Alcohol is one of the most dangerous drugs to detox from. This is due to the deep and wide ranging changes that alcohol addiction produces in the body and brain. Depending on the amounts and length of time someone drank, if left unchecked alcohol withdrawal can cause seizures, delirium, brain damage, or death. These risks rise dramatically if a person has underlying medical conditions such as diabetes or heart disease. Another issue which is dependent on the length of time someone drank is the duration of withdrawal. This can range from as little as 5 days to several weeks, although the severity will be decline after about a week.
Acute Alcohol Withdrawal Symptoms
This is primarily due to GABA and glutamate receptor changes. GABA, an inhibitor of activity, has reduced efficacy while glutamate, an activity promoter, has a drastically increased impact. This means that the brain is in a state of hyperactivity and is incapable of slowing down. This produces the physical symptoms of alcohol withdrawal including hallucinations and seizures as well as wild fluctuations in body temperature, heart rate, and blood pressure.
Some of the more minor physical symptoms will manifest when someone hasn’t had a drink for several hours and may include:
- Tremors or Shaking
- Anxiety or Panic Attacks
- Disorganized Thinking and Inability to Focus
- Irregular or Fast Heartbeat (Tachycardia)
- Blood Pressure Fluctuations
- Diaphoresis (excessive sweating)
Some of the more severe symptoms won’t begin until a day or more after the last drink. These may begin mild, and increase in intensity over several days and might include:
- Severe Anxiety: Begins hours from last drink and can last for days or weeks. Usually includes insomnia and psychomotor agitation symptoms such as pacing back and forth or incessant foot tapping.
- Tremors: Trembling or even violent shaking which can begin hours after your last drink and can last for several days.
- Alcohol Hallucinosis: Visual, tactile, or auditory hallucinations which most often manifest as voices and typically begin within a day of your last drink and last for several days after.
- Grand Mal Seizures: Also called tonic-clonic seizures, these are characterized by violent involuntary muscle contractions and loss of consciousness. This can escalate to status epilepticus which can cause brain damage or death¹².
- Delerium Tremens: Experienced by some very heavy drinkers, DTs include the above-mentioned anxiety, tremors, hallucinations, and seizures but also include wild fluctuations in body temperature, blood pressure, heart rate, breathing, and produce severe disorientation and confusion. This can cause brain damage, heart attack, or death if medical help is not provided immediately¹. Delirium Tremens is fatal in roughly 37% of cases when left untreated¹.
Post Acute Withdrawal
The acute phase of alcohol withdrawal lasts roughly 5 to 7 days but lingering symptoms may persist for several weeks. These aren’t directly life threatening, but they can make someone extremely uncomfortable and depressed. When someone who is addicted to alcohol abruptly stops drinking, the brain becomes extremely unbalanced. This takes time to return to normal, and the weeks or months this could take are marked by severe mood swings, sleep disturbances, and neurological upsets. Some of these symptoms may include:
- Extreme Anxiety
- Deep Depression
- Sleep Disturbances (vivid dreams or nightmares)
- Lethargy and Fatigue
- Irritability and Restlessness
- Mood Swings
- Cravings for Alcohol
As mentioned, alcohol withdrawal can be extremely dangerous. It is highly advised to seek medical help if someone is going through withdrawal from alcohol so that the risks might be minimized. This could take the form of a hospital emergency room, or more appropriately, a specialized detox facility. The risks with alcohol withdrawal are not to be taken lightly, and help is needed to safely undergo this process. The goal of a detox center is to safely reduce the pain and discomfort of alcohol withdrawal so that continuing treatment and recovery can begin. This is contrasted with a hospital whose goal is strictly to keep someone from dying. Both options are viable, but detox gives someone the best chance at lasting recovery since they are often times connected with continuing care providers and can refer them to an appropriate facility.
Medications for Alcohol Withdrawal
Since alcohol is such an old drug, there are a variety of well tested and effective medications which can be used to help lessen the withdrawal symptoms. The “best” medications will vary from person to person as everybody responds to medications in their own way. Additionally, the symptoms will vary over the course of alcohol withdrawal since they change from the acute to post acute phases.
Medications for Acute Alcohol Withdrawal
- Benzodiazepines (most commonly Lorazepam, Diazepam, Oxazepam, and Chlordiazepoxide)¹²: This class of drugs will reduce the risks of suffering some of the most dangerous symptoms. Since they exhibit sedative-hypnotic effects this will also result in lessened anxiety, decreased tremors, lower risk of seizure, and lower likelihood to suffer Delirium Tremens. Benzos are cross-tolerant to alcohol, meaning that while withdrawing from alcohol these drugs can act as a substitute to prevent the worst symptoms.
- Carbamazepine¹²: An anti-convulsant drug used in mild to moderate withdrawal, it will greatly reduce the possibility of a seizure and can lessen cravings for alcohol. This class of drugs can also treat mood disorders and during alcohol withdrawal can result in decreased anxiety, irritability, and help with depression.
- Valproic Acid¹: Also an anti-convulsant, it can lessen withdrawal symptoms and reduce the number of seizures suffered.
- Gabapentin¹²: A GABA analogue, it can be as effective as lorazepam in mild to moderate alcohol withdrawal through stimulating GABA activity in the brain, thus inhibiting nervous system hyperactivity. This can reduce anxiety, tremors, and lower the risk of seizure.
- Clonidine: Originally a blood pressure medication, it and can lessen nervous system hyperactivity such as tremors and high blood pressure.
- Baclofen: This drug acts as a muscle relaxant and has been used to moderate severe withdrawal symptoms and has been shown to reduce cravings.
Medications for Post Acute Alcohol Withdrawal
The symptoms of post acute alcohol withdrawal are much less severe and dangerous than the acute phase, however they can last much longer. These are typically neurological in nature and include anxiety, depression, sleep issues, and mood disorders. Medication can help manage the symptoms, but the brain will take time to heal. Some medications which have been found effective include:
- Naltrexone: An opioid antagonist, this drug is commonly used in alcohol and opioid addiction treatment. It may reduce cravings for alcohol.
- Antidepressants: SSRI antidepressants have been found to be extremely helpful with managing depression and anxiety, but there are other varieties such as tricyclic antidepressants. A sampling of these 2 classes may include Paxil (SSRI) and Amitriptyline (Tricyclic).
- Mood Stabilizers: Drugs such as aripiprazole may help with mood swings and lessen the effects of depression.
- Propanolol: Originally a blood pressure medication, it is also known to reduce anxiety and is usually tolerated well over an extended period of time.
- Disulfiram: This drug changes the way the body metabolizes alcohol which can make someone feel sick or vomit when they drink. It is frequently used in alcohol addiction treatment programs.
- Sleep Aids: Drugs such as doxylamine, diphenhydramine, or melatonin are very safe and non addictive. These may be a great help when dealing with insomnia or sleep disturbances.
- Bupropion: An antidepressant and smoking cessation aid, it may be able to reduce cravings for alcohol.
- Quetiapine: Originally an antipsychotic, this medication has been shown to reduce cravings in people with drug or alcohol addictions.
- Veterans Affairs Medical Center Epilepsy Research Laboratory: Pathophysiological Mechanisms of Brain Damage from Status Epilepticus
- SUNY Upstate Medical University: Delirium Tremens (DT)
- Yale University School of Medicine: Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders