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Kindling Due to Alcohol Withdrawal

Most adults in the United States drink alcohol at some point in their lives – a cocktail with friends, wine with dinner, or beers after work. Most people manage to drink alcohol in moderation; in fact, a recent survey of Americans’ drinking habits found that 30 percent of American adults do not drink at all, and another 30 percent drink less than one alcoholic beverage on average per week. However, 10 percent of American adults drink 10 servings of alcohol per day, hitting an average of 74 drinks per week. Over 24 million Americans, ages 18 and older, drink far too much in the form of binge drinking, heavy drinking, or because of alcohol use disorder (AUD).

What Does Alcohol Do to the Brain?

Alcohol alters how neurotransmitters are managed in the brain, especially gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that induces a feeling of relaxation and sedation. Too much GABA, and you will appear sluggish, slow, and stumbling, which are stereotypical signs of being drunk. Too little GABA, however, and you may experience anxiety or panic attacks, or you could even develop a seizure disorder.

People who struggle with alcohol abuse, whether they meet the criteria for AUD or suffer from another form of problem drinking, may attempt to quit drinking. Often, this is a “cold-turkey” approach, which involves quitting suddenly with no outside help or medical interventions. The rapid change in how neurotransmitters are managed can cause a condition called kindling.

What Is Kindling?

When a person struggling with alcohol addiction quits and then relapses several times, they are at risk of developing kindling. This condition is a worsening of withdrawal symptoms each time the individual attempts to quit alcohol again. The body becomes increasingly sensitive to changes in neurotransmitters, as GABA floods the brain during periods of drinking too much and is suddenly stopped during periods of abstinence. Over a few cycles, the risk of developing delirium tremens, seizures, and other health problems associated with unsupervised alcohol withdrawal dramatically increases.

The medical framework of kindling is applied to many issues involving brain chemistry – not just alcohol use disorder, but also epilepsy, benzodiazepine abuse, and mood disorders, including depression and bipolar disorder. The phenomenon was first recorded in 1967 when neuroscientist Graham Goddard electrically stimulated various areas of rats’ brains to examine the learning process. However, as he applied these electrical stimuli daily, the rats began to have seizures in response to other stimulation that would normally be too low to cause convulsions. Eventually, the rats developed seizure disorders, experiencing convulsions that would begin without any stimuli. Goddard referred to this phenomenon as kindling because he had essentially kindled epilepsy in the brains of his rats.

Since Goddard’s publications on the phenomenon, the concept of kindling has been applied to many conditions in which the initial experience of symptoms is fairly mild, but over time, re-experiencing the symptoms will lead to heightened sensitivity. For example, people with bipolar disorder will experience emotional discomfort and mood changes but may not receive a diagnosis until after their first manic episode is kindled; after that initial episode, however, the individual is more likely to experience a manic episode triggered by stressful life events. Essentially, the individual becomes more sensitive to stress, so they are more likely to experience intense symptoms. The brain is primed with specific pathways that triggered conditions may follow.

Chronic heavy alcohol consumption changes the central nervous system. When the chemical changes caused by high-volume consumption of alcohol do not occur, the brain is not able to balance its own chemistry at first. The sudden reduction in available GABA can trigger panic, restlessness, insomnia, and potentially convulsions or seizures. The experience of kindling is not universal; not everyone who relapses back into alcohol abuse multiple times will develop this condition. However, the problem highlights the importance of getting medical help to safely detox from alcohol dependence and then enter a rehabilitation program to change your behaviors around alcohol and reduce the risk of relapse.

What Are the Effects of Kindling?

Kindling not only increases your sensitivity to alcohol withdrawal symptoms, but also the discomfort of subsequent bouts of withdrawal can increase your risk of relapsing back into alcohol abuse. The first signs of kindling, after one or two relapses with subsequent cold-turkey detoxes, are emotional state changes. These include:

  • Low feelings or depression
  • Anxiety or panic
  • Insomnia
  • General feeling of malaise
  • Other negative emotional experiences

The mental discomfort associated with these states increases the risk that you might self-medicate with alcohol to take the edge off withdrawal. However, after more periods of relapse and withdrawal, physical symptoms will begin and may lead to delirium tremens, which is life-threatening.

Delirium Tremens from Kindling

As kindling increases the severity of symptoms during alcohol withdrawal, you may begin to experience serious, uncomfortable, or even dangerous side effects. This may become delirium tremens (DT), which typically begins 48-96 hours after the final drink. Symptoms of DT include:

  • Sudden, severe confusion (delirium)
  • Tremors all over the body
  • Suppressed mental function
  • Irritability or agitation
  • Extreme fatigue
  • Sleeping for a full day or longer
  • Fear, paranoia, or overexcitement
  • Sudden bursts of energy followed by very low energy
  • Sensitivity to stimuli, such as light, touch, or sound
  • Stupor, or being awaken but unresponsive
  • Rapid mood changes
  • Hallucinations
  • Insomnia or disturbed sleep
  • Loss of appetite, nausea, or vomiting
  • Sweating
  • Fever
  • Chest pain

Seizures may develop 12-48 hours after the final drink. Past complications during alcohol withdrawal, repeated attempts to quit followed by relapse, and kindling all increase the risk of seizures. These are usually tonic-clonic seizures, also called grand mal seizures, which are characterized by:

  • Physical convulsions
  • Incontinence
  • Clenched teeth or jaw
  • Biting the tongue or cheeks involuntarily
  • Difficulty breathing or stopped breathing
  • Weakness after the muscular convulsions

Overcoming Kindling with Alcohol Rehab

If you develop delirium tremens or are at risk for seizures during the detox process, your doctor will likely prescribe some form of anticonvulsant medication. This may be a benzodiazepine (short-term use of anti-anxiety medication that works on the GABA receptors to induce similar effects as alcohol), or your physician may prescribe a different anticonvulsant, especially if epilepsy is likely to be ongoing.

Brain scans have shown that the brain remains impaired during the early stages of the recovery process, and this can last for several weeks. Even when the body is not technically dependent on alcohol to manage brain chemistry, compulsive behaviors triggered by stress or cravings may still lead to relapse without appropriate help in a rehabilitation program. Repeated attempts to quit without sustained success may mean you need an inpatient rehabilitation program instead of an outpatient program.

Kindling can be overcome with a long enough period of abstinence from alcohol and other drugs. New brain cell growth can help overcome this process, but that requires avoiding toxins like alcohol, eating a healthy diet, and exercising moderately. Evidence-based rehabilitation can help you get started on this path.