Alcohol Withdrawal: What Happens When You Stop Drinking Alcohol?
Symptoms of Alcohol Detox
Acute alcohol withdrawal is the most dangerous and uncomfortable phase of getting sober. These symptoms are due to changes in the brain made in response to chronic alcohol use. During acute alcohol withdrawal, the neurotransmitters GABA and glutamate are disrupted. GABA, a calming and inhibitory neurotransmitter, has reduced effects. Glutamate, an excitatory and activity-promoting neurotransmitter, has a drastically increased effect. When these neurotransmitters are out of balance, the brain is in a state of hyperactivity and is unable to calm itself. This imbalance is responsible for the psychological and dangerous physical symptoms of alcohol withdrawal. These include 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
- 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 as mild and increase in intensity over several days.
- Severe Anxiety. Begins hours from the last drink and can last for days or weeks. This can escalate to very high anxiety within the first week.
- Tremors. Trembling or violent shaking can begin hours after the last drink. They can last for several days or weeks in some cases.
- Alcohol Hallucinosis. Visual, tactile, or auditory hallucinations most often manifest as voices and begin within a day of your last drink. They 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. They may escalate to status epilepticus which can cause brain damage or even death.
- 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. Delirium Tremens is fatal in roughly 37% of cases when left untreated.
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. While the symptoms aren’t directly life-threatening, they can be unpleasant. The changes that the brain made to operate in the presence of alcohol will take some time to reverse. 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
- Sleep Disturbances (vivid dreams or nightmares)
- Lethargy and Fatigue
- Irritability and Restlessness
- Mood Swings
- Cravings for Alcohol
Unmonitored alcohol withdrawal can be dangerous. Medical help is critical if someone expects to go through withdrawal so that risks might be minimized. This could take the form of a hospital emergency room or a specialized facility. The risks posed by alcohol withdrawal should not be taken lightly, as they can cause permanent brain damage and death. The goal of an alcohol detox center is to reduce the risks, pain, and discomfort of alcohol withdrawal so that continuing treatment and recovery can begin.
Both hospital and specialty detox options are viable, but a detox center gives the best chance at lasting recovery. These facilities are oftentimes connected with treatment and continuing care providers and can refer to appropriate facilities following detox.
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. At our rehab centers in Georgia, we work with our clients to find the medications that will be most helpful for their particular situation. 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 result in lessened anxiety, decreased tremors, lower risk of seizures, and a lower likelihood to suffer delirium tremens.
- 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. It may reduce some of the psychological discomforts of withdrawal as well.
- Gabapentin. This medication may be as effective as lorazepam for preventing seizures during withdrawal. It also reduces anxiety, insomnia, and the risk of dangerous complications during acute alcohol withdrawal.
- Clonidine. Originally a blood pressure medication, it can decrease 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. It may be able to reduce cravings as well.
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 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 used medications include:
- Naltrexone. One of the oldest medications that is FDA approved to treat alcohol withdrawal. It can reduce cravings.
- Antidepressants. SSRI antidepressants are helpful in managing depression and anxiety. These can help reduce 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. This drug is usually tolerated well over an extended period of time.
- Disulfiram. This drug changes the way the body metabolizes alcohol and can make someone feel sick or vomit when they drink.
- 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.
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