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withdrawn, the brain’s neurons can be described as "excited", they start to fire rapidly as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