Alcohol detox is the crucial first step in recovery from alcohol abuse and addiction. Since alcohol is both physically and psychologically addictive, detoxification procedures can vary. Detox procedures depend on the circumstances surrounding each individual, specifically the severity of alcohol addiction, which is generally characterized as the degree to which an individual’s tolerance to alcohol has grown.
In addition to the goal of removing alcohol from the body, detox also aims to manage acute alcohol withdrawal symptoms, which may range from mild to extremely severe.
Alcohol detox is a period of medical treatment, usually including counseling, during which a person is assisted in overcoming physical and psychological dependence on alcohol. Although all drugs of abuse are psychologically addictive, alcohol addiction presents an especially dubious challenge in detox. The physical dependence on alcohol is a direct result of changes that occur in the brain with both sustained and heavy alcohol use. Unlike many other drugs of abuse and addiction, alcohol has significant and severe effects on the brain’s delicate functional balance, which can become seriously erratic upon the sudden cessation of heavy and frequent alcohol consumption.
Brain function is maintained in a balance of neurotransmitters, which regulate behavior, thought processes, and essential functions, like control and coherency. When high amounts of alcohol are frequently present, the brain adjusts to compensate for alcohol’s regularly occurring effects, essentially normalizing them. This compensation doesn’t happen just once; the brain continually compensates for increased amounts of alcohol, which is how tolerance grows. It is the continued growth of an individual’s tolerance for alcohol that leads both to the need for more alcohol in order the feel its euphoric effects and the increased dependence on alcohol in order to feel “normal.”
The time period it may take to complete alcohol detox also depends on the individual and the circumstances surrounding his or her alcohol abuse, age, and other preexisting medical or psychiatric conditions. These are among the most common factors that may complicate or create a severe and life-threatening alcohol detox process.
Compiled in a 2013 study published in the US Library of Medicine, the following is a list of some common predictors of severe alcohol withdrawal, which require medical attention and often hospitalization:
These are not the only predictors of severe alcohol detox but are among the most commonly reported in the medical community. Alcohol detox can become severe and dangerous at any time, but the most severe symptoms often present between twenty-four and seventy-two hours after the last alcoholic beverage. It is during this time period when delirium tremens (DTs) most typically occurs in severe cases.
Although delirium tremens presents in the most severe cases of alcohol detox, the recognizable signs of its development may begin one to four days into detoxification. Most commonly occurring in individuals who drink heavily for several years and often exacerbated by insufficient food intake.
Signs of impending delirium tremens include:
A medical assessment may be performed to determine the severity of alcohol withdrawal and the need for medically assisted alcohol detox.
This assessment includes things like checking the individual’s heart rate and assessing a series of ten categories to determine the severity of alcohol withdrawal:
Each of these ten categories are assessed on a scale ranging from 0-8, 8-10, 10-15, or more than 15. This scale is known as the Clinical Institute Withdrawal Assessment-Alcohol (CIWA-A) and is used in a variety of medical settings as a reliable and feasible manner to recognize delirium tremens before the condition progresses.3 Sometimes, symptoms of impending delirium tremens provide insufficient notice before the condition is full-blown.
Immediate medical attention should be sought upon the observation of the following signs of delirium tremens:
Delirium tremens can include extreme hyperactivity, hallucinations, and even death in up to 5 percent of individuals who experience it. However, the risk of death is significantly decreased in those individuals who receive adequate medical attention and support.4 The dangerous and life-threatening potential of alcohol detox is manageable with medical assistance and monitoring, but the onset of acute alcohol withdrawal symptoms may not come with warning. For this reason, it is imperative to seek medical consultation and assistance before attempts to suddenly quit using alcohol.
Alcohol detox, especially when delirium tremens is present, may require large amounts of benzodiazepines to counter the potential for seizures. The preferred benzodiazepine for alcohol detox is either diazepam (Valium®) or lorazepam (Ativan®), and phenobarbital in situations where benzodiazepines are insufficient in sedation efforts.
It is important to note that self medication is not recommended under any circumstances of severe alcohol detox, especially those that involve delirium tremens. In some serious cases, benzodiazepines are not sufficient for sedation and management and require medical staff to administer other, more powerful medications like phenobarbital or dexmedetomidine, in the event that a medical ventilator is required.
Alcohol detox specifics will vary by individual circumstances, including medical conditions, personal health, and the details of alcohol abuse and dependence. All of these play major roles in determining how long and risky and alcohol detox may be.
Knowing whether or not an alcohol detox is necessary does not require being able to assess the potential for the onset of delirium tremens. This is the most severe manifestation of alcohol withdrawal symptoms in detox, but it is not the only reason to seek medical assistance during the process.
The symptoms of alcohol withdrawal are not always severe enough to precipitate delirium tremens, however, the need for an alcohol detox is based on more than the physical danger of severe symptoms. Every drug of abuse causes a psychological dependence, and that alone is cause for a supervised detox. Psychological addiction is what drives the intense craving for a substance, prompting relapse. Alcohol-dependent people suffer from severe psychological addiction just as they do from physical addiction.
Fortunately, alcohol detox is not only for the management of physical symptoms, but also to manage some of the psychological discomfort. This dual treatment in detox allows for people to be more comfortable and “take the edge off” to some degree. Medical treatments in alcohol detox address symptoms like insomnia, anxiety, agitation, and shaky hands, but do not address cravings. The support of staff to help an individual continue to resist cravings is a tremendous benefit of a medical alcohol detox.
Hangover symptoms and alcohol withdrawal symptoms do have some crossover; however, they are not the same experience and should not be conflated as having the same implications. Most people who drink alcohol have experienced a hangover at some time in their lives, and a considerable number of those who have had hangovers have likely been through pretty severe ones. With symptoms like sweating, nausea, vomiting, anxiety, tremor, and sensory disturbances, it has been studied and argued that hangovers are actually mild manifestations of alcohol withdrawal in those who are not alcohol dependent. The difference between a hangover after a heavy drinking episode and hangover-like symptoms at the onset of alcohol withdrawal is related to an individual’s dependence on alcohol. For individuals who have an alcohol dependency, experiencing a hangover does not mean alcohol withdrawal symptoms will not follow, nor does it mean that alcohol detox is not necessary.
Individuals who need alcohol detox include people who experience any symptoms of alcohol withdrawal in the absence of alcohol. Separate from symptoms occurring after a heavy drinking episode, alcohol withdrawal symptoms present upon the cessation of drinking alcohol, whether or not heavy drinking immediately preceded the symptoms.
These withdrawal symptoms include:
All symptoms of alcohol withdrawal, specifically cravings, constitute the need for alcohol detox, which incorporates some level of medical care. Alcohol withdrawal symptoms can become severe even if the initial symptoms begin as mild, since the peak time for acute withdrawal often occurs two to three days after the last drink has been consumed.
It is important to note that one of the greatest dangers of alcohol withdrawal is the fact that the most severe and dangerous symptoms present days into the process. If this danger is not taken seriously, alcohol detox can become deadly without medical attention and supervision.
Even if severe symptoms never present during the alcohol detox process, medical attention is recommended to provide a more stable and comfortable detox experience. In addition to their benefit in mediating severe alcohol detox and delirium tremens, benzodiazepines are the preferred medical course of treatment for symptoms like anxiety, insomnia, shaky hands, and agitation.
Additionally, alcohol detox should not be delayed until such time that severe symptoms of alcohol withdrawal present themselves.
Alcohol detox is not only necessary for severe alcoholics in need of intensive medical care, but it is also necessary for those who abuse alcohol to the degree at which they:
These are signs of psychological dependence, and alcohol detox is necessary to begin the process of addressing these symptoms in an effective addiction treatment program.
Alcohol detox has one primary goal, which is to remove alcohol from someone’s system as safely and comfortably as possible. Alcohol detox, when completed with medical assistance and supervision, has a very low mortality rate, ranging between 1 percent to 2.4 percent, as of 2003.6 Additionally, detox can be performed in a variety of settings, including authorized addiction treatment facilities, on an outpatient basis in confirmed mild cases, and in general hospitals.
Any person seeking an alcohol detox should always consult a medical professional prior to cessation of alcohol. During a consultation, it is imperative to be completely honest about alcohol consumption habits and history, including:
The ability for a medical professional to accurately assess alcohol detox needs is contingent upon honest responses and transparency about alcohol consumption habits and history. Dishonest answers can lead to a dangerous misdiagnosis and mistreatment for impending alcohol withdrawal symptoms.
Depending on the severity of symptoms, alcohol detox usually takes between seven and ten days to complete. Complications and severe symptoms may extend this time, and everyone’s alcohol detox is different, as the outcome depends heavily on individual circumstances.
Once detox is complete, it is important to continue along a path of recovery from problem drinking. Numerous studies on repeated alcohol detox episodes, or “kindling,” reveal significantly higher rates of seizures and medical complications directly related to multiple alcohol withdrawal experiences.7 Studies have also shown a connection between multiple alcohol detox events and relapses and reduced cognition and impaired executive functions, specifying damage to the frontal lobe as a result of an inability to maintain recovery.
Alcohol addiction is much more than a physical dependence and cannot be fully addressed by detox. In fact, detox is only the first step in alcohol addiction treatment and recovery. Physically ridding the body of alcohol is a very important first step, and addiction recovery cannot begin until the detox process is complete. However, a recovery process is the only way to ensure another alcohol detox is not necessary in the future.
While the physical relief of alcohol detox is necessary, the psychological aspect of alcohol addiction is responsible for the intense cravings that often lure addicts back to relapse. Psychological dependence results from the changes related to how the brain maintains balance with the constant presence of alcohol. While most of this can be reversed, it takes time to “retrain” the brain and reestablish balance, without the presence of alcohol. This retraining process is also necessary for individual habits, activities, coping skills, communication, and mental health management. All of these crucial elements of recovery take place within an effective addiction treatment program, which should immediately follow detox.
Most alcohol and drug addiction treatment providers integrate detox into their program details, noting whether it can be completed at the facility or in an offsite hospital setting. Before engaging in alcohol detox, it is recommended to have a treatment program that can provide a seamless transition from detox into rehab. In some cases this may not be possible, as alcohol detox may become an emergency medical necessity. In these severe circumstances, it is common for staff in any hospital or medical setting where alcohol detox can be completed to have the ability to refer to a nearby rehab program. It is rare that a medical professional will treat severe alcohol withdrawal symptoms without offering referrals to rehab programs. In some hospitals, a partial hospitalization rehab program may actually be available onsite, and medical staff will inform critical patients of that option also.
Alcohol detox is crucial, and medical advancements and specialized care can make it extremely manageable and safe for individuals in need. It cannot be stated strenuously enough that alcohol detox is entirely pointless and very potentially creates greater future health risks to the individual without a sustainable recovery plan. If you or someone you know is struggling with alcohol abuse or dependence, start looking into rehab programs right away.
Alcohol detox is imperative for the safety and the preservation of life during alcohol withdrawal, but having an effective alcohol rehab in place once detox is completed provides the tools for each individual to preserve their own life, free from alcohol dependence and further abuse.
pubs.niaaa.nih.gov – NEUROSCIENCE: PATHWAYS TO ALCOHOL DEPENDENCE
ncbi.nlm.nih.gov – Clinical management of alcohol withdrawal: A systematic review
cbhallc.com – Clinical Institute Withdrawal Assessment
pubs.niaaa.nih.gov – Complications of Alcohol Withdrawal
emedicine.medscape.com – Delirium Tremens (DTs) Treatment & Management
pubs.niaaa.nih.gov – Alcohol Hangover
academic.oup.com – Analysis of the Factors Determining Survival of Alcoholic Withdrawal Syndrome Patients in a General Hospital
pubs.niaaa.nih.gov – Kindling in Alcohol Withdrawal
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