For many people struggling with an alcohol use disorder (AUD) or whom have otherwise developed significant alcohol dependence as a result of chronic heavy drinking, quitting can be a challenge. However, in addition to the difficulty of changing often longstanding, compulsive patterns of alcohol use, the detox period may also give rise to unpleasant withdrawal symptoms and present severe risks to their health because of the potential for serious withdrawal complications.
However, the detox process can be made safer and less uncomfortable for those in early recovery. Medical detox programs provide individuals with supportive care, close monitoring, and, when needed, medical intervention to reduce the risk of painful or life-threatening symptoms.
For those with a certain level of withdrawal risks, an inpatient setting is recommended. These facilities help to guide individuals through the process and customize a plan for treatment—from detox to follow-up support—that will give the person the best opportunity to achieve recovery and avoid relapse in the future.
What is Alcohol Use Disorder?
Characterized by compulsive alcohol use, a poor emotional state when not using, and a loss of control over alcohol consumption, alcohol use disorder is considered a chronic relapsing brain disease.1 It is one of several substance use disorders outlined in the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition. A diagnosis of AUD is made based on the presence of several characteristic signs, symptoms, and behaviors present within the 12 months prior to diagnosis. Some examples include:
- A strong longing or craving to use alcohol.
- Inability to minimize use or control alcohol consumption following continual attempts to quit.
- School or job performance begins to suffer because of the aftereffects of drinking or being intoxicated.
- Interpersonal relationships suffer because of, or exacerbated by, alcohol.
- A growing tolerance in which more and more alcohol is needed to achieve intoxication or other desired effect.
- When abstaining from alcohol, symptoms of withdrawal occur.
Alcohol use disorders may develop among people of all ages, gender, socioeconomic status, and cultures. It’s estimated that more than 100 million people globally have an AUD, with males making up over 70 percent of that population.2 Americans account for around 15.1 million of the overall total (based on adults aged 18 and older).1
Risks of Alcohol Detox
When a person with significant levels of physical alcohol dependence decides to quit drinking, medical supervision is critical to ensuring their safety and comfort. Alcohol’s withdrawal symptoms can include extremely unpleasant and/or life-threatening side effects such as agitation and seizures, which may require pharmacologic intervention to safely manage.
- Mood swings
- Sleep problems
- Nausea, vomiting, and upset stomach
- Increased heart rate
- Increased body temperature
- Severe tremor
One particularly severe manifestation of the acute alcohol withdrawal syndrome is called delirium tremens (DTs),3 which may result in profound mental status changes and life-threatening seizures. Decreasing the likelihood of these and certain other severe withdrawal symptoms is a primary goal of medical detox.
Do I Need Medical Detox?
Medical detox allows the body to rid itself of the influence of alcohol in a comfortable, controlled environment. It gradually restores balance and eases the brain and body back to functioning on their own without the need for alcohol. This can be achieved through a variety of methods, either alone or in combination, including:
- Sedative medications to mitigate the risks of severe withdrawal and/or withdrawal complications, which will then be tapered.
- Nutritional support and physical exercise to promote early recovery.
- Psychological and behavioral counseling and support.
- Supervision by a doctor and medical team to manage any emergencies that arise.
Inpatient Alcohol Treatment
The level of withdrawal management and intensity of care needed when detoxing from alcohol varies based on the magnitude of physical dependence and other individual addiction issues. Though it is not easy to precisely predict the course of any given individual’s acute withdrawal experience, some people may be at more risk than others.
For example, people with a history of multiple or severe withdrawal, seizures or previous DTs may be at risk of having similarly complicated withdrawal experiences again—in cases such as these, having the medical supervision and support afforded by an inpatient program can ensure the safest and most comfortable detox process. With an inpatient alcohol detox program, a person is admitted to a facility where their progress is continuously monitored by the treatment staff and appropriate medical care is administered as needed.
A few reasons to consider choosing an inpatient detox center include:
- Medical staff on hand: There is a certain level of risk involved with ceasing alcohol consumption, particularly if the person has developed severe physiological dependence. Because withdrawal symptoms can include agitation, fever, seizures, and hallucinations, having on-call medical staff nearby is essential should the situation become life-threatening.
- Closed environment: Getting away from an environment that promotes or triggers alcohol use is an important step in working toward recovery. Because relapse occurs in 40-60% of adults in recovery,4 having a controlled atmosphere while detoxing can be helpful in managing cravings and triggers that lead to drinking.
- Increased focus on recovery: The relatively closed environment of an inpatient treatment facility also allows the person to place more focus on his or her recovery. A person in an outpatient program might still have to contend with certain stressors, daily commitments and other factors that could interfere with recovery.
If unsure whether a person’s drinking constitutes a need for a supervised medical detox supervision, it may be worth discussing treatment options with a doctor or other medical professional to best gauge the appropriate level of care.
Are Medications Used in Detox?
A variety of medications may be used to manage acute alcohol withdrawal. These medications help relieve symptoms of withdrawal and chemical imbalances in the body. Within medical detox centers, individuals may be provided with a safe and controlled level of these medications. Common medications used to decrease the severity of withdrawal and/or the risk of certain withdrawal complications include:
- Benzodiazepines*: These substances, which include common medications like Valium (diazepam) and Ativan (lorazepam), are used to stabilize a person during detoxification by muting the temporary tendency toward excitatory neural signaling associated with acute alcohol withdrawal. Unlike alcohol itself, they provide an opportunity to safely and reliably taper dosage to ease the body’s reaction to loss of the substance.7
- Barbiturates*: These substances act similarly to benzodiazepines; however, they are potentially more problematic (and consequently, less frequently utilized) because overdose can occur at low doses and response to these medications can be unpredictable.7
- Other supportive medications: There is some research evidence that gabapentin may help to correct some of the physiologic imbalances that arise during alcohol withdrawal, thereby easing certain symptoms (e.g., alcohol-related insomnia, dysphoria).8 Over-the-counter medications, such as Tylenol or Pepto-Bismol, can also help with some milder symptoms.
*Benzodiazepines and barbiturates are themselves addictive substances and can be extremely dangerous when mixed with alcohol. Use is not recommended without proper supervision from an addiction treatment professional, doctor or other experienced medical staff.
Inpatient Alcohol Rehab vs Detox
There is a common misconception that all inpatient alcohol programs are roughly the same. In reality, they can be divided into two groups: residential non-hospital facilities and hospital-based inpatient facilities. Residential non-hospital facilities are also called inpatient rehab facilities and they are much more common. Hospital inpatient facilities, also called medical detox facilities, are far less common. While all inpatient facilities keep patients in the facility, rehab does not have medical staff on hand to treat withdrawal symptoms. Medical detox facilities may be combined with rehab in that they offer counseling and group support, but rehab alone rarely refers to a facility capable of helping a patient detox medically.
From Detox to Treatment
Because alcohol use disorder is a chronic issue, a period of treatment followed by consistent, longer-term recovery efforts help many to avoid relapse and maintain a life of sobriety. Beyond detoxification—which is only the first step in a sometimes-lifelong process—further addiction treatment can provide the tools, skills, support, and resources to help the individual learn to better manage cravings, avoid triggers, and react to stressors without returning to alcohol use and abuse. Both inpatient and outpatient treatment facilities can help an individual work toward recovery through a mix of behavioral therapies, motivational tools, peer support, and addiction-related education.
. National Institute on Alcohol Abuse & Alcoholism. (2015). Alcohol Use Disorder.
. Hannah Ritchie, Max Roser. (2019). Alcohol consumption. Our World in Data.
. Rahman A, Paul M. (2018). Delirium Tremens (DT). U.S. National Library of Medicine.
. National Institute on Alcohol Abuse & Alcoholism. (2018). Drugs, Brains, and Behavior: The Science of Addiction.
. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse. Treatment Improvement Protocol. (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131.
. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
. Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J. 2013;22(2):100–108. doi:10.4103/0972-6748.132914
. Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med. 2014;174(1):70–77. doi:10.1001/jamainternmed.2013.11950