When excessive drinking becomes compulsive, severe, and leads to sickness or withdrawal symptoms, the condition may have developed into alcohol use disorder (AUD). This condition is a chronic disease that changes the brain and behaviors. Like other chronic diseases, AUD requires medical treatment.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that about 16 million Americans – 15.1 million adults age 18 and older, and 623,000 adolescents between the ages of 12 and 17 – had a diagnosable AUD in 2015. AUD, along with other forms of excessive drinking such as binge drinking and heavy drinking, kills about 88,000 people in the U.S. every year.
These deaths result from acute problems like drunk driving and chronic health problems like liver failure or cancer. One of the 11 symptoms of alcohol use disorder is attempting to quit, more than once, without success. This is partly why trying to quit alone does not work. Additionally, some of the withdrawal symptoms associated with detox from alcohol may be life-threatening, so medical supervision during this time can keep you safe.
Detoxing at Home is Not Safe
Detoxing at home is not safe. You are much more likely to relapse if you try to quit without medical and social support. A relapse back into alcohol abuse can lead to alcohol poisoning, which may be deadly.
There are specific signs of alcohol poisoning. They include:
- Confusion
- Loss of physical control, like stumbling and falling
- Vomiting
- Slow or irregular breathing
- Blue-tinted skin from oxygen deprivation
- Low body temperature, or hypothermia
- Passing out
- Seizures
If someone displays symptoms of alcohol poisoning, call 911 immediately. Do not leave the person alone, and do not let them drink more alcohol.
The experience of withdrawing from alcohol can be uncomfortable at a minimum and deadly at its worst. This is because of how alcohol changes the brain. Ethanol, the intoxicating chemical in alcoholic beverages, binds to the gamma-aminobutyric acid (GABA) receptors in the brain, which releases the neurotransmitter GABA. This slows down reaction times between neurons, inducing a feeling of relaxation, slowness, tiredness, or positivity. Once the body develops a dependence on alcohol, the brain needs more ethanol to produce GABA because it stops producing the neurotransmitter on its own. Without alcohol, there is less GABA available to the brain, and without GABA, nervousness and physical discomfort from withdrawal begin. In some extreme cases, this lack of GABA can cause seizures.
There are common withdrawal symptoms associated with alcohol detox. Among them are:
- Anxiety
- Nervousness
- Panic attacks
- Irritability and mood swings
- Shakiness or jumpiness
- Nightmares, insomnia, or other sleep disturbances
- Cloudy thinking
- Sweaty, clammy skin
- Dilated pupils
- Headaches
- Loss of appetite, stomach discomfort, nausea, and vomiting
- Rapid heart rate
- Tremors in the hands or other parts of the body
Typically, alcohol withdrawal lasts about a week; however, it is possible for some withdrawal symptoms, especially psychological ones like cravings or anxiety, to extend past a week. Alcohol withdrawal syndrome (AWS) is more likely to occur among people who have been heavy, regular drinkers for a long time and try to quit without medical supervision.
The U.S. Centers for Disease Control and Prevention (CDC) defines heavy drinking as:
- 8 or more drinks per week, or just over one serving of alcohol per day, for women.
- 15 or more drinks per week, or just over two servings of alcohol per day, for men.
Patterns of heavy drinking are more likely to lead to physical dependence on alcohol, which can cause withdrawal symptoms. AWS will likely develop between six hours and two days after the last drink.
Extreme AWS cases are referred to as delirium tremens (DTs). This condition is the most extreme form of alcohol withdrawal, and it can be fatal. While it is rare, it is most likely to develop in a person who drinks enormous amounts of alcohol every day for months. People who drink heavily for a decade or more are most at risk.
DTs is associated with drinking four or five pints (1.8 to 2.4 liters) of wine, seven or eight pints (3.3 to 3.8 liters) of beer, or one pint (half a liter) of hard alcohol like bourbon, whiskey, or gin, every day for many months. Signs of DTs begin within 48 to 96 hours, or two to four days, after the last drink. In some instances, they have been known to appear a full week after the last drink.
Symptoms of DTs begin with more common alcohol withdrawal symptoms, but they continue to develop into more severe symptoms, which include:
- Sudden, severe confusion (delirium)
- Full body tremors
- Chest pain
- Stomach pain
- Changes in mental function
- Irritability and agitation
- Deep sleep that lasts for a full day or two
- Extreme excitement or fear
- Hallucinations
- Bursts of physical energy
- Rapid mood swings
- Sensitivity to stimuli like light, sound, or touch
- Stupor
- Fever
- Seizures
The risk of relapse, alcohol poisoning, AWS, and delirium tremens make detoxing at home too dangerous to pursue. If you are worried about how much you drink or are concerned that a loved one may have AUD, consult a doctor for a diagnosis and treatment referral.
Medical Supervision in a Detox Program
Because alcohol use disorder is a chronic medical condition, like diabetes or high blood pressure, it is important to follow evidence-based practices around treatment to stay healthy. Detox, supervised by medical professionals, is the first step in the process of overcoming drug or alcohol abuse, according to the National Institute on Drug Abuse (NIDA).
At a minimum, medical supervision can help you manage symptoms like body aches or fatigue; at most, some drug detox protocols involve medication-assisted treatment (MAT) to ease the body off dependence on drugs or alcohol. After detox, there are medications available for some substance addictions that can reduce cravings and relapse.
To diagnose the severity of withdrawal symptoms, a doctor will:
- Ask you questions based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AUD.
- Ask how much alcohol you consume and for how long you have been doing so.
- Perform a physical exam, including blood tests.
- Assess withdrawal symptoms as they appear.
If your withdrawal symptoms are serious, you may receive a prescription for a benzodiazepine like Ativan, Valium, Klonopin, or Xanax. Benzodiazepines act on a similar region of the brain as alcohol, so they ease anxiety, panic attacks, confusion, and the risk of seizures. However, since benzodiazepines are potentially addictive as well, these are not likely to be prescribed unless there is a risk of AWS or delirium tremens. Other withdrawal symptoms may be treated with anti-nausea medication or over-the-counter pain relievers.
Once you have safely detoxed with medical supervision, you may receive a prescription for medications that reduce cravings and relapse.
- Naltrexone: This medication blocks the euphoric effects of both alcohol and opioids, so if you relapse and drink alcohol, naltrexone will prevent the drink from triggering the reward system. Without feeling any positive effects from alcohol, you are less likely to drink more in the future. This helps to reduce compulsive behaviors around alcohol or drugs.
- Acamprosate: This medication reduces cravings. It is effective only after you have stopped drinking or doing other drugs and completed detox. Reducing cravings for alcohol can help you remain in recovery.
- Disulfiram: This was one of the first medications developed to treat AUD. If you drink while taking disulfiram, you experience extreme nausea, headaches, and physical illness; instead of feeling good, you feel awful. Disulfiram is no longer a preferred treatment for AUD because there are some risky side effects, but it can be effective for people who have gone through AUD treatment before and still struggle with relapse.
The point of a medically supervised detox program is to help you end your physical dependence on alcohol and, if needed, start taking maintenance medications so you can focus on behavioral therapy in a rehabilitation program. Detoxing at home is too risky. Get help from medical professionals who are knowledgeable about addiction and substance abuse.
