Detoxification from Alcohol

The term “detox” describes the process of coming off substances like alcohol and other drugs. It can refer to a variety of evidence-based practices that support recovery from substance overuse.

Most alcohol detoxification programs aim to:¹

  • Protect you from the physiological dangers of alcohol withdrawal
  • Mitigate the difficulties that alcohol may cause
  • Assist you in getting sober

Alcohol detox encompasses a wide range of treatments for easing the effects of withdrawal after alcohol overuse. Alcohol withdrawal usually occurs after heavy, prolonged drinking and can be dangerous if not medically treated.

What Does Alcohol Detox Involve?

Alcohol detoxification has no one-size-fits-all approach. It varies according to patient needs and institutional policies and protocols.² If your alcohol detox symptoms warrant immediate medical attention—for example, if you are at risk for seizures or are comatose—acute hospitalized care treatment may begin immediately.

Some examples of alcohol detox practices include:

Alcohol Withdrawal

Alcohol withdrawal refers to a physiological response to the absence of alcohol and only occurs when your body has become accustomed to significant amounts of alcohol regularly.

Alcohol withdrawal occurs between 6-24 hours after your last alcoholic drink.³ If you have stopped heavy, prolonged drinking, and have at least two symptoms related to nervous system excitability, then you more than likely have alcohol withdrawal.⁴

It can lead to dangerous physiological effects if not managed and usually requires clinical care. Medically-supervised alcohol detox is recommended if you are experiencing any of the following symptoms:¹

  • Tremors
  • Nausea and vomiting
  • Abnormal heart rhythms
  • Anxiety and irritability
  • Hallucinations
  • Seizures
  • Fevers

Common, mild symptoms of alcohol withdrawal include:¹

  • Anxiety
  • Irritability
  • Dehydration
  • Sweating
  • Insomnia
  • Confusion
  • Lack of mental clarity

Timeline of Alcohol Withdrawal

Withdrawal symptoms can vary from person to person, but the general timeline is as follows, with only more severe cases evolving into the later, more serious stages of withdrawal:⁷

  • 6-12 hours after last drink: Anxiety, headache, upset stomach, restlessness.
  • 12-24 hours: Hallucinations (can be auditory, visual, or tactile).
  • 24-48 hours: Seizures.
  • 48-72: Delirium tremens, fever, high blood pressure, fast heart rate, sweating.

Delirium Tremens

You may have heard people used the term “the DTs” to describe withdrawal. This stands for delirium tremens, the most severe form of alcohol withdrawal, and is essentially physiological instability.

It is life-threatening and requires immediate treatment and hospitalization. A small percentage of people who go through alcohol withdrawal experience delirium tremens. If you have a history of previous alcohol withdrawal, whether treated or not, you are at higher risk of having a more severe withdrawal in the future.³

Where to Detox from Alcohol

A qualified provider should assess your need for detoxification when you quit drinking. You may find that detox results in a trip to the emergency room. If you have a good relationship with your primary care provider, they may be able to connect you to local resources for detoxification and treatment if they believe you have a risk for withdrawal.

Rehab centers (both outpatient and inpatient) also offer detoxification programs, but usually only for more serious withdrawal.

What Type of Detox Program Do You Need?

In most cases, figuring out which detox program you need involves a brief review of your drinking history and an appraisal of your current state.

Today, many detox programs rely on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) to determine what may be the best detox program for you. This scale rates your symptoms and provides a score that guides clinical decision-making about your risks related to withdrawal.⁵

Intake will also seek to rule out that you are not suffering from another medical condition that could resemble alcohol withdrawal or complicate detoxification.²

Detox from Alcohol Without Medication

Not everyone requires medication for alcohol detox—you may just need to be closely monitored. This may involve a brief hospitalization, which ensures your safety as your body withdraws.

You may or may not stay in a medical facility during detoxification for milder symptoms. Again, it depends on your specific situation. Non-pharmacological measures may include:

  • Nursing supervision
  • Reduced sensory stimulation
  • Reassurance measures
  • Reality orientation
  • Social peer support
  • Relapse prevention counseling

These non-pharmacological treatments are the “first line” treatments for alcohol withdrawal.⁶

Detox from Alcohol with Medication

If you require medical detoxification programs, a doctor may provide the following types of medication:⁶

  • Sedatives
  • Anti-nausea medication
  • Anti-seizure medication
  • Muscle relaxers
  • Intravenous fluids
  • Vitamin and electrolyte supplementation

Sedative medications prevent and manage the serious complications associated with alcohol withdrawal, such as tremors, physical and emotional agitation, and seizures.

Ideally, detox takes place in a quiet, dim area to minimize agitation.² Sedatives, such as benzodiazepines, are commonly prescribed as part of detoxification because they help ease and prevent withdrawal symptoms.

While going through alcohol withdrawal, medical staff will also monitor you closely to assess the stability of your vital signs.

Nutritional supplementation and IV fluids are also often used. If you have a history of problematic drinking, you may have nutritional deficiencies and electrolyte imbalances that improve through vitamin and electrolyte infusion.

In very severe cases, such as liver disease or delirium tremens, high-acuity care, like the intensive care unit, may be indicated.

Who Needs Medical Detox?

The extent to which you are at risk for withdrawal varies among individuals. Factors that may influence your need for medical detoxification include:

  • How much and how often you drink
  • Your liver’s health
  • How long you have been drinking
  • A history of previous withdrawal
  • Your age
  • Your health status and health history

Chronic overuse of alcohol increases both the likelihood and severity of withdrawal.² Although you may only experience mild to moderate symptoms, the course of alcohol withdrawal can be very unpredictable and, in some cases, dangerous.

It is advisable to see your doctor if you’re having concerns about going through alcohol withdrawal or call 800-839-1686Who Answers? to speak to a treatment specialist.²

Drinking After Detoxification

Part of the alcohol detoxification process includes honest conversations with caregivers regarding the extent of your drinking and its effect on your life. Resources will be offered to you to prevent you from having to return to detox and alcohol withdrawal.

You may end up going to inpatient or outpatient alcohol rehabilitation after detoxification, but ultimately that decision will be between you and your providers.

After detoxification, abstinence from alcohol is encouraged to avoid the increased risk of more severe withdrawal in the future.

Other Programs to Help You Stay Sober

Ever-increasing resources are available today for issues related to alcohol and substance use, including:

  • Counseling
  • Group program (e.g., 12-step programs)
  • Inpatient rehab
  • Outpatient rehab
  • Primary care management

For the acute withdrawal phase, hospitalization is usually recommended for at least 24 hours to initiate detoxification if you have a substantial history of drinking.³

You can find information about local detox programs through your insurance provider or primary care provider, as well as via multiple local and federal hotlines, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator. You can also contact 800-839-1686Who Answers? to discuss detox/rehab options with a treatment specialist.

References

  1. National Library of Medicine. (2020). Alcohol withdrawal.
  2. Hoffman, R.S. & Weinhouse, G.L. (2021) Management of moderate and severe alcohol withdrawal syndromes. In S.J. Traub & J. Grayzel (Eds.) UpToDate.
  3. US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol[Brochure]. Rockville, MD: Author.
  4. Bayard M, McIntyre J, Hill KR, Woodside J Jr. (2004) Alcohol withdrawal syndromeAm Fam Physician. 69(6):1443-1450.
  5. Sullivan, J.T.; Sykora, K.; Schneiderman, J.; Naranjo, C.A.; and Sellers, E.M. Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction 84:1353-1357, 1989.
  6. Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543

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