The World Health Organization (WHO) estimates that there are approximately 160 million alcoholics worldwide, and counting. Alcohol is one of the most commonly abused substances and can also be one of the most deadly substances from which to detoxify. The risks involved with alcohol withdrawal and detoxification are underestimated due to the fact that the drug is legal and is rarely considered as dangerous as illicit drugs such as cocaine and heroin. Few other drugs can match the health risks associated with alcohol detox.
Tolerance and addiction to alcohol develop as a result of abuse and strengthening dependence; physical addiction to alcohol, a depressant, forms in the brain and affects neurotransmitter activity. There is an extremely high rate of suicide among those afflicted with chronic alcohol dependence due to the physiological distortion of brain chemistry; however, the most common cause of death among alcohol-dependent individuals results from cardiovascular complications.
Alcohol Withdrawal Symptoms
Symptoms of alcohol withdrawal during detoxification can range from mild to life threatening, depending on the severity of the individual’s dependence on the drug. Chronic, daily drinkers experience more intense symptoms compared with those of occasional drinkers; nevertheless, whenever drinking is abruptly discontinued, some degree of physical and mental discomfort is experienced.
Withdrawal symptoms occur between approximately five and ten hours after cessation and peak at forty-eight to seventy-two hours into detoxification. Alcohol is identified as a sedative-hypnotic, therefore detoxification from this substance exhibits the reversal of the effects of alcohol, centering on what is referred to as “neuropsychiatric excitability” (physiological and psychiatric irritability).
According to a study conducted in 1989, ethanol interferes with processes that activate or excite nerve cells in the central nervous system. Ethanol also enhances those processes that communicate certain nerve cells to be restrained. Thus, ethanol acts as a nonspecific biochemical inhibitor of activity in the central nervous system during alcohol withdrawal.
When someone experiences a “hangover” the morning after a night of excessive drinking, that person is actually suffering from mild forms of alcohol withdrawal. Subtle sleep disturbance and anxiety can arise during withdrawal while other, more serious stages of withdrawal and detox can result in hallucinations and life-threatening seizures. Generally, withdrawal symptoms activate once the drinker awakens due to the fact that blood alcohol levels drop during hours of sleep.
The severity of withdrawal symptoms depend on many factors such as genetics, age, other related medical conditions and most importantly, the history of alcoholism, including the degree and duration of the disease and past detoxifications.
Physical Withdrawal Symptoms Include:
- Gastrointestinal upsets
- Nausea and Vomiting
- Pupil dilation
- Mild to Severe Seizures; Death
Psychiatric Withdrawal Symptoms Include:
- Mild to Severe Anorexia
- Mild to Severe Hallucinations
- Mild to Severe Panic Attacks
- Mild to Severe Psychosis
Chronic dependence on alcohol, and its severe withdrawal and detox symptoms, may progress to Delirium Tremens (DTs) within three to five days of the cessation of drinking. DT’s have a multitude of acute symptoms including profound confusion, disorientation, hallucinations, severe autonomic nervous system over-activity and extreme cardiovascular instabilities. Many chronic alcoholics die as a result of cardiovascular complications that can lead to heart attack and stroke.
The psychiatric and physiological concerns associated with alcohol withdrawal and detox can persist beyond severe stages and into a condition known as protracted withdrawal syndrome (PWS). PWS has a mild initial detoxification stage, which gradually fades until symptoms completely disappear. Signs and symptoms of PWS usually include anhedonia (lack of pleasure), nausea, vomiting and bewilderment.
If an alcoholic or heavy drinker wishes to abruptly discontinue the abuse of and dependence on alcohol, they are strongly advised to detoxify in an inpatient treatment center or hospital setting due to the physical dangers associated with alcohol withdrawal symptoms. Individuals who are only at risk of mild to moderate withdrawal symptoms can be detoxified as outpatients through a rehabilitation treatment center.
The medical process of detoxification from alcohol may require the use of several medications; Benzodiazepines are generally used to aid in this course of treatment. Benzodiazepines such as Chlordiazepoxide (Librium), Diazepam (Valium), Lorazepam (Ativan), or Oxazepam (Serax) are most commonly administered in order to reduce the severity of alcohol withdrawal symptoms.
This assortment of medications helps to slow down the brain, which is “sped up” by alcohol, to more manageable levels, thereby allowing the detoxification to proceed in a safe, relatively comfortable manner. These specific drugs are used because they do not linger in the system and allow for doses to be easily regulated to the patient’s response.
Alcohol (ethanol) itself has been found to be very helpful in small doses during detoxification. Many hospitals will administer low levels of ethanol as a means of weaning chemically dependent individuals off of alcohol, which was found to ease sleep disturbances during detoxification. A study presented at the American College of Surgeons 91st Annual Clinical Congress in 2005 stated that the use of ethanol has been found to reduce treatment time, improve the failure rate from 20% down to 7% and increase retention in treatment centers.
Vitamins are also likely to be prescribed, particularly Vitamin B1 (Thiamine), during the detoxification process. Individuals who are dependent on alcohol normally do not have healthy eating habits and severely lack certain vitamins. The lack of vitamin B1 is usually common in alcohol dependent patients, which can lead to serious brain conditions.
Danger of Alcohol Detox
The physical and mental risks of unmanaged detoxification are extremely high; therefore, no individual with a serious history of alcohol addiction should attempt to detox without medical supervision. Detoxification from alcohol neither treats nor cures the disease of alcoholism and it is crucial to follow up on detoxification with the appropriate treatment program for alcohol abuse or dependence in order to reduce the risk of relapse.