Alcohol Detox

Detox from alcohol is a process that allows the body to get rid of the toxins that accumulate in the body in someone who drinks heavily on a regular and consistent basis and is physiologically dependent on alcohol.  It is different from a hangover, which is a constellation of unpleasant symptoms (e.g., headache, malaise, diarrhea, nausea, difficulty concentrating, etc.) that occur after a period of heavy drinking.

If you are physiologically dependent on alcohol, withdrawal symptoms generally begin anywhere from 6 to 24 hours after your last drink.¹ The severity and duration of symptoms can vary  widely , with some people beginning to experience withdrawal while still having significant blood alcohol levels.¹

Unlike some substances, severe withdrawal from alcohol can be life-threatening.¹ Luckily, medications can be used in a supervised detox setting to help mitigate severe withdrawal symptoms and prevent potentially fatal consequences.¹

What Is Alcohol Detox?

Alcohol detox is a set of interventions aimed at removing alcohol from the body while minimizing harm. Oftentimes, alcohol detox is a first step in a larger continuum of addiction care. People who are dependent on alcohol experience alcohol withdrawal symptoms while going through the detox process.² Alcohol withdrawal can bring with it a variety of symptoms ranging from mild to severe. Those who are at risk of experiencing severe alcohol withdrawal symptoms  should enlist medical assistance , as severe withdrawal symptoms can be fatal.

Symptoms of Alcohol Withdrawal

As previously mentioned, the symptoms of alcohol withdrawal can vary widely. And, in general, many of the symptoms resemble the opposite of what it feels like to be intoxicated by alcohol. Alcohol is a depressant and therefore its effects increase the body’s inhibitory tone, resulting in sedation and decreased anxiety. Alcohol withdrawal symptoms, however, indicate increased excitatory tone. These symptoms include: ^{2, 3, 7}

• Anxiety.
• Insomnia.
• Irritability.
• Decreased appetite.
• Sweating.
• Elevated heartrate and blood pressure.
• Hand and arm tremors.
• Nausea and vomiting.
• Hypersensitivity to light and sound.
• Hallucinations (seeing or hearing things that aren’t real).
• Severe agitation.
• Seizures.
• Delirium tremens.

Uncomplicated or Mild Alcohol Withdrawal

In general, the first 6–24 hours after your first drink may bring what are known as “early withdrawal signs and symptoms,” such as the following: ^{3, 4, 7}

• Insomnia (difficulty sleeping).
• Shakiness in hands and arms.
• Anxiety.
• Headache.
• Sweating.
• Increases in heart rate and blood pressure.
• Lack of appetite.
• Nausea.
• Mild impairments in cognitive function.

Uncomplicated or mild alcohol withdrawal may include perceptual distortions of a visual, auditory, tactile nature but they are typically not full-fledged hallucinations as seen in delirium tremens, a more serious condition that indicates severe withdrawal and that usually appears later in the withdrawal process.

Symptoms of mild to moderate alcohol withdrawal peak within 2-3 days and then gradually subsides and is typically resolved by the fifth day.⁷

Complicated or Severe Alcohol Withdrawal

As previously stated, fewer than 10% of people will experience more complicated alcohol withdrawal with severe symptoms.

Withdrawal seizures are a medical emergency and usually a sign of severe alcohol withdrawal.² Seizures induced by alcohol withdrawal are typically generalized tonic-clonic seizures, and typically begin within 8 to 24 hours after a person’s last drink.⁸ Tonic-clonic seizures involve your whole brain and body.⁶ They may cause one to have repeated jerks or muscles spasms, lose consciousness, or cry out.⁶

If a person has had a prior episode of alcohol withdrawal, they are at increased risk of experiencing more severe withdrawal symptoms should they experience alcohol withdrawal again. Some predictors of severe alcohol withdrawal are: ^{2, 7}

• Older age.
• Having had symptoms of severe alcohol withdrawal (e.g., delirium tremens or alcohol withdrawal seizure) in a previous withdrawal episode.
• Severe withdrawal symptoms early on.
• Certain co-occurring medical conditions or illnesses (e.g., liver failure, pneumonia, hypoglycemia, head trauma resulting in brain lesions, or other conditions resulting in electrolyte imbalances).

Delirium tremens (alcohol withdrawal delirium), typically appears 48–96 hours after your last drink ^{2, 4, 7} The duration of DTs varies but generally it lasts 2 to 3 days. Symptoms of delirium tremens may include:³

• Extreme or profound confusion and disorientation.
• Visual hallucinations.
• Marked agitation and increased psychomotor activity.
• Extreme sweating.
• Significantly elevated heart rate and blood pressure.
• Hyperthermia.

The mortality rate from untreated delirium tremens is estimated to be 37%.³ Medical interventions can greatly reduce its severity and early detection and treatment has decreased the fatality rate of delirium tremens to less than 5%.³

Medications for Alcohol Withdrawal

Many potential medications help with alcohol withdrawal, but the first choice medicines are benzodiazepines.¹ Due to their chemical nature, benzodiazepines affect the same receptors that alcohol does, allowing them to serve as a substitute and potentially lessen the severity of alcohol withdrawal symptoms.² Benzodiazepines are usually prescribed as part of a larger medical detox program, though occasionally they may be prescribed on an outpatient basis with heavy restrictions.¹ A few other medications that may be used are antiseizure medicines (e.g., carbamazepine), barbiturates (when benzodiazepines aren’t tolerated), and other neuro-modulators (e.g., gabapentin).²

How Long Does It Take To Detox From Alcohol?

Complete detoxification from alcohol can take several days, and the timing of both onset and conclusion of symptoms can vary significantly from person to person. It is estimated that approximately half of individuals with alcohol use disorder have ever experienced alcohol withdrawal. For those who experience withdrawal, typically after a period of extended periods of heavy drinking, symptoms can start as early as 6 hours after their last drink, when blood concentrations of alcohol decline sharply. ^2,7 Symptoms usually peak in intensity during the second or third day and are improved or on their way to being resolved by the fourth or fifth day.⁷

It’s estimated that fewer than 10% of people who experience alcohol withdrawal will ever develop severe symptoms like tremors, dramatic increases in heart rate and blood pressure, seizures, or delirium tremens.⁷

After 1 Week of Alcohol Detox

After making it through the first week of alcohol detox, the worst of it is usually over. ⁵ Even when withdrawal includes the most severe symptoms, delirium tremens or seizures, acute withdrawal symptoms are typically resolved within 5-7 days.⁴

So, after 1 week, the acute manifestation of alcohol withdrawal is typically resolved, however, certain symptoms like anxiety, insomnia, and even some indicating autonomic dysfunction (regulation of heart rate or blood pressure, sweating, issues with appetite and digestion) can persist for up to 3 to 6 months but at a much lower level of intensity.⁷

Why Should I Avoid Alcohol Detox at Home?

Alcohol detox is sometimes done at home on an outpatient basis, but this should only be done after consulting with a physician or another addiction specialist after determining you are not at risk of experiencing severe life-threatening symptoms. Suddenly abstaining from alcohol after an extended period of heavy use can be dangerous. Many people benefit from seeking professional help to supervise or medically manage alcohol withdrawal symptoms. Medical detox is a safe and available option for those who want to take back control of their lives.

Luckily, there are several ways to find nearby detox centers. One of the first steps would be to reach out to your doctor or a trusted medical professional. They may be able to help determine your treatment needs and possibly refer you to a facility. You may also want to visit SAMHSA’s treatment locator. Additionally, you could reach out to American Addiction Centers (AAC) helpline. Our 24/7 addiction helpline can connect you with trained professionals who can answer questions you may have about alcohol detox, help you find a suitable detox center, and verify your insurance information. Don’t delay critical addiction care, call us today at .

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