11 Minutes

Edited & clinically reviewed by THE BALANCE Team
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For all those addicted to alcohol, there comes a point when enough is enough. The constant blacking outs, uncomfortable hangovers, and a total memory collapse following a night of heavy drinking suddenly become unbearable. They grow tired of constantly disappointing their family and friends over and over again, and wish to stop. This realization alone is the first step towards an addiction-free life. But when such people enter an addiction clinic to stop their drinking habits, what must be expected?

Alcohol detox is the first and the most crucial step of alcohol treatment in most rehabilitation centers out there. The process involves ridding the body of all alcohol residues in an attempt to medically stabilize it. Detoxification can be hard to get through and potentially dangerous if performed without any professional help; hence, joining a rehab is the most appropriate and safest piece of advice to achieve complete sobriety.

Detoxing from alcohol brings about several withdrawal symptoms with mild to severe intensities. In many instances, the severity and longevity of an alcohol use disorder play a role in determining how severe a withdrawal can be. For instance, individuals who have been struggling with heavy drinking for years are likely to go through serious withdrawal symptoms while others who have recently developed dependence may go through it relatively easily.

Some minor alcohol detox symptoms include:

  • Headaches
  • Anxiety
  • Nausea
  • Sweating
  • Insomnia

Some people may carry on to develop more serious symptoms, such as: 

  • Tremors
  • Extreme hallucinations
  • Seizures
  • Disorientation
  • Delirium tremens

Delirium tremens is a rare but the most serious side effect of alcohol detox. The condition begins within two to five days following the last drink and can quickly progress to become life-threatening. Fortunately, the side effect is not common as less than five percent of people seeking alcohol addiction treatment will develop it.

Due to the severity of certain alcohol withdrawal symptoms, it is safe to continue the process under the supervision of a medical professional. This is particularly true for those with a history of heart or lung disease as withdrawals for these people can quickly worsen.

Detoxing from alcohol brings about several withdrawal symptoms with mild to severe intensities. In many instances, the severity and longevity of an alcohol use disorder play a role in determining how severe a withdrawal can be. For instance, individuals who have been struggling with heavy drinking for years are likely to go through serious withdrawal symptoms while others who have recently developed dependence may go through it relatively easily.

Some minor alcohol detox symptoms include:

  • Headaches
  • Anxiety
  • Nausea
  • Sweating
  • Insomnia

Some people may carry on to develop more serious symptoms, such as: 

  • Tremors
  • Extreme hallucinations
  • Seizures
  • Disorientation
  • Delirium tremens

Delirium tremens is a rare but the most serious side effect of alcohol detox. The condition begins within two to five days following the last drink and can quickly progress to become life-threatening. Fortunately, the side effect is not common as less than five percent of people seeking alcohol addiction treatment will develop it.

Due to the severity of certain alcohol withdrawal symptoms, it is safe to continue the process under the supervision of a medical professional. This is particularly true for those with a history of heart or lung disease as withdrawals for these people can quickly worsen.

Alcohol withdrawal symptoms usually begin to surface within two hours after the last drink. The most painful of these symptoms peak in the first few days and generally subside after the first week; however, a few milder ones continue to linger for a few extra days or weeks. While there is no exact timeline as to what or when these symptoms will pop up, a general outline of what to expect is mentioned below:

First Six to Twelve Hours

The initial symptoms of alcohol detox begin within six to twelve hours and are generally mild. However, they can quickly begin to worsen with time and may include headaches, nausea, irritability, and shakiness.

Day One

By the end of the first 24 hours of detox, the symptoms may become progressively severe. Apart from the symptoms developed in the first twelve hours, the detoxing individuals may experience hand tremors, disorientation, and seizures.

Day Two

The most painful symptoms from day one continue through day two. As the body continues to rid alcohol of its symptoms, some people may experience panic attacks and hallucinations.

Days Three To Seven

Different withdrawal symptoms keep coming and going during the rest of the first week of detox. This time frame is also when most people are at the highest risk of developing the most serious side effect of alcohol withdrawal i.e., delirium tremens.

After One Week

After the completion of the first week, most of the withdrawal symptoms begin to taper off. While some of them may linger on for a few more weeks, these are usually minor and manageable with medication.

Even after managing most of the withdrawal symptoms during the first few weeks, some people may develop post-acute withdrawal syndrome (PAWS). PAWS refer to the condition in which recovering addicts continue to experience the prolonged symptoms of detox, such as low energy, delayed reflexes, anxiety, and sleep disturbances. The condition can be uncomfortable and may last for several months up to a year.

For any type of addiction, detox is often the first step of treatment. The process helps individuals navigate and pass through the difficult process of alcohol withdrawal. In general, the course of medical detox from alcohol is highly variable and unpredictable to some extent. No assessment or screening tools can give physicians the power to predict who will or will not develop life-threatening alcohol detox symptoms. Hence, it is recommended to go through detox under professional supervision in a dedicated treatment center where there are enough resources to make the process easier and more comfortable to bear.

The process of alcohol detox begins with in-depth analysis to determine the severity of addiction, history of substance abuse, the presence of any co-occurring disorders, and the current health status. These factors help clinicians make a calculated risk regarding the severity of withdrawal expected to follow. Depending on these calculations, those with a high risk typically enter an inpatient treatment center where they reside within the center for the entire length of detox. Here, they receive round-the-clock care from staff members who keep checking on them every few hours to confirm if the recovering individuals are medically stable. Medical and psychological resources and support are always available for those who require it.

On the other hand, those with a low to moderate risk of experiencing alcohol withdrawal may enter an outpatient alcohol detox program. In these programs, the recovering individuals continue to live in their homes while visiting the facility every day for daily checkups and support. It is important to remember that sometimes, the calculated risk may show errors, forcing some individuals who initially entered outpatient care to transition into inpatient treatment due to an unexpectedly harsh withdrawal.

As a part of both outpatient and inpatient alcohol detox programs, patients may gain access to: 

  • Therapies, including cognitive behavioral therapy and family therapy
  • 12-steep meetings, including meetings conducted by Alcoholics Anonymous
  • Other mutual support groups, including Smart Recovery
  • Online virtual support meetings

Medical detox from alcohol typically includes the use of different medications to reduce uncomfortable withdrawal symptoms. These medications help by keeping the body chemicals of recovering individuals in balance; thereby lowering their risk of acquiring serious complications during the process. Known as medication-assisted therapy (MAT), this therapy is normally a part of inpatient detox rehab but can also be given to those attending outpatient detox clinics.

Some common medications experts use to make alcohol detox more bearable and effective include the following:

Benzodiazepines

Also known as benzos, these medications are the commonest ones to treat withdrawal symptoms during alcohol detox. Benzodiazepines work by calming the central nervous system and may treat anxiety, muscle, spasms, and insomnia that typically occur as a person goes through the detox process. There are two different forms of benzodiazepines: short-acting and long-acting benzos. Most experts prefer using the long-acting variant for at least three days or as required. The two most common types of benzos that most alcohol detox clinics typically use are diazepam and chlordiazepoxide.

Naltrexone

Naltrexone works by killing alcohol cravings to make detox more bearable for recovering individuals. In an event of a relapse, the medication promptly inhibits the euphoric feeling that alcohol may cause. Available in an injectable and tablet form, experts typically waitfor 7 to 10 before prescribing it as it can stimulate withdrawal symptoms, especially in the early stages of detox.

Acamprosate

Heavy drinking for years can easily alter how the brain looks and functions. To restore the normal functions of the brain in a person who is attempting to quit alcohol, experts may prescribe acamprosate. The medication can successfully reduce alcohol cravings and research is still underway to confirm its beneficial effects for reducing other alcohol withdrawal symptoms, such as insomnia, restlessness, and anxiety.

Disulfiram

Disulfiram is another medication commonly used in alcohol detoxification. Unlike other drugs mentioned above, it works by producing intense reactions if a recovering individual consumes alcohol. For instance, if someone using disulfiram in detox succumbs to cravings and drinks alcohol, they will experience several unwanted effects, such as weakness, nausea, facial flushing, and headaches. These negative effects then deter them from relapsing again in the future. Keep in mind that while disulfiram can control relapses, it is not capable of restoring brain functions.

While a detox program can help individuals get over the physical dependence on alcohol, it does not manage the behavior and pattern of thought that contribute to this addiction. Hence, it is essential to seek behavioral therapy the following detox to seek ongoing support and maintain long-term sobriety. Most rehabs offer alcohol behavioral treatment at the following levels of care:

  • Inpatient treatment involves living at a facility for the entire duration of treatment while receiving round-the-clock support and intensive counselling and therapy in group and individual sessions. 
  • Partial hospitalization involves living at a personal accommodation while coming to a rehab 5 days a week to seek around nine hours of therapy per day
  • The intensive outpatient program involves living at a personal residence while receiving therapy from rehab three times a day

Tele health program involves receiving therapy and counseling individually and as a part of a group along with attending support group meetings through online platforms without the requirement of visiting a rehab in person

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