The National Institute on Alcoholism and Alcohol Abuse (NIAAA) reports that, in 2015, about 15.1 million adults ages 18 and older in the United States struggled with an alcohol use disorder (AUD); this includes about 9.8 million men and 5.3 million women. Additionally, about 623,000 adolescents, ages 12-17, reportedly struggled with AUD. Drinking too much is a serious problem, leading to 88,000 deaths every year, according to the Centers for Disease Control and Prevention (CDC); people who drink excessively cut an average of 30 years off their lives.
Overcoming an alcohol use disorder, or stopping another form of problem drinking, like binge drinking or heavy drinking, is very important for both short-term and long-term health. However, just quitting alcohol is not that easy. People who drink a lot of alcohol for months or years are at risk of withdrawal symptoms because the brain has become dependent on the presence of alcohol to regulate the body and emotions. Most withdrawal symptoms are uncomfortable, but some can be life-threatening. This means that detoxing at home is risky, not just because one is more likely to relapse back into alcohol abuse, but also because the person may require hospitalization or may even die.
The Brain and the Alcohol Detox Process
Alcohol, along with some other substances like benzodiazepines, antiepileptic drugs, and sedative-hypnotic sleep aids, activates the gamma-aminobutyric acid (GABA) receptors. The neurotransmitter GABA is one of the most important chemicals in the brain, and it is highly involved in signaling among neurons. When there is more GABA present, neurons fire less often; when there is less, neurons fire rapidly, and neurotransmitters like dopamine and serotonin may be absorbed very quickly.
Alcohol and other drugs that act on these receptors mimic GABA, so they slow down the brain’s processes. This slowing leads to alcohol’s intoxication and symptoms like slurred speech, slow thinking and reaction times, weakness, sleepiness, and pleasant relaxation, among others.
The brain of a person dependent on alcohol does not produce enough GABA to safely regulate the neurons. This leads to withdrawal symptoms like physical shaking, anxiety, jumpiness, insomnia, headaches, irritability, rapid heartbeat and breathing rate, and confusion. The individual may feel like they must drink alcohol to feel normal, not overly anxious, or calm in social settings, or to get to sleep. In some senses, this is true, but consuming more and more alcohol is very dangerous.
The detox process helps the brain relearn to produce GABA without the presence of alcohol. With medical supervision at an inpatient detox facility, this process is manageable. However, without medical supervision, a person may develop alcohol withdrawal syndrome (AWS) or delirium tremens – life-threatening conditions that can lead to lasting harm and even death.
Alcohol Withdrawal Syndrome and Delirium Tremens
- Physical tremors
- Nausea and vomiting
- Increased heartbeat
- High blood pressure
Without medical supervision, these symptoms are likely to feel intense, and they begin between six hours to three days after the last drink. If a person tries to quit drinking “cold turkey,” these symptoms may cause them to go back to drinking a lot of alcohol to cope; this puts them at risk of alcohol poisoning.
Severe and life-threatening symptoms associated with AWS are called delirium tremens (DTs). This condition includes:
- Sudden, severe confusion (delirium)
- Tremors all over the body
- Changes in cognition and mental function
- Extreme agitation and mood swings
- Fear or paranoia
- Bursts of energy followed by extreme fatigue
- Restlessness and excitability
- Sensitivity to light, touch, sounds, and other sensory input
- Stupor, or appearing conscious without response
People with a history of drinking a lot of alcohol every day for months or years are at greater risk for delirium tremens; additionally, those who have tried to quit drinking, developed uncomfortable withdrawal symptoms, and returned to drinking are at greater risk for DTs. Seizures, hallucinations, and paranoia are all very dangerous and require hospitalization if they begin; this will likely occur 12-48 hours after the person stops consuming alcohol.
Even when a person receives emergency medical attention, there are complications associated with DTs, including:
- Over-sedation, leading to coma
- Respiratory depression, irregularity, or arrest, so the person does not get enough oxygen
- Cardiac arrhythmias
- Pneumonia from aspirating
Brain damage, heart damage, lung damage, and liver damage are all associated with consuming too much alcohol, and with trying to stop drinking cold turkey. A study suggested that 3-5 percent of those hospitalized due to alcohol withdrawal symptoms met the criteria for delirium tremens. About 1-4 percent of those hospitalized for DTs die due to complications. Medical supervision is required for the entire detox process because alcohol abuse puts the individual at risk of several acute and chronic problems.
Even if the person does not develop seizures, heart problems, or worse, they are at risk for experiencing a longer period of alcohol withdrawal. DTs typically begins on the second or third day of the withdrawal process, and the intense experience can last anywhere from one day to eight days. Feeling serious symptoms from alcohol withdrawal for more than a week puts the person at risk of relapsing into compulsive, high-volume consumption of alcohol, which is also extremely dangerous and can lead to death.
Inpatient Detox Is Crucial
People who get medical supervision to safely detox at an inpatient treatment center are much more likely to overcome their physical dependence on alcohol. Follow-up care should include comprehensive therapy and peer support groups, which can reduce the risk of relapse and change compulsive behaviors.
Most people who develop alcohol withdrawal syndrome recover, with medical treatment and therapy. Although some symptoms, like cravings or mood swings, may reappear occasionally, these are manageable with ongoing social support. To start the process of safely withdrawing from alcohol abuse and dependence, contact a physician to receive an assessment of dependence level. Mild, moderate, or severe experiences of withdrawal symptoms will be managed with different levels of medical supervision.
Withdrawing from any substance can cause symptoms that are uncomfortable, but alcohol withdrawal can be especially difficult and dangerous. Overall, inpatient care to manage detox can reduce discomfort and risk associated with withdrawal; it can also help to prevent relapse, which can lead to overdose.