When someone who regularly drinks heavily suddenly stops or dramatically reduces their alcohol intake, they may experience unpleasant and even dangerous alcohol withdrawal symptoms. Understanding the common symptoms, risks of severe reactions, and benefits of medically supervised detox can help keep alcoholics safe as they take the difficult first steps toward sobriety.
Common Alcohol Withdrawal Symptoms
Alcohol withdrawal symptoms occur because the brain adapts to the constant presence of alcohol. When alcohol levels abruptly drop, the brain is thrown out of balance, causing physical and psychological reactions.
Withdrawal symptoms often begin 6 to 24 hours after the last drink. They peak around 24 to 72 hours in, before gradually improving over 5 to 7 days. However, in severe cases, hallucinations can last for weeks.
Mild to moderate withdrawal symptoms include:
- Anxiety, irritability, jumpiness or shakiness
- Sweating and clamminess
- Insomnia and nightmares
- Nausea, vomiting and loss of appetite
- Fatigue
- Depression
- Mood swings
- Headaches and muscle aches
More severe symptoms include:
- High blood pressure, racing heartbeat, and fever
- Mental confusion, disorientation, and an inability to think clearly
- Heightened senses and overreactions to stimuli like sounds and light
- Hallucinations – typically visual rather than auditory
- Seizures – these are the most dangerous symptom
The severity of symptoms depends on factors like:
- Amount and frequency of alcohol use
- Length of time drinking heavily
- Underlying medical conditions
- Use of other drugs or medications
- History of alcohol withdrawal
Those at highest risk for severe reactions have been drinking heavily for a long time. Binge drinking in particular predisposes the brain to more extreme imbalances when alcohol levels drop.
Risks of Severe Alcohol Withdrawal
About 5% of people going through withdrawal have grand mal seizures. These most often occur 12 to 48 hours after the last drink. Withdrawal seizures come on suddenly and involve the entire body rigidly convulsing.
Alcoholics who have a history of withdrawal seizures have over a 50% chance of having another one in subsequent withdrawals. Seizures pose serious risks including:
- Fall injuries during the seizure
- Choking from vomit
- Aspiration pneumonia from breathing vomit into the lungs
- Metabolic abnormalities like low potassium, sodium, magnesium, and glucose
- Progression to status epilepticus – a state of prolonged, unrelenting seizures that constitutes a medical emergency
The most severe form of alcohol withdrawal is known as delirium tremens (DTs). This happens in 3 to 5% of alcoholics undergoing withdrawal. Onset is typically 48 to 96 hours after the last drink.
DTs involve very heavy tremors as well as a confused, delirious mental state. DTs come with significant dangers including:
- Dehydration from vomiting, diarrhea, sweating, and fever
- Falls and injuries from severe disorientation and tremors
- Respiratory distress
- Heart arrhythmias like atrial fibrillation
- High blood pressure and stroke risk
- Exhaustion
- Metabolic imbalances
- Death in 1 to 5% of cases
Those at greatest risk of DTs include people with concurrent medical illnesses, a history of DTs during prior withdrawals, or other health impacts from alcoholism like liver problems, malnutrition, electrolyte abnormalities, and infections.
Medically Supervised Detox
Because of the risks involved in alcohol withdrawal, detoxing under medical supervision is strongly recommended for alcoholics. Inpatient and outpatient treatment programs provide 24/7 support and monitoring during this unstable time.
Benefits of medically supervised detox include:
- Preventing and immediately treating withdrawal complications like seizures, DTs, and electrolyte disturbances
- Providing fluids, nutrition, and vitamins to restore health
- Monitoring vital signs, mental status, and physical exam findings
- Providing medications to ease symptoms
- Creating a controlled, supportive environment to focus fully on early sobriety
Common medications used in detox include:
- Benzodiazepines like Valium, Ativan, and Librium to prevent seizures, treat anxiety, insomnia, and muscle tremors
- Antiemetic drugs like Zofran for nausea and vomiting
- Alpha-blockers like Clonidine to control blood pressure and body temperature
- Antipsychotics like Seroquel as needed for hallucinations and agitation
Detox alone is not a treatment for alcoholism. It manages the acute physical withdrawal, while therapy and counseling address the underlying psychological addiction. After detox, alcoholics need continued care through either outpatient programs or residential rehab to maintain their newfound sobriety.
Those struggling with alcoholism don’t have to brave withdrawal risks alone. Reaching out for intervention assistance can help guide them to begin treatment supported by medical and psychological professionals. With determination and the right help, it is possible to push through the difficulties of early sobriety to start finding sobriety after rock bottom.
Getting Help for Alcohol Withdrawal
The first step towards getting help for alcohol withdrawal is consulting with a doctor. Primary care physicians can evaluate withdrawal risks, advise on medication needs, and refer patients to specialty addiction treatment programs.
Emergency rooms also frequently treat people going through alcohol withdrawal. ER doctors can rapidly administer fluids, electrolytes, vitamins, and medications to stabilize patients. They also arrange referrals to inpatient detox or rehabilitation facilities.
For those unwilling to undergo formal detox, doctors may prescribe a short benzodiazepine taper to be taken at home under a family member’s supervision. However, self-managed withdrawal carries substantially more medical risks.
Many alcoholics try quitting cold turkey on their own. However severe withdrawal reactions can quickly spiral out of control without professional help. Seizures, delirium tremens, and other deadly complications can occur rapidly and unexpectedly.
Seeking support from family, friends, support groups, addiction counselors, or religious leaders provides accountability and motivation to get through withdrawal safely under medical care. Loved ones can assist by arranging interventions, driving to appointments, providing emotional support, and removing alcohol from the home.
Alcohol Withdrawal Medications
Medications make withdrawal safer by easing symptoms and preventing complications. Benzodiazepines are the cornerstone, taken on a carefully managed tapering schedule to avoid prolonged dependence. Other drugs treat specific symptoms.
- Benzodiazepines curb overactivity in the central nervous system to reduce the risk of seizures, anxiety, agitation, and blood pressure spikes. Long-acting benzodiazepines like chlordiazepoxide and diazepam are preferred for their steady, sustained effects.
- Anticonvulsants like carbamazepine may supplement benzos to prevent seizures. Pregabalin also reduces anxiety and insomnia.
- Alpha agonists like clonidine decrease sympathetic nervous system activity, lowering blood pressure, heart rate, tremors, and sweating without sedative effects.
- Antipsychotics treat hallucinations, delusions, and agitation. Haloperidol is commonly used, although atypical antipsychotics like olanzapine may be preferred for sedation and anxiety reduction.
- Sedative hypnotics like zolpidem, zaleplon, and eszopiclone can ease insomnia during withdrawal. Trazodone treats anxiety, agitation, and sleep issues.
- Antiemetics relieves severe nausea and vomiting. Ondansetron is very effective, given intravenously or orally dissolving tablets.
While medications make withdrawal safer, they are not a substitute for comprehensive treatment. Addiction counseling and lifestyle changes are necessary to achieve lasting sobriety. But medical detox provides the crucial first step.
