Alcohol Withdrawal Timeline

Drug Withdrawal and At-Home Detox: What Are the Risks? » Alcohol Withdrawal Timeline

Around 17 million Americans (aged 12 and older) battled an alcohol use disorder (AUD) in 2014, as reported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). One of the side effects of an AUD is alcohol dependence. Drinking large amounts of alcohol on a regular basis can cause the brain and body to become dependent on the changes to brain circuitry and chemistry that alcohol produces.

Alcohol acts on some of the neurotransmitters in the brain, like dopamine, which signals pleasure. This is how alcohol works as a mood enhancer and encourages people to want to drink more and more often. With regular alcohol consumption, the body builds up a tolerance to alcohol’s effects, and more alcohol will need to be introduced in order to produce any effect. Drinking more after a tolerance has formed may more quickly create a dependence on alcohol. Once a dependence on alcohol has set in, withdrawal symptoms can occur when alcohol stops being active in the bloodstream, or its effects wear off. The National Library of Medicine (NLM) reports that alcohol withdrawal can start as soon as eight hours after the last drink.

Factors Influencing the Alcohol Withdrawal Timeline

Alcohol is metabolized differently in each person; therefore, the rate at which it wears off will vary from person to person as well. The journal Clinics in Liver Disease postulates that the following factors can impact how quickly, or slowly, alcohol moves through a person’s system, therefore influencing when withdrawal symptoms may start:

  • Gender: Women typically are thought to metabolize alcohol at a slower rate than men, which may be due to the fact that alcohol elimination in the body may be directly correlated to body size.
  • Age: Alcohol is metabolized slower as a person ages, meaning that younger people may potentially experience withdrawal symptoms faster than older individuals.
  • Biology: A person’s biology and genetic makeup can impact alcohol metabolism.
  • Ethnicity: Some races, such as Native Americans, may metabolize alcohol faster than others due to specific genes or alleles that they carry.
  • Food intake: A full stomach contributes to a better and faster metabolism of alcohol, as someone drinking on an empty stomach may become intoxicated faster and remain so longer.
  • Exercise rate: Exercising may help to metabolize alcohol faster, leading it to leave the system more quickly.
  • Polydrug use: Other drugs in the body can disrupt and either increase or decrease the rate that alcohol is metabolized and therefore eliminated.
  • Level of alcohol dependence: Someone who is heavily dependent on alcohol likely metabolizes it faster, leading to a faster onset of withdrawal.
  • Co-occurring disorders: The presence of liver disease, which is common in individuals with chronic alcohol abuse patterns, may slow the metabolism of alcohol. Other medical or mental health conditions may influence alcohol elimination in the body as well.

In general, as soon as alcohol stops being active in a person’s bloodstream, withdrawal can start.

Symptoms of Alcohol Withdrawal

The New England Journal of Medicine (NEJM) publishes that half of all people who battle an AUD will suffer from alcohol withdrawal symptoms when they attempt to stop or slow down their drinking. Alcohol withdrawal symptoms can vary in severity from mild to life-threatening. They may be directly related to how dependent the person’s brain and body are on alcohol.

Alcohol dependence varies from person to person, and it is impacted by genetics, biological and environmental factors, the amount of alcohol consumed regularly, the length of time abusing alcohol, any polydrug abuse, and potential co-occurring medical or mental health disorders. The more heavily dependent a person is on alcohol, the more significant the alcohol withdrawal syndrome may be.

Alcohol withdrawal may include the following symptoms:

  • Headache
  • Dizziness
  • Nausea and/or vomiting
  • Diarrhea
  • Muscle aches
  • Lethargy and fatigue
  • Insomnia and potential nightmares
  • Loss of appetite
  • Anxiety
  • Irritability
  • Restlessness
  • Depression
  • Rapid heart rate
  • Clammy skin
  • Shakiness and tremors
  • Cloudy thinking
  • Memory impairment
  • Mood swings
  • Sweating
  • Trouble concentrating

Alcohol withdrawal likely peaks within 1-3 days, with some of the psychological side effects lasting longer in some cases, NLM publishes. A more serious alcohol withdrawal syndrome, that the NEJM reports affects 3-5 percent of individuals suffering from alcohol withdrawal, is called delirium tremens (DTs). DTs is characterized by hallucinations or delirium, severe confusion, agitation, fever, and seizures; it may be fatal. Unlike typical alcohol withdrawal, DTs may not appear for a day or two after stopping drinking. This can make it especially dangerous if a person attempts to detox without professional supervision.

Due to the potentially life-threatening symptoms of alcohol withdrawal, it is not recommended to stop drinking suddenly, or “cold turkey.” Medical detox is required as it provides the support and monitoring necessary to manage withdrawal safely.

Alcohol Detox

Generally speaking, alcohol detox will last, on average, around 5-7 days. Less time may be needed for less severe withdrawal syndromes and more time may be needed for more significant side effects.

The main goal of detox is to help a person reach a stable physical level, so they can enter into a treatment program that can address all of the potential concerns and issues surrounding alcohol abuse and addiction. Medical detox is the most comprehensive form of detox available. It is usually performed in a specialized substance abuse treatment facility wherein individuals remain onsite under close medical supervision for the duration of withdrawal. Vital signs are monitored, and medications may be given to ease or prevent specific withdrawal symptoms.

The sudden stoppage of alcohol after a dependence is formed can cause levels of the brain’s neurotransmitters, like dopamine and gamma-aminobutyric acid (GABA), to dip significantly. While dopamine is related to feelings of happiness and pleasure, GABA acts like a natural sedative and helps to reduce anxiety, promote better sleep, and calm some of the functions of the central nervous system (CNS) like those regulating blood pressure, body temperature, and heart rate. When GABA levels drop, these CNS functions speed up, seizures may occur, and rebound anxiety and insomnia may be common side effects.

Benzodiazepines, which increase levels of GABA in the brain, are considered the frontline medications used to alleviate some of the more severe side effects of alcohol withdrawal, the World Health Organization (WHO) publishes. Librium (chlordiazepoxide) and Valium (diazepam) are two of the most widely prescribed benzodiazepines, or benzos, for alcohol withdrawal, Psychology Today reports. Both are considered long-acting benzos. They are recommended to only be used on a short-term basis during alcohol detox, as they too carry a risk for dependence when used long-term. As a result, they should only be used under direct medical supervision.

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Other medications are useful in targeting specific symptoms of alcohol withdrawal. Low levels of dopamine may cause depression and potentially suicidal thoughts or actions, prompting the use of antidepressants during withdrawal as adjunct medications. Medical detox has the added benefit of 24-hour supervision, so medical and mental health providers can ensure that individuals do not present harm to themselves or others during withdrawal.

Vitamins and minerals may be depleted from excessive alcohol consumption and therefore may need to be reintroduced during detox. Thiamine or vitamin B1 is commonly low in individuals who drink alcohol regularly in large amounts. Low levels of this essential vitamin can cause a particularly severe form of dementia known as Wernicke-Korsakoff syndrome. This syndrome may be incurable and significantly debilitating, so it is essential to correct any thiamine deficiencies early in the withdrawal process.

Electrolytes and fluids may also need to be replenished during alcohol detox, sometimes via intravenous (IV) fluids, as alcohol abuse can also lead to dehydration and other complications. Medications for gastrointestinal upset and other specific symptoms may also be beneficial during medical detox.

Medical detox can provide the smoothest and safest method for removing alcohol from the body. It can also set people up to continue on with a substance abuse treatment program upon completion of withdrawal. Some treatment centers offer the full continuum of care, starting with medical detox and then transitioning clients to comprehensive addiction treatment.

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