The experience of alcohol detox will vary based on the severity of the dependence on alcohol and various individual factors.
Since some symptoms of alcohol withdrawal can be life-threatening, medical detox with continual supervision is recommended.
The diagnostic criteria for alcohol withdrawal as defined in the the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), and stated here, indicate that withdrawal signs typically occur after one stops drinking alcohol when their alcohol use has been heavy and/or chronic. Withdrawal symptoms can occur within several hours to a few days after the person stops drinking or cuts down significantly on their alcohol use.
More severe withdrawal symptoms are associated with higher levels of alcohol use. People who are diagnosed with moderate to severe alcohol use disorders are more likely to have more severe and complicated withdrawal symptoms.
The difference between a mild alcohol use disorder compared to a moderate or severe alcohol use disorder depends on the number of diagnostic criteria the person meets. People satisfying more of the diagnostic symptoms listed by APA have more severe manifestations of alcohol use disorders.
The symptoms of alcohol withdrawal can be mild to severe, and they can be dangerous even in individuals with mild alcohol use disorders. The potential for individuals to develop seizures associated with withdrawal from alcohol is significant enough that anyone diagnosed with alcohol use disorder should only stop drinking while under the care of a physician.
Those who have chronic alcohol use disorders and experience a drop in their blood alcohol level as a result of abstinence may develop delirium tremens, a severe syndrome that consists of confusion, disorientation, psychosis, periods of hyperactivity or hypoactivity, and potential seizures. Delirium tremens occurs most often in those who chronically abuse alcohol.
Seizures without associated delirium tremens could potentially occur in anyone diagnosed with an alcohol use disorder who suddenly stops drinking, but they are more likely to occur in individuals diagnosed with moderate to severe alcohol use disorders.
Emotional distress and confusion without delirium tremens or seizures can also occur during alcohol withdrawal.
Seizures can produce significant brain damage and be potentially fatal. People experiencing psychosis, emotional distress, or confusion are potential dangers to themselves as a result of accidents or poor decisions.
Individuals diagnosed with mild alcohol use disorders can typically expect:
Those with more moderate to severe alcohol withdrawal symptoms can usually expect:
The American Society for Addiction Medicine (ASAM) outlines the protocols and procedures used in the treatment of substance use disorders, including the treatment of alcohol withdrawal. Individuals who meet the diagnostic criteria for mild alcohol use disorder would most likely be initially followed by a physician on an outpatient basis unless they begin to develop significant distress associated with their withdrawal symptoms. They can expect to receive some medications to deal with nausea, headache, sluggishness, and sleepiness. A physician needs to make the initial assessment regarding the best course of treatment.
Those who are at risk to develop complicated withdrawal symptoms from alcohol should receive more intense supervision. This includes people who have very chronic and moderate to severe alcohol use disorders, a history of complicated withdrawal, and a history of relapses.
The overall recommendation is to place someone in an inpatient medical detox program where they can be observed and treated around the clock. Depending on the severity of the withdrawal symptoms, this can last for several days to several weeks.
The protocols used to address alcohol withdrawal symptoms are extremely effective. Individuals can typically get through the withdrawal process with minimal discomfort.
ASAM and other organizations recommend the use of benzodiazepines to assist with withdrawal associated with moderate to severe alcohol use disorders. The most common benzodiazepines used for this process are long-acting benzodiazepines, such as Valium (diazepam) or Librium (chlordiazepoxide). Benzodiazepines are very effective at controlling alcohol withdrawal symptoms, potential issues with seizures, and even psychosis during the withdrawal process.
Other benzodiazepines can be used in some instances, and have been proven effective in controlling seizures during alcohol withdrawal over numerous studies.
The general program consists of:
Although benzodiazepines are often the drug of choice for alcohol withdrawal, physicians certainly use other medications. Anticonvulsant medications will control any potential seizures, and antipsychotics can manage any issues with psychosis.
In addition, there are three medications that are approved by the U.S. Food and Drug Administration (FDA) to treat alcohol abuse, and these may be used during the withdrawal process.
Antabuse (disulfiram) is used to keep individuals from drinking alcohol due to its ability to produce a nauseous state when individuals take the medication and then drink alcohol. This medication would likely not be used during the detox process, but it could be used for someone who has had numerous relapses.
Campral (acamprosate) is approved to reduce cravings in individuals with alcohol use disorders. It appears to be more effective in limiting the amount of alcohol a person uses as opposed to stopping a person from drinking. It may be part of a detox medication regime.
ReVia (naltrexone) is an opioid antagonist drug that has been shown to reduce cravings for alcohol in individuals recovering from alcohol use disorders, but it does not address alcohol withdrawal.
Although not formally approved by the FDA, several other medications are commonly used during the withdrawal process because they have some research evidence that supports their use.
Although individuals who are in medically assisted detox can expect to receive some interventions like group participation or therapy, the detox process focuses on addressing withdrawal symptoms from alcohol safely and avoiding relapse during withdrawal.
Detox is not enough. If it is not followed by rehab, where an individual participates in more intensive therapy, acquires new skills, and learns relapse prevention, relapse is likely.
Rehab is designed to teach a person to live without drinking alcohol. Detox is designed to get the person through withdrawal. Going through detox without aftercare or rehab will not result in a successful recovery.
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MedicineNet. Alcohol Withdrawal: Symptoms and Signs. (n.d.) Retrieved from from https://www.medicinenet.com/alcohol_withdrawal_symptoms_and_signs/symptoms.htm
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(June 2018). Medication-Assisted Treatment for Alcohol Use Disorder: Hope for Incarcerated Patients and for Our Communities. The American Journal of Psychiatry. from https://www.ncbi.nlm.nih.gov/pubmed/29961365