity of their addiction, history of abuse, other health conditions, other substance use disorders, and genetics. However, a 2016 research paper published a generalised timeline of withdrawal that gives an idea of the process.

  • Minor withdrawal symptoms (6–12 hours): Around six-to-twelve hours after their last drink, someone with alcohol use disorder will experience minor symptoms. These include nausea, tremors, excessive sweating, elevated heart rate, rapid breathing, hypertension, and increased body temperature.
  • Alcoholic hallucinosis (12–24 hours): Within the first twenty-four hours, some people start to experience hallucinations. This can include hearing and seeing things that aren’t actually there. Many people also report experiencing bodily sensations like pins and needles.
  • Alcohol withdrawal seizures (24–48 hours): People with more severe forms of alcohol use disorder can experience seizures during this time. Individuals in this position should seek immediate medical attention, if not at the hospital already.
  • Delirium tremens (48–72 hours): The most severe withdrawal symptom that can present when coming off alcohol is one called delirium tremens. This is an encompassing term referring to extreme confusion and hyperactivity leading to heart failure. Again, immediate medical attention is advised here as these symptoms can last up to five days and result in a mortality rate of 37%.

Alcohol Withdrawal Treatment

While people with a mild form of the alcohol addiction can undergo their detox at home with a strong support group, people with moderate or severe cases of the disorder should always seek medical assistance. This is because of the potentially severe and dangerous nature of these symptoms. Healthcare professionals can devise an appropriate treatment plan, with around the clock support if needed so the detox process can be undergone with as little risk and chance of relapse as possible.

A doctor may administer intravenous fluids to prevent dehydration, be ready for emergency intervention, and prescribe medication. Most people undergoing treatment for alcohol withdrawal syndrome receive benzodiazepines – such as a diazepam – to relax the overstimulated CNS, in turn reducing the intensity of withdrawal symptoms and the rate of relapse. Some withdrawal symptoms benzodiazepines help treat include:

  • Nausea and vomiting
  • Chills and sweats
  • Aggravation and irritability
  • Headaches
  • Insomnia
  • Seizures

Studies have shown that taking benzodiazepines during withdrawal also reduces the rate of delirium tremens, making this detox period safer. Other medication may also be prescribed such as sedatives, barbiturates, and phenytoin.

Prolonged Withdrawal Symptoms

Most people stop experiencing intense physical withdrawal symptoms from alcohol after the first few weeks from their last drink, though some people’s symptoms can worsen over time. In these cases, it is vital to seek emergency medical attention and receive expert treatment to overcome the detox period safely.

For most people, milder symptoms can persist for an extended period while their body readjusts to the lack of alcohol in their system. These include fatigue, irritability, and sleep disturbances. Here, a strong support system is key to get through this challenging time, enlisting friends and family and also support groups. These groups offer a safe space for thoughts and feelings to be shared in a non-judgemental environment with people who have gone through a similar situation. Many people find these meetings a source of motivation to stay on track and hear inspiring stories from others who have made it to the other side.

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    Author / Jason Shiers / Dip.Psych MBACP

    Jason Shiers is a Certified Transformative Coach & Certified Psychotherapist who is a specialist in addiction, trauma and eating disorders. He has been working in the field of addiction for 25 years now.

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