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iRecover US | Alcohol withdrawal and detox

Updated: Jul 5, 2023

Those who seek help for alcohol addiction often have questions and concerns about

withdrawal and detox. These questions can come from individuals struggling with

alcohol addiction themselves or from family members seeking help for their loved ones.

At iRecover US, we understand these concerns and have extensive experience helping

people withdraw from various substances in a safe and effective environment. With this

in mind, I will answer some common questions regarding alcohol withdrawal.

addiction treatment south Dakota

Q: Do all people who stop drinking go through withdrawal or “detox”?

A: Most people do, but not everybody. Any substance with intoxicating properties has

the potential to cause a withdrawal reaction when discontinued. This reaction can range

from mild to severe, depending on factors such as how long someone has been

drinking, the age at which they started drinking, how often they drink, and how much.

Our trained nursing staff carefully assess each patient's; history and conduct

breathalyzer and urine drug screening on presentation to our facility in Howard, South

Dakota. Generally, blood tests are also conducted to identify any underlying medical

conditions or abnormalities that require further management.

If someone is physically dependent on alcohol, the withdrawal reaction usually starts

within 6 to 24 hours from the last alcohol consumed. Generally, withdrawal symptoms

consist of headaches, feeling anxious or restless, feeling nauseated with decreased

appetite, disturbed sleep, and vivid dreams. Heart rate and blood pressure can

increase, and sweating and tremors can develop, along with abnormal body


Q: Why does alcohol withdrawal happen?

A: Alcohol has a major effect on the brain and is generally classified as a depressant

(while other substances can have the opposite effect and act as a stimulant). Alcohol

works on receptors in the brain via the same pathway as one of the natural brain

chemicals or neurotransmitters called Gamma-Aminobutyric Acid (GABA). GABA

generally suppresses systems in the brain, including coordination, temperature control,

and heart rate. With prolonged use of alcohol, these brain receptors undergo change, a

process called neuroadaptation. In simple terms, the brain adjusts to the continued

depressant effect of alcohol in order to remain functioning normal. When alcohol is

withdrawn, the brain’s neurons can be described as "excited", they start to fire rapidly as

they are not being depressed anymore. Thus causing irritability, anxiousness, increased

heart rate, sweating, and tremors.

Q: Is alcohol withdrawal always serious?

A: No, the majority of patients (9 out of 10, to be accurate) going through alcohol

withdrawal have mild symptoms only, and these stop within 2 days from the last drink.

Q: Do I need to be in a hospital setting to go through withdrawal?

A: This depends on several factors. It is true that some people can safely go through

withdrawal at home, but a careful assessment by someone trained in addiction medicine

needs to be done before this decision is made. Especially patients with heavier and

prolonged drinking preferably needs to be seen in a setting where experienced medical

staff are available. This allows for 24-hour supervision and support, the ability to

administer medication to alleviate withdrawal symptoms, and referral to a hospital

setting, if necessary. Also, being removed from the environment where drinking used to

occur removes the social and environmental stimuli that triggered drinking or substance

use in the past.

For those with multiple other medical conditions (e.g., previous withdrawal seizures or

Delirium Tremens, simultaneous use of other substances, heart conditions, high blood

pressure, infection, or diabetes) careful assessment and possible brief hospital

admission may be necessary.

Q: A friend/relative/family member had seizures when they stopped drinking, will it

happen to me?

A: Withdrawal seizures can occur, and some people are genetically predisposed to this.

In other words if a relative developed seizures, you will be at a higher risk for this.

Seizures can start as soon as 8 hours from the last drink, but generally, the highest

chance of this occurring is on the second day after quitting. Those who had seizures in

the past will be at a higher risk of developing this again. Fortunately, various

medications can prevent seizures. Careful monitoring and support by medical staff can

help avoid this.

Q: What are hallucinations, and are they the same as Delirium Tremens (DT)?

A: Hallucinations are an abnormal perception, where one can see, hear, feel, smell, or

taste something that is not there. The most common sensations include itching, pins

and needles, burning, and feeling bugs crawling under the skin. Delirium Tremens (DT)

is different, although characterized by hallucinations as well patients with DT lose

contact with reality, become confused and disoriented, not knowing the time of day or

week, or where they are. Those who experience DTs have physical signs of the same

nature as with milder alcohol withdrawal but much more pronounced. For example a

significantly elevated heart rate, tremors, sweating, and fever. In the past, this was

serious and even fatal, but now, with early recognition and effective management, death

from DTs has become uncommon.

Q: What is the CIWA-Ar score?

A: The Clinical Institute Withdrawal Assessment - Alcohol (CIWA) scale and later the

revised version (CIWA-Ar) is a specific scale used to ascertain the severity and

progress of alcohol withdrawal. By using this scale, the intensity of alcohol withdrawal

can be classified, and treatment and support can be given as needed. A score of less

than 10 indicates mild withdrawal, 10-15 moderate withdrawal, greater than 15 severe

withdrawal, and more than 20 indicates an urgent situation that might need hospital

admission if the situation does not improve.

I hope this addresses some of the most common questions or concerns that people

have regarding alcohol withdrawal. On the next Question and answer I will discuss the

withdrawal of opiate medications (ie Heroin, Morphine, Oxycodone and now the most

common substance - Fentanyl)

By Dr Hilgard Goosen

iRecover US is considered by many to be the top alcohol rehab and drug rehab in South Dakota. iRecover US employs evidence based treatment programs to provide the best alcohol addiction treatment and drug addiction treatment to all residents of South Dakota and the Mid-West. We accept insurance and self-pay options are available.

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