While many people are at least somewhat familiar with the dangers and difficulty of withdrawing from heroin and cocaine, the truth is alcohol detox and withdrawal can also be dangerous. Alcohol withdrawal can lead to a range of symptoms that may begin as early as two hours after the last drink. These symptoms can persist for many weeks and range from shakiness and anxiety to serious complications such as delirium tremens (DTs), seizures, convulsions, and heart attack. Don’t take alcohol detox lightly; detoxification from alcohol should not be attempted at home.
Alcohol withdrawal syndrome (AWS) refers to a number of symptoms experienced by a heavy drinker or suddenly stops drinking or drastically reduces alcohol intake. Symptoms can appear within just a few hours of the last drink. AWS can cause a range of emotional and physical symptoms ranging from anxiety, nausea, and fatigue to hallucinations, hand tremors, vomiting, irritability, nightmares, and insomnia. The symptoms of AWS can be life-threatening and tend to worsen over a period of three days and last for weeks.
During the first day of stopping drinking, some people experience hallucinations that end after another 24 hours. This condition is called alcoholic hallucinosis, but it’s not the same as the hallucinations that occur with the DTs (a very serious form of alcohol withdrawal syndrome) because people with alcoholic hallucinosis know that the hallucinations are not real.
More serious alcohol withdrawal symptoms occur in about 10% of people being treated for alcohol withdrawal. Over 90% of alcohol withdrawal seizures happen within 48 hours of quitting alcohol, although it is possible for seizures to occur up to 20 days after the last drink. Research has indicated that the risk of having seizures and the severity of seizures increases with the number of past alcohol withdrawals the person has had.
Symptoms of alcohol withdrawal can worsen rapidly, so it’s important to seek medical care even if symptoms seem minor.
Heavy and prolonged drinking disrupts the neurotransmitters in the brain which are responsible for sending messages and regulating the central nervous system. Initially, alcohol boosts the effects of the neurotransmitter GABA which produces a sense of relaxation. Chronic drinking over time suppresses GABA activity and causes a tolerance to build up, requiring more alcohol to produce the same effect. Chronic drinking also suppresses glutamate, a neurotransmitter that causes excitability. Glutamate is necessary to maintain equilibrium.
A sudden or dramatic reduction in alcohol consumption means the neurotransmitters are no longer suppressed. They quickly rebound and cause brain hyperexcitability. This is why alcohol withdrawal symptoms are the opposite of symptoms associated with drinking, including anxiety, tremors, and anxiety.
The most serious type of alcohol withdrawal syndrome is called delirium tremens (DT). DTs usually start between 2 and 3 days after the last drink. People who have a history of withdrawal seizures, abnormal liver function, acute illness, and those who are older are more likely to experience these life-threatening symptoms.
Symptoms of DT include:
These symptoms are considered a medical emergency. If AWS advances to delirium tremens, it can be fatal. Death can occur in 1% to 5% of people with DTs, but the risk of death is reduced with medical support and medication to reduce withdrawal symptoms.
Because alcohol withdrawal can be very painful and life-threatening, supervised detox in an inpatient setting is recommended for heavy or long-term drinkers.
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