Alcohol Detox Guide: How Long Do Withdrawals Last?
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There are many reasons to cut down on the intake of alcoholic drinks or quit drinking altogether. For some people, the motivation is health reasons. For others, it is financial concerns or a personal resolution. Nonetheless, when someone decides to quit drinking, there are many physical and mental challenges. What to expect when quitting alcoholic beverages? And how long does it take to withdraw from alcohol? This is a guide through the process of detoxification for people battling an addiction to alcoholic drinks. It is designed to provide a better understanding of how to ease withdrawal symptoms.
Table of contents
- What causes alcohol withdrawal syndrome?
- Signs of detoxification
- Goals of detox treatment
- How long do alcohol withdrawals last?
- When do alcohol withdrawal symptoms start and what to expect during detox?
Alcohol and the Human Body: What Causes Withdrawal Symptoms?
The National Institute on Drug Abuse defines detox for alcohol abuse as a medically-supervised procedure where doctors manage and treat the physical symptoms of detoxing off alcohol. In fact, this is the first step in addiction treatment.
Alcohol acts as a depressant in the human body. In other words, it slows down the systems. It affects brain function. With consistent drinking over time, the central nervous system gets used to exposure to alcoholic drinks. The body overcompensates to maintain nerve communication and brain alertness. But what happens when we take alcohol out of this equation? The body cannot instantaneously revert to its original healthy state, and this is what causes withdrawal symptoms when at the beginning of a detox program.
Chronic drinking changes the brain chemistry by:
- inhibiting the functioning of GABA, a neurotransmitter that induces feelings of relaxation.
- inhibiting the effect of glutamate, a neurotransmitter that induces feelings of excitability.
Signs of Detoxification
Like any drug, the effect that alcohol has on different people varies, and so do the withdrawal symptoms. The first question on a recovering alcoholic’s mind is probably, how bad will the alcohol withdrawal be? As a general rule, the longer and heavier a person has been drinking, the more severe and prolonged the symptoms of withdrawal are.
When do alcohol withdrawals start? The first mild symptoms may start as early as 6 hours after the last drink and may include:
- Shaky hands
- Loss of appetite
- Foggy thinking
- Heart palpitations
- Mood swings
The second wave of symptoms, which may be slightly more severe, include:
- High blood pressure
- Irregular heart rate
- Stronger mood disturbances
What to expect when detoxing from alcohol if someone has been a heavy drinker? The severest symptoms occur in long-term abusers and include:
- Hallucinations (12-24 hours after the last drink)
- Seizures (in the first 2 days after the last drink)
- Extreme confusion
In addition, there is a separate class of symptoms known as delirium tremens, commonly referred to as DTs or “the shakes.” This affects only about 5 percent of people going through detoxification. How long do the shakes from alcohol withdrawal last? They can start anywhere between 48 and 72 hours after the last drink. Symptoms of DT include:
- Severe delusions
- Vivid hallucinations
- Extreme sweating
- High blood pressure
- Racing heart
Alcohol Detox Programs and Goals of Treatment
The ultimate goal of any detoxification programs is to return the affected person to a healthy state in a safe manner. The goals of treatment during withdrawal from alcoholic drinks are:
- To ensure a safe and stable withdrawal: Doctors need to manage and treat the physical symptoms that arise as a result of abruptly quitting alcoholic drinks. It is not safe to detox at home. For instance, delirium tremens is a rare, but severe and potentially fatal complication which can occur a day or two after the last drink. It is critical to monitor the vital signs 24×7 to prevent the onset of DTs.
- To prevent relapse: The rate of relapse is highest during the initial period of abstinence. Many recovering addicts relapse when withdrawal symptoms become too unpleasant to bear. By managing the intensity of symptoms, doctors not only keep the person safe but also ensure that they do not revert to old drinking patterns.
- To get rid of toxins: Alcoholic drinks are toxic to the human body. Until the toxins are flushed out, a recovering addict cannot proceed to the next stage of the alcohol detox treatment.
- To ensure a smooth progression to the subsequent stages of addiction treatment: Alcohol damages the brain and clouds a person’s thinking and reasoning. The presence of alcoholic drinks in the body can impair the ability to think straight and appreciate the necessity of the treatment. Once the toxins are cleared out of the body, a recovering addict may be persuaded into participating in the subsequent stages of treatment. This process helps improves the outcome for most people.
Detox Duration: How Many Days to Detox from Alcohol?
Perhaps the biggest question on a recovering alcohol abuser’s mind is how long does it take to go through alcohol withdrawal? This depends on a number of factors:
- The duration of alcohol abuse
- The number of alcoholic drinks consumed every day
- The presence of coexisting physiological disorders
- The presence of concurrent mental illnesses
Withdrawal symptoms are usually the most severe when a person has been drinking for a long time or has been a heavy drinker. The more severe the symptoms, the more prolonged the alcohol detox treatment.
How long before alcohol withdrawal starts? The first symptoms typically manifest about 8 hours after the last drink. Initial symptoms are usually mild and consist of anxiety, insomnia, nausea, vomiting, mood swings, loss of appetite, and fatigue. Over the next 24-72 hours, these symptoms intensify. Moderately intense symptoms such as increased blood pressure, increased body temperature, irregular heartbeat, and mental confusion may manifest during this time. This is a critical period before more severe symptoms such as hallucinations, tremors, agitation, seizures, and DTs occur.
How many days does it take to detox from alcohol? In most cases, it takes around 5-14 days to stabilize the person and control symptoms of withdrawal, provided there are no complications. The presence of coexisting physiological and/or mental disorders can complicate the detox process and prolong it.
Detox Programs: What to Expect From Alcohol Withdrawal?
According to the National Center for Biotechnology Information, an alcohol detox program consists of medications, psychosocial support, or a combination of the two.
Medication Support During Withdrawal
Is it possible to suffer no alcohol withdrawal symptoms? If a person has been a heavy drinker, the answer is no, but certain medicines are prescribed to ease withdrawal from alcoholic drinks:
- Medicines to manage withdrawal symptoms: Medicines commonly used during treatment are chlordiazepoxide and lorazepam. They belong to a class of drugs known as benzodiazepines that affect the central nervous system and have a calming effect. They are prescribed to manage symptoms of anxiety and restlessness.
- Medicines to boost general health: Alcoholics tend to neglect their diet and often suffer from nutritional deficiencies. Vitamins, folic acid, and iron supplements are administered during treatment to help regain general good health. In fact, alcoholics are typically deficient in vitamin B1 (thiamine). Severe deficiency of this vitamin is associated with neurological complications such as memory loss and even death. Intravenous B1 is sometimes necessary if an alcoholic is diagnosed with a deficiency of this vitamin.
- Medicines to curb alcohol cravings: A person undergoing detoxification period suffers from intense cravings. Certain drugs such as acamprosate, naltrexone, and disulfiram reduce the intensity of the cravings. These medicines are prescribed to people detoxing at outpatient facilities as these people spend a part of the day at home or in the workplace where they may be exposed to triggers or obtain access to alcohol.
- Medicines to manage coexisting mental disorders: Long-term alcoholics often suffer from coexisting mental conditions that are exacerbated when the person abruptly stops drinking. During the detox program, doctors treat these mental health issues with a number of drugs, including antipsychotics such as olanzapine and haloperidol to treat symptoms of schizophrenia.
Psychosocial Support During Alcohol Detox
Many facilities provide integrated alcohol detox programs where a combination of medications and psychotherapy help a person overcome the withdrawal symptoms and prepare to stay off alcoholic drinks after completing the treatment. During psychotherapy, a person’s mind is recalibrated and they are taught to:
- cope with stress in a healthy manner without resorting to alcoholic drinks
- become mindful of cravings and process them without acting impulsively
- resist cravings and avoid the urge to drink
- identify triggers in the environment
- devise habits to stay away from triggers
- develop ways to deal with triggers and not react to them by drinking
- rebuild burned bridges and reconnect with friends and family
- improve social interactions and activities to replace drinking sessions
- Schaper A, Ebbecke M. Intox, detox, antidotes – Evidence based diagnosis and treatment of acute intoxications. Eur J Intern Med. 2017 Nov;45:66-70. https://www.ejinme.com/article/S0953-6205(17)30427-2/fulltext
- Azuar J, Questel F, Hispard E, Scott J, Vorspan F, Bellivier F. Hospital Stay and Engagement in Outpatient Follow-Up After Alcohol Emergency Detox: A 1-Year Comparison Study. Alcohol Clin Exp Res. 2016. https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.12962
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