Alcohol Detox: The First Step on the Road to Recovery

When breaking an addiction to alcohol, the first step is detoxification—your brain needs to adjust to functioning without the drug. It generally takes somewhere between three and five days for the body to transition to a sober state. Prolonged, heavy drinking changes the brain’s neurotransmitters, the chemicals responsible for transmitting messages. Drinking initially boosts the activity of the neurotransmitter that generates feelings of relaxation and calm. But a chronic drinking habit will suppress neurotransmitter activity, so more and more alcohol is required to produce the same calming effect. Alcohol addiction also limits the function of glutamate, the neurotransmitter that produces feelings of excitability. To maintain a balance, the glutamate acts at a far higher level than it does in moderates and non-drinkers.

Once a chronic drinker suddenly stops or cuts back their alcohol consumption, the neurotransmitters previously suppressed by the drug bounce back in force, causing a condition known as brain hyperexcitability. The painful symptoms associated with alcohol withdrawal are, logically, the reverse of those associated with drinking. Alcoholics with a milder dependence on alcohol should see these symptoms subside after a few days. Those with a heavier addiction may see some symptoms persist after the initial detox stage. Fortunately, the brain is a flexible organ that can compensate for damage and adapt to change.

Alcohol withdrawal symptoms differ from person to person. Not everyone will exhibit the same symptoms, and symptoms can vary in duration and intensity, but generally some of the following will occur.

• Anxiety: Marked signs of anxiety generally occur between 12 and 48 hours after the cessation of drinking. Many drink to escape feelings of extreme fear and anxiety, so once the depressant (alcohol) is removed from their system, they face an onslaught of suffering. Anxiety is often accompanied by heart palpitations, hyperventilation, sweating, and dizziness.
• Depression: Many in detox struggle with the decline from peak intoxication to sombre sobriety. The psychological and physical challenges associated with alcoholism and alcohol withdrawal often advance the development of depressive disorders.
• Sleep disturbances: Sleep disturbances, such as frequent waking, restless sleep, night terrors, and insomnia are some of the most common complaints of those undergoing detox.
• Seizures: Withdrawal seizures tend to occur within 48 hours after the stopping drinking. Alcoholics who have undergone the withdrawal process in the past are more likely to experience more complications, including more frequent and severe seizures. The cycle of drinking, detoxing, and drinking again causes long-term changes in brain excitability, which increases the risk of complications during detoxification.
• Hallucinations/nightmares: Visual, auditory, and tactile hallucinations are very common during alcohol withdrawal. Three to ten percent of alcoholics undergoing detox will experience hallucinations not connected with delirium tremens. One study suggests that those who hallucinate tend to have been younger at the start of their alcohol problems, consumed more drinks per occasion, and have higher rates of drug use than those who do not hallucinate.

Delirium tremens (DTs) is the most dangerous alcohol withdrawal symptom. The cessation of alcohol consumption after a long period of drinking triggers a sudden shift in biochemicals. Drinking reduces production of the GABA chemicals, the neurotransmitters responsible for heart rate, blood pressure, seizure threshold, and other nervous subsystems. The alcohol helps the body function without the GABA chemicals, but once the alcoholic stops drinking, their body goes haywire, trying to find a way to cope without the chemicals.

DTs manifest through extreme confusion and agitation, fever, and seizures. People suffering from DTs will also experience hallucinations, which can be tactile (consisting of itching, burning, and numbness), auditory (hearing nonexistent sounds), and visual (seeing nonexistent images). The symptoms may appear suddenly, usually two or three days after the cessation of drinking. Symptoms usually peak at night, and the fourth and fifth day are notoriously painful.

Detox is the time it takes for the substance to completely leave the body. The process isn’t easy, but it’s an important preliminary step in the management of alcoholism.Withdrawal symptoms are unpleasant, but in some cases, medications might be administered to ease the discomfort of withdrawal. Chlordiazepoxide is one of the most well-documented of these detoxification medications. Its long half-life provides gentle and effective pain relief over an extended period of time. Medical professionals will monitor the entire process, ensuring a safe detoxification. But simply detoxing isn’t usually enough—further treatment is needed to continue down the path to sustained sobriety.