What Helps Alcohol Withdrawal?Anna Ciulla
Alcohol claims more lives each year in America than opiates, and the search for more effective treatments for those with alcohol use disorder (AUD) is both necessary and crucial in ending the scourge of alcoholism. Besides heavy drinkers, even when someone who’s dependent on alcohol contemplates going into treatment, however, the looming and dreaded alcohol withdrawal phase often scares them off. There’s good reason for that, although researchers are hard at work to identify and develop medications and therapies beyond existing ones approved by the Food and Drug Administration (FDA) to use to treat AUDs during alcohol detox and into formal treatment. Nevertheless, one key question for anyone who wants to stop drinking is, what helps alcohol withdrawal?
WHAT IS ALCOHOL WITHDRAWAL?
As WebMD describes it, alcohol withdrawal is what happens when you’ve been drinking heavily for a period of week, months, or years and suddenly stop drinking. You may experience physical and mental problems when the alcohol you normally consume has been drastically cut back or stopped. Symptoms of alcohol withdrawal may range from mild to moderate to severe.
HOW LONG DOES ALCOHOL WITHDRAWAL LAST?
In general, symptoms begin to appear in the first 8-24 hours after the last drink. More symptoms will occur in the next 24-48 hours before gradually diminishing, while most symptoms are gone in about a week. Once you realize that alcohol withdrawal, as much as you dislike the idea of having to through it, doesn’t last that long, it’s a little easier to want to go through the process of getting alcohol out of your body through medically managed alcohol detox.
However, you’re not out of the woods yet. If you’ve been a heavy drinker or chronic drinker for a long time, you could experience more serious alcohol withdrawal symptoms, such as seizures or hallucinations, occurring within 24 hours and 10-72 hours after the last drink, respectively. Only about 25 percent of those who go through alcohol withdrawal will experience hallucinations, and those are mostly brief. Delirium tremens (DTs), one of the most serious of alcohol withdrawal symptoms, generally appears in the first 3 days after initial symptoms of alcohol withdrawal appear, last from 1-8 days, although typically only 2-3 days in duration.
WHY IS ALCOHOL WITHDRAWAL WORSE FOR SOME DRINKERS THAN OTHERS?
While horror stories of excruciatingly painful alcohol withdrawal do not depict the typical alcohol detox experience, they are enough to give pause to anyone who seriously wants to quit drinking for good. A study by researchers from Yale reported in the journal Alcoholism: Clinical and Experimental Research offers insight into why some heavy drinkers suffer intense alcohol withdrawal symptoms when they quit drinking, while others have less severe withdrawal symptoms. Indeed, as researchers noted, alcoholics going through intense alcohol withdrawal have symptoms that are worse than any hangover. Such symptoms include anxiety, blood pressure fluctuations, nausea, shakes, and seizures in the most serious of cases.
During the international study of those with alcohol dependence, researchers identified gene variants (SORCS2) they say may help explain why alcohol detox is especially tough for some individuals. They demonstrated a causal relationship between stress hormone levels and SORCS2 expression, showing that levels of SORCS2 in culture increase with alcohol exposure and withdrawal. The hope is that further investigation of the pathophysiology of alcohol withdrawal involving the effects of stress hormones on neurotrophic factor signaling could lead to new methods to manage the negative consequences of abrupt alcohol discontinuation.
WHAT CAN I DO TO MAKE ALCOHOL WITHDRAWAL EASIER?
Knowing that physical and mental symptoms will occur as alcohol use is curtailed or stopped understandably prompts a question of what an individual can do to make alcohol withdrawal easier? If not easy, at least less uncomfortable? Addiction treatment experts caution against self-detox from alcohol, since going cold turkey is not only dangerous, it’s also less likely to result in a positive outcome. Once some of the more painful or difficult symptoms start to appear, especially severe ones such as hallucinations, possibly delirium tremens (DTs), the almost inevitable response will be to drink again to stop the symptoms. Without a medical professional monitoring the detox, even if you do all sorts of remedies and therapies touted on the Internet, you may not be successful. Not that such therapies aren’t useful, and many are used during medical detox to help with withdrawal symptoms, it’s just that when you’re in the middle of alcohol withdrawal, you’re not the best judge of what’s going to work, nor are you able to benefit from medications to ease alcohol withdrawal.
Good mental and physical preparation for alcohol detox, on the other hand, will prove beneficial as you go into medically-supervised alcohol detox at a certified alcohol and drug rehab center.
Long-term alcohol use is often accompanied by unhealthy eating patterns. As such, to help make withdrawal easier and promote the return to more normal functioning of the brain, it’s important to eat the right kind of foods. Add foods proven to help the brain heal such as berries, broccoli, celery, coconut oil, garbanzo beans, nuts and seeds, red meat, and turmeric root. Other research points to the benefit of algae and seaweeds to restore the damage to the body caused by alcohol abuse.
Since alcohol use dehydrates the body, another helpful recommendation is to drink plenty of fluids, especially water. Also minimize salt intake and cut out consumption of sugary foods, particularly those with processed sugars and high fat content.
Recognize that when alcohol withdrawal occurs, you’re going to feel bad, then worse, eventually leveling off and then beginning to feel better. You can help your alcohol withdrawal process by maintaining a positive attitude, getting lots of sleep, distracting yourself when disconcerting cravings appear, and surrounding yourself with optimistic family and friends.
WHAT HAPPENS DURING ALCOHOL DETOX?
During detoxification (detox) from alcohol, you are monitored 24/7 by medical professionals who constantly assess your withdrawal symptoms for frequency and severity, and appearance of new symptoms and address your pain and discomfort with appropriate medications and other therapies. The primary goal is to ensure a safe and as comfortable as possible alcohol detox.
Anyone entering treatment for alcohol dependence or AUD will require alcohol detox before formal treatment begins. A thorough medical and clinical assessment is the first step, followed by creation of a personalized treatment plan.
Part of the plan often includes medication-assisted treatment (MAT) during detox and formal treatment. This is a groundbreaking approach to treating AUD and other substance use disorders (SUDs) with a combination of FDA-approved medications and behavioral therapy.
- Medications used during alcohol detox may include Vivitrol (naltrexone), which is known for its effectiveness in decreasing cravings for alcohol and opiates.
- Someone with AUD and SUD may be prescribed Suboxone or Subutex (buprenorphine) to help with opiate withdrawal symptoms (especially cravings) as a short-term intervention through early recovery.
- Librium or Ativan (both benzodiazepines) are highly effective in decreasing dangerous or problematic alcohol withdrawal symptoms, such as seizures or death. Another reason benzodiazepines may be used as part of MAT is that they significantly reduce the likelihood of alcohol withdrawal-induced medical complications.
- Those with co-occurring (dual diagnosis) AUD or SUD and mental health disorder may be prescribed medications to help with the psychiatric condition such as anxiety, depressive disorders, or post-traumatic stress disorder that may have gone untreated and even been a cause of AUD or SUD.
- Behavioral therapies, such as cognitive-behavioral therapy (CBT), may be prescribed during detox for those who are able to participate. Getting introduced to therapies early sets the stage for continued implementation of these evidence-based treatment modalities following detox and entering into formal treatment.
- 12-step group therapy is another intervention that, with the ability to participate clearly evident, alcohol detox clients may be introduced to. Again, early involvement in peer self-help groups helps familiarize the individual in alcohol detox with an important aspect of formal treatment and a strategic element of effective long-term recovery.
WILL ALCOHOL WITHDRAWAL BE WORSE AFTER RELAPSE?
How severe or how much worse alcohol withdrawal will be after a relapse is going to vary from one person to the next. Alcoholism is a chronic relapsing disease, and many people who’ve become dependent on alcohol go through more than one bout of heavy drinking followed by periods of abstinence. This doesn’t mean that treatment failed, only that it may need reinforcing.
As to how you’re going to feel going through alcohol withdrawal after relapse, it may be worse than before, or some aspects (particularly psychological, as in cravings) may be worse. Research suggests that cognitive functioning may suffer, and sleep problems may be more prevalent. Repeated withdrawals, according to the National Institute on Alcohol Abuse and Alcoholism promote the opportunity for those who are alcohol-dependent to experience alcohol’s negative reinforcing properties – that is, they associate drinking alcohol with stopping or minimizing withdrawal-related negative consequences, such as malaise. This increases vulnerability to relapse and also prompts escalation of drinking as well as sustained levels of drinking that may be potentially harmful. A history of multiple detox and withdrawal episodes can produce increased sensitivity to withdrawal syndrome. This is a process known as “kindling.” Numerous studies have demonstrated susceptibility to more severe and medically-complicated withdrawals in those with a history of multiple detoxifications.
None of this should deter you from seeking treatment after an alcohol relapse. If you’ve already gone through inpatient treatment for alcohol abuse, you may benefit from participating in an intensive outpatient program (IOP). There’s also continuing care, aftercare and alumni programs to help you get back on track with your sobriety.
For more about alcohol addiction, withdrawal and recovery, check out these articles:
- Alcoholism: Clinical & Experimental Research. “Risk Locus Identification Ties Alcohol Withdrawal Symptoms to SORCS2.” Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.13890
- American Journal of Psychiatry. “Current Status of Co-Occurring Mood and Substance Use Disorders: A New Therapeutic Target.” Retrieved from https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.2012.12010112
- Annual Review of Psychology. “Addiction and the Brain Antireward System.” Retrieved from https://www.annualreviews.org/doi/abs/10.1146/annurev.psych.59.103006.093548
- National Institute on Alcohol Abuse and Alcoholism. “Alcohol Dependence, Withdrawal, and Relapse.” Retrieved from https://pubs.niaaa.nih.gov/publications/arh314/348-361.htm
- National Institute on Alcohol Abuse and Alcoholism. “Kindling in Alcohol Withdrawal.” Retrieved from https://pubs.niaaa.nih.gov/publications/arh22-1/25-34.pdf
- National Institute on Alcohol Abuse and Alcoholism. “Rethinking Drinking.” “How much is too much?” Retrieved from https://www.rethinkingdrinking.niaaa.nih.gov/How-much-is-too-much/
- Psychopharmacology. “Previous experience of ethanol withdrawal increases withdrawal-induced c-fos expression in limbic areas, but not withdrawal-induced anxiety and prevents withdrawal-induced elevations in plasma corticosterone.” Retrieved from https://link.springer.com/article/10.1007/s00213-005-0301-3
- WebMD. “What Is Alcohol Use Disorder?” Retrieved from https://www.webmd.com/mental-health/addiction/what-is-alcohol-abuse#1
- WebMD. “What Is Alcohol Withdrawal?” Retrieved from https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#1
- Yale News. “Genes explain why alcohol withdrawal is so hard on some.” Retrieved from https://news.yale.edu/2018/09/25/genes-explain-why-alcohol-withdrawal-so-hard-some