Why can’t you just quit?
Anyone who’s ever struggled with alcohol abuse and alcohol withdrawal – or known someone who was – has probably asked themselves that question. Unfortunately, it’s a simple question without a simple answer.
Like all addictive drugs, alcohol can produce unpleasant effects when drinking stops. Known as withdrawal symptoms, this combination of physical and mental effects can be particularly unpleasant – even dangerous – for long-term drinkers. Clinical detox is a must when recovering from alcohol abuse.
Why Is Alcohol Addictive?
Like other drugs, using alcohol feels good.
In small doses, alcohol acts like a stimulant. People become more talkative and less inhibited. In larger doses, alcohol acts more like a central nervous system depressant, which is why people who drink heavily tend to slur their speech, have trouble standing and often pass out.
Chemically, alcohol amplifies the effects of a neurotransmitter called gamma-aminobutyric acid, or GABA. This brain chemical suppresses central nervous system activity. Also, recent studies have shown alcohol increases the amount of dopamine and other reward chemicals in the brain, leading to euphoric feelings in some drinkers.
Like other drugs, alcohol loses its effects over time as a person continues drinking. A drinker has to keep drinking more and more to feel the same effects. This is known as tolerance; while being able to outdrink everyone at the table seems like a fun party trick, it’s a massive red flag. Tolerance is a behavior pattern that eventually fuels addiction.
Eventually, tolerance becomes dependence. At this stage, a person will continue drinking to avoid feeling the symptoms of withdrawal. Unpleasant and occasionally life-threatening, withdrawal can be overwhelming if done outside of a monitored, clinical environment.
For patients recovering at a detox center, clinicians take steps to ensure they are as safe and comfortable as possible during this critical first step of recovery.
What Is Withdrawing From Alcohol Like?
In a word, difficult. Alcohol’s depressive effect on the brain makes the nervous system work harder to keep the body functioning. When alcohol is removed from the body (particularly if it’s done suddenly), it upsets homeostasis, the body’s constant attempt to maintain balance.
As the body works to regain balance and adjust to the lack of alcohol, a person will experience a variety of unpleasant symptoms. This is called withdrawal, and in alcohol’s case, the symptoms can range from the unpleasant to potentially fatal. Much of this depends on:
- The patient’s physiology
- How much they drink
- How long they’ve been drinking
In a detox program, a patient’s symptoms can be monitored closely. More dangerous symptoms such as hallucinations and seizures are treated rapidly, ensuring a safe detox in a caring environment.
Detoxing from alcohol is a very personal experience. The following timeline of alcohol withdrawal is meant as a general guide and not necessarily a guarantee of what a patient will experience while detoxing from alcohol.
The First Symptoms Of Alcohol Withdrawal
Alcohol withdrawal lacks a strict timeline. In general, the first symptoms can start anywhere from hours to a day or so after the last drink. As is the case with all addictive substances; everyone’s case is different. Symptoms, complications, and the intensity of both depend on age, physiology, length of time abusing alcohol, and more.
The symptoms include:
- Shaking hands
- Anxiety
- Headache
- Vomiting and nausea
- Heavy sweating
Later Symptoms Of Alcohol Withdrawal
This is when withdrawal gets dangerous, especially for someone who’s been a heavy alcohol user for years … or is dealing with other health issues. The first symptoms get more intense during this phase. Meanwhile, the patient may experience hallucinations and potentially life-threating symptoms involving the heart and nervous system:
- Shaking hands
- Anxiety
- Headache
- Vomiting and nausea
- Heavy sweating
- Seizures
- Irregular or racing heart rate
- Hallucinations
The danger of this phase speaks to the necessity of finding a professional detox center. Both the sudden stop, “cold turkey” approach and trying to manage these symptoms without medical professionals can be extremely dangerous.
The Third Phase Of Alcohol Withdrawal
This phase can start in the second or third day after drinking stops. Some of the symptoms can be extremely severe during this period when withdrawal peaks:
- Shaking hands
- Anxiety – including panic attacks
- Vivid hallucinations
- Delirium tremens, aka the DTs
- Aggression
- Grand mal seizures
- Dangerous changes in body temperature
- Headache
- Vomiting and nausea
- Heavy sweating
A word about delirium tremens: Although this is a rare complication, the DTs consist of extremely intense delusions and hallucinations, a dangerous condition for anyone, let alone a person recovering from prolonged alcohol abuse.
The Fourth Phase Of Alcohol Withdrawal … And The Danger Of Kindling
After 72 hours, the worst is usually over. The risk of seizures greatly decreases during this phase, and the heart returns to its normal function. However, some symptoms do persist for a longer time, including sweating, the shakes, mental fog, and mood disorders such as anxiety & depression.
An important thing to be aware of at this stage is kindling. Although the reasons for it aren’t well-understood, each time a person goes through alcohol withdrawal they face worse, more intense symptoms. This is another reason alcohol detox is so important – detoxing in a monitored environment gives a far better chance of lasting success than going it alone.
Finally, there is one more problem to be aware of: lingering withdrawal symptoms.
Alcohol Withdrawal & Post-Acute Withdrawal Syndrome (PAWS)
It’s not fully understood why some people experience post-acute withdrawal symptoms, or PAWS. Similar to the symptoms of alcohol withdrawal, PAWS symptoms are less serious but still capable of interfering with normal daily activities.
The severity of PAWS symptoms change often, and they can disappear and return at a later date. They include:
- Mood disorders including depression and anxiety
- Mood swings
- Problems with mental tasks such as problem solving
- Sleep problems
- Substance cravings
- OCD-like behaviors
- Poor stress responses
- Social problems
Researchers at the University of California Los Angeles think PAWS may result from chemical changes in the brain created by substance abuse.
Although PAWS is a long-lasting condition, there’s reason to hope: the condition responds well to the types of therapy offered in rehab.
Detox Is The Beginning
As important as detox is, it’s just the first step towards recovery. It’s important to consider one’s next steps after leaving detox. Rehab gives recovering patients the tools they need to live long, fulfilling lives free from substance abuse.
Typically, patients who leave detox programs enter a stage of care known as a partial hospitalization program (PHP). Usually taking place towards the end of detox, this treatment stage allows patients to begin learning the coping mechanisms and other tools which let them build their successful recovery.
After PHP is intensive outpatient, or IOP. This level of care adds more useful tools, including skills aimed at long-term recovery, independent living, and relationship mending. Many patients in this period of treatment continue their education and reenter the workforce.
But none of this is possible without detox. Given the risks of alcohol abuse, the difficulties of withdrawal, and kindling issues getting medically monitored, professional detox is critical to long-term recovery.
