Alcohol Withdrawal: What Happens When You Stop Drinking Alcohol?

Alcohol can be one of the most dangerous drugs to detox from without medical supervision. This is due to the deep and wide-ranging changes that alcohol addiction produces in the body and brain. Depending on the amount and length of time someone drank if someone stops drinking suddenly alcohol withdrawal can cause seizures, delirium, brain damage, or even death. These risks rise dramatically if a person has underlying medical conditions such as diabetes or heart disease. Another major issue that is subject to variability is the duration of withdrawal. This can range from as little as 5 days to several weeks, although the severity will often decline after about a week.

Symptoms of Alcohol Detox

The symptoms of acute alcohol withdrawal, the most dangerous and uncomfortable phase, are due to changes the brain made in response to chronic alcohol use. During acute alcohol withdrawal the neurotransmitters GABA and glutamate are seriously disrupted. GABA, a calming and inhibitory neurotransmitter, has reduced effects while glutamate, an excitatory and activity promoting neurotransmitter, has a drastically increased effect. When these neurotransmitters are out of balance as they are during acute alcohol withdrawal, the brain is in a state of hyperactivity and is unable to calm or slow itself down. This imbalance is responsible for the psychological and the dangerous physical symptoms of alcohol withdrawal including hallucinations, delirium, and seizures as well as wild fluctuations in body temperature, heart rate, and blood pressure.

Some of the more minor, although still unpleasant, symptoms that will manifest when someone hasn’t had a drink for several hours may include:

  • Tremors or Shaking
  • Anxiety or Panic Attacks
  • Disorganized Thinking and Inability to Focus
  • Insomnia
  • Irregular or Fast Heartbeat (Tachycardia)
  • Blood Pressure Fluctuations
  • Diaphoresis (excessive sweating)

Some of the more severe symptoms won’t usually 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. This can escalate to very high anxiety levels within the first week.
    • Tremors: Trembling or even violent shaking which can begin hours after the last drink and can last for several days, or even weeks in some cases.
    • Alcohol Hallucinosis: Visual, tactile, or auditory hallucinations which most often manifest as voices and typically begin within a day of your last drink and can last for several days once they have begun.
    • Grand Mal Seizures: Also called tonic-clonic seizures, these are characterized by violent involuntary muscle contractions and loss of consciousness. The time of highest seizure risk is roughly 36 hours after the last drink, and these may escalate to status epilepticus which can cause brain damage or even death. 1,2
    • Delirium Tremens (DTs): 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 immediately. ¹ Delirium Tremens is fatal in roughly 37% of cases when left untreated. 3

Post-Acute Withdrawal

While the acute phase of alcohol withdrawal lasts roughly 5 to 7 days, lingering symptoms may persist for several weeks. This is known as post-acute alcohol withdrawal, and while the symptoms aren’t directly life-threatening, they can be extremely unpleasant. The changes that the brain made to operate in the presence of alcohol will take some time to reverse themselves, and someone may experience hyperactive psychological and physical symptoms while this is taking place. Some of the more common symptoms of post-acute alcohol withdrawal may include:

  • Extreme Anxiety
  • Deep Depression
  • Insomnia
  • Sleep Disturbances (vivid dreams or nightmares)
  • Lethargy and Fatigue
  • Irritability and Restlessness
  • Mood Swings
  • Cravings for Alcohol

Alcohol Withdrawal

Alcohol Detox

Unmonitored alcohol withdrawal can be extremely dangerous. It is highly advised to seek medical help if someone is expected to go through withdrawal from alcohol so that the risks might be minimized. This could take the form of a hospital emergency room or a specialized detox facility. The risks posed by alcohol withdrawal should not be taken lightly, as it can cause permanent brain damage and death. The goal of an alcohol detox center is to safely reduce the risks, pain, and discomfort of alcohol withdrawal so that continuing treatment and recovery can safely begin. Both hospital and specialty detox options are viable, but a detox center gives someone the best chance at lasting recovery since they are oftentimes connected with treatment and continuing care providers and can refer them to an appropriate facility.

Medications for Alcohol Withdrawal

There is a wide variety of well tested and effective medications that can reduce the dangers and discomfort of alcohol withdrawal. The most effective medications will vary from person to person, as everybody responds to medications in their own way.

Medications for Acute Alcohol Withdrawal

  • Benzodiazepines: The most commonly used benzodiazepines for alcohol withdrawal include lorazepam, diazepam, and chlordiazepoxide. This class of drugs will reduce the dangers and discomfort of withdrawal since they are cross-tolerant to alcohol and work on some of the same neurotransmitters. They also exhibit sedative-hypnotic effects which can also result in lessened anxiety, decreased tremors, lower risk of seizure, and a lower likelihood to suffer delirium tremens. 4
  • Carbamazepine: An anticonvulsant medication used to treat mild to moderate withdrawal, it can reduce the possibility of a seizure and can lessen cravings for alcohol. This medication is thought to work on the same inhibitory neurotransmitter (GABA) as alcohol, so it may reduce some of the psychological discomforts of withdrawal as well. 5, 6
  • Gabapentin: This medication may be as effective as lorazepam for preventing seizures during withdrawal. It has also been shown to reduce anxiety, insomnia, and reduce the risk of dangerous complications during acute alcohol withdrawal. 5, 7
  • Clonidine: Originally a blood pressure medication, it and can lessen some of the uncomfortable symptoms such as restlessness, tremors, and high blood pressure.
  • Baclofen: This drug acts as a muscle relaxant and has been used to reduce the severity of withdrawal symptoms and may be able 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 although they can last much longer. These are typically neurological in nature and can include anxiety, depression, sleep problems, and mood disorders. Medication can help manage the symptoms, but the brain and body will take time to heal. Some of the most commonly used medications include:

  • Naltrexone: One of the oldest medications that is FDA approved to treat alcohol withdrawal, naltrexone can reduce cravings for alcohol.
  • Antidepressants: SSRI antidepressants have been found to be extremely helpful in managing depression and anxiety. These can help reduce the negative psychological symptoms while the brain recovers.
  • 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: Medications such as doxylamine, diphenhydramine, or melatonin are usually quite safe and non-habit-forming. These can improve the amount and quality of sleep.
  • 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 recovering from alcohol addictions.

References

  1. Epilepsia: Pathophysiological Mechanisms of Brain Damage from Status Epilepticus
  2. Annals of the Indian Academy of Neurology: Status Epilepticus
  3. SUNY Upstate Medical University: Delirium Tremens (DT)
  4. Journal of Clinical & Diagnostic Research: Alcohol Withdrawal Syndrome – Benzodiazepines and Beyond
  5. Yale University School of Medicine: Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders
  6. Journal of Clinical Pharmacy and Therapeutics: The Role of Carbamazepine and Oxcarbazepine in Alcohol Withdrawal Syndrome
  7. Federal Practitioner: Gabapentin Use in Acute Alcohol Withdrawal Management 

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