Alcohol Detox 101: How to Take the First Step Into Your Sober Life

The 2019 National Survey on Drug Use and Health found that around 14.5 million people age 12 and older met the criteria for alcohol use disorder.1 In a small 2021 study, were asked about their experience with how to detox from alcohol. About 95% of respondents reported withdrawal symptoms lasting 2-8 days, whether they detoxed at home or at a medical facility.2

What Is Detox?

The word “detox” is commonly used in several ways. Casually, detox may be used to describe eliminating any substance from the body.

Detox is also sometimes used interchangeably in the addiction recovery industry to describe the process in which your body responds to no longer having the substance as well as to describe the services provided to help you manage these symptoms.

When speaking more specifically, the physical reaction to lower levels of alcohol or alcohol cessation is known as “withdrawal” or “withdrawal syndrome.” Generally speaking, about 50% of all individuals with an alcohol use disorder will experience withdrawal symptoms, some of which will require medical attention and treatment.3

The related services can also be called “withdrawal management” and there are many types of detox depending on an individual’s history, alcohol use, and symptom severity.

What Physical Detox from Alcohol Like?

When you stop consuming alcohol, your body enters into a state of withdrawal. This physical reaction can begin within 6-24 hours of the reduction of or the complete cessation from alcohol.4

These symptoms may range from mild to severe, usually depending on how often you use alcohol and how much you drink. These symptoms can include: 3,4

  • Agitation
  • Irritability
  • Tremors
  • Anxiety
  • Depression
  • Nausea
  • Vomiting
  • Confusion
  • High blood pressure
  • Elevated heart rate
  • Fever
  • Twitches or muscle spasms
  • Sweating

Severe withdrawal symptoms may include neurological symptoms such as:

  • Hallucinations
  • Seizures
  • Delirium tremens (DT)
  • Coma

How Long Does It Take to Detox from Alcohol?

Typically, mild to moderate symptoms resolve in a maximum of 5-7 days, whereas more severe symptoms may require medical attention and take longer to resolve.3

Many factors influence the likelihood of developing certain symptoms, such as:3, 5

How to detox from alcohol includes managing symptoms.

  • How much alcohol you are consuming
  • How long you have been consuming alcohol
  • Any other medical conditions
  • Use of any other substances or medications
  • Age and gender
  • Organ function

This withdrawal state is typically divided into four stages:3

  • Stage I—Minor withdrawal symptoms like nausea, changes in heart rate, and mild changes in breathing. Stage I can start within 6-8 hours after last drink.
  • Stage II—Alcoholic hallucinosis, which can include hallucinations—or any sensation that does not match reality, such as crawling skin, changes in sense of smell, and visual disturbances. Stage II can start within 12-24 hours after last drink.
  • Stage III—Alcohol withdrawal seizures with an onset of 24-48 hours after last drink.
  • Stage IVDelirium tremens (DT), the most severe potential withdrawal symptom, which can start within 48-72 hours after last drink. DT is rare and estimated to affect at most 5% of people detoxing from alcohol, but can include profound confusion, extremely high blood pressure, seizures, and potential coma.

Although most within a week, with respondents of the 2021 survey reporting an average of 4.58 days, sometimes physical symptoms can last up to 10 days.2, 3 Importantly, psychological withdrawal symptoms (e.g., cravings, insomnia, anxiety, and depression) can last longer.3

What Do Doctors Consider When Recommending Detox?

Due to potentially severe withdrawal symptoms, it is recommended you speak with your medical provider. When recommending specific detox services, your medical provider may conduct an evaluation of your risk. The Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) scale is a common tool. The CIWA-Ar provides three ranges with general recommendations on forms of treatment:3,4,5

  • 0-8: Mild alcohol withdrawal—The individual is usually a good candidate for treatment in an outpatient setting with little to no need for medication
  • 8-15: Moderate alcohol withdrawal—The individual is a good candidate for outpatient treatment if not contraindicated by other medical concerns, but medication is typically needed and medical supervision is advised
  • 16+: Severe alcohol withdrawal—The individual requires inpatient detox care under direct supervision of medical providers

Regardless of the chosen option, it is important to prepare yourself and be in a place of readiness for change.5 You may also consider questions like:

  • Does my insurance cover all or part of certain kinds of withdrawal management services? Detox may be covered through insurance, scholarships, grants, payment plans, or alternative payment methods like crowdfunding or medical loans. If you have current insurance, check if any detox centers and services are covered.
  • Are there alcohol detox centers near me that offer the services my doctor recommends? Detox care may be most accessible if it is local to you. Consider starting your search locally and expanding it based on the services you may need if they are not available in your immediate area.
  • Which facilities near me have immediate availability? While ideally you would be able to weigh many options for detox treatment, it is sometimes more important to enter treatment as soon as possible so you can mitigate health risk factors, comply with legal conditions, or begin your recovery journey. Decide if going on a waitlist is feasible or not.
  • Is my chosen detox facility affiliated with a rehab facility that I can transition into after detox? Because psychological symptoms like cravings can continue after you become abstinent from alcohol, many addiction professionals recommend transitioning directly into an inpatient rehab or outpatient program based on your needs. This is also called “stepping down” in your level of care.

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What Types of Detox Are There?

Based on assessment, your medical provider may give you recommendations or refer you to a type of detox facility or to a specific detox center.

Types of detox include:

  • At-home detoxification from alcohol in your home without assistance from a care provider
  • At-home detoxification from alcohol with medical assistance (e.g., medications prescribed for you to take)
  • At-home detoxification from alcohol under medical supervision from a medical professional who you consult about your home plan and who provides medication and care
  • Short-term facility that provides several days in rehab mainly focused on treating physical symptoms of withdrawal process
  • Long-term facility that weeks to months in rehab facility beginning with management of withdrawal symptoms and then assistance with maintaining recovery

Your medical provider may recommend at-home detoxification if it is estimated that you would experience no to mild withdrawal symptoms.

There are four primary tiers of intervention that psychiatrists examine when assisting their patients with detoxifying from alcohol. These four tiers are:5

  • Tier 1: Individuals are expected to have mild to moderate symptoms and those with high anxiety levels. Best line of treatment includes supportive and “feel good” therapies.
  • Tier 2: Individuals are expected to have moderate to severe symptoms and require medication treatment. Primary care offices and medical and psychiatric outpatient clinics operate from this tier.
  • Tier 3: Individuals are expected to have moderate to severe symptoms requiring specialized staff, whether in an outpatient or inpatient facility. This tier is able to accommodate complex prescribing regimes. This tier is also utilized to treat neurological symptoms.
  • Tier 4: Individuals with the most severe symptoms, often including delirium tremens, seizures, and medical complications. These individuals need round-the-clock care.

Detox is often just the first step toward long-term recovery, which may involve additional resources and treatment. Call 800-839-1686Who Answers? to speak to a specialist about your alcohol addiction treatment options today.

Resources

  1. SAMHSA, Center for Behavioral Health Statistics and Quality. (2019). National Survey on Drug Use and Health. Table 5.4A – Alcohol use disorder in past year among persons aged 12 or older, by age group and demographic characteristics: Numbers in thousands, 2018 and 2019.
  2. Carmona, M. (Ed.). (2021). Alcohol Use Survey Reveals Risks Before, During and After an Addiction. The Recovery Village.
  3. Addolorato, G., Antonelli, M., Caputo, F., D’Angelo, C., Ferrulli, A., Gasbarrini, A., Leggio, L., Mirijello, A. & Vassallo, G. (2015, February 10). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353-365.
  4. Attilia, F., Attilia, M. L., Capriglione, I., Ceccanti, M., Cereatti, F., Coriale, G., Fiore, M., Iannuzzi, S., Perciaballi, R. Rotondo, C. & Vitali, M. (2018). Alcohol withdrawal syndrome: diagnostic and therapeutic methods. Rivista di Psichiatria, 53(3), 118-122.
  5. Raistrick, D. (2000). Management of alcohol detoxification. Advances in Psychiatric Treatment, 6(5), 348-355.
  6. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol withdrawal syndrome: Benzodiazepines and beyond. Journal of Clinical and Diagnostic Research, 9(9), VE01–VE07.
  7. Bergeron-Parent, C. (2020). Alcohol withdrawal in my office…Yes! Family Doctor: A Journal of the New York State Academy of Family Physicians, 8(3), 52-55.

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