Most people in the United States will try alcohol at some point in their lives, but most people drink moderately. The U.S. Centers for Disease Control and Prevention (CDC) reports that just more than 25 percent of U.S. residents age 18 and older had at least one day of heavy drinking (five or more drinks throughout the day) in the past year.
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A study published in The Washington Post in 2014 found that most people in the country barely drink alcohol at all. The bottom through the sixth deciles drink less than one serving of alcohol per week, while the seventh drinks just over two per week, the eighth drinks between six and seven beverages per week (the upper end of moderate drinking), the ninth drinks more than 15 beverages per week (considered heavy drinking), and the 10th decile drinks almost 74 servings of alcohol per week, or more than 10 servings of alcohol per day. These upper deciles are at risk of serious health problems – from alcohol poisoning after a binge, to liver failure and cancer later in life, to addiction to alcohol.
Among those who drink heavily, binge drink regularly, or struggle with alcohol use disorder, trying to quit can lead to withdrawal symptoms. These may require medical oversight with prescription medications to manage, especially if they develop into delirium tremens, a condition that appears in 3 percent to 5 percent of people who try to quit drinking. Even if you are not at risk of developing DT, it is important to work with medical professionals such as counselors, addiction specialists, and physicians to manage your alcohol withdrawal symptoms; otherwise, you risk relapse.
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Alcohol Withdrawal Timeline Depends on the Severity of Symptoms
Typically, alcohol withdrawal symptoms may begin anywhere from six hours to two days after the last drink. Symptoms can persist for up to seven days, although for mild or moderate withdrawal symptoms, the most uncomfortable symptoms will go away in two or three days.
The most common alcohol withdrawal symptoms include:
- Anxiety, nervousness, restlessness, and irritability.
- Other mood swings.
- Cravings for alcohol.
- Nightmares, insomnia, and other sleep disturbances.
- Trouble thinking clearly.
Physical symptoms, which may be the most uncomfortable and are most likely to occur two or three days into withdrawal, include:
- Clammy or sweaty skin
- Pallor, or pale skin
- Dilated pupils
- Rapid heartbeat
- Nausea and vomiting
- Tremors or shaking, especially in the hands
People who drink several pints of alcohol per day for months, who drink heavily for more than a decade, or who repeatedly try to quit and suffer multiple relapses back into alcohol abuse are at risk of developing a severe, life-threatening withdrawal syndrome called delirium tremens (DTs). This typically appears within 48 hours after the last drink, and symptoms peak between days five and seven. Symptoms include:
- Tachycardia, or very rapid pulse.
- Extreme agitation and disorientation (delirium).
- Hypertension, or high blood pressure.
- Intense sweating and high fever.
- Hallucinations, audible or visual.
- Seizures, or severe tremors.
The heart problems, hallucinations, and seizures associated with DTs make this condition very risky. It is extremely important to get medical help before detoxing from alcohol because you may be at risk of developing DTs, which requires hospitalization or inpatient detox treatment.
Detox Help Is Needed for Alcohol Withdrawal
For your clinician to understand how serious your alcohol withdrawal experience might be, they will use a diagnostic chart like the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). On this scale, the maximum score is 67.
Those who score lower than 10 points can typically withdraw from alcohol safely without medications or inpatient treatment, although working with a counselor and physician during this time is still important. People who score more than 15 are at risk of serious withdrawal symptoms including delirium tremens, so they need higher levels of medical supervision during detox.
By determining how serious your symptoms are and your past medical history, a physician or addiction specialist will be able to determine what kind of medical intervention you need during detox to stay safe and end your body’s dependence on this substance.
If you need prescription medications during withdrawal, benzodiazepines are the most frequently prescribed drugs since they use the same area of the brain as alcohol—the gamma-Aminobutyric acid (GABA) receptors. The GABA neurotransmitter slows the function of the neurons it binds to, which reduces how often these neurons fire. When there is not enough GABA neurotransmitter in the brain, the person may feel anxious, stressed, or have panic attacks. In the most extreme cases, low GABA can lead to seizures.
Alcohol mimics GABA, as do benzodiazepines. While benzodiazepines were designed to treat anxiety and some seizure disorders, alcohol has never been approved for these uses. Withdrawal symptoms from both alcohol and benzodiazepines mimic anxiety or, at their most severe, epilepsy.
Using benzodiazepines to stimulate the GABA receptors is a temporary solution when applied to alcohol use disorder. Your clinician will work with you to taper off these drugs so your brain can manage production of the GABA neurotransmitter on its own. The tapering schedule should not last more than 10 days for most people, but your physician will work with you to determine how long you will take benzodiazepines, in decreasing doses, before you have successfully overcome your body’s dependence on alcohol.
There is no way to detox safely from alcohol without medical oversight. Even if you experience mild withdrawal symptoms and can work in an outpatient detox program, it is important for a physician or addiction specialist to monitor your progress as you go, so you can report any serious discomfort that comes up.
If you do not have support when you experience cravings, depression, anxiety, or nausea, you may relapse back into alcohol abuse. This can lead to alcohol poisoning, or you could drink more, which puts you at risk of developing delirium tremens when you attempt to quit again.
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Overcoming Alcohol Use Disorder Means Evidence-Based Treatment
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 16 million adolescents and adults in the U.S. struggle with alcohol use disorder, representing about 6.2 percent of the population. Unfortunately, very few people get help, which leads to serious problems.
Research from the Journal of the American Medical Association: Psychiatry found that there is a 29.1 percent lifetime prevalence of alcohol use disorder adults in the U.S.; however, only 19.8 percent of those individuals struggling with addiction ever get the help they need. Short-term, this can lead to problems like:
- Life-limiting or threatening accidents
- Violence, including suicide and domestic abuse
- Alcohol poisoning
- Risky sexual behavior
- Miscarriage or stillbirth in women who drink while pregnant
Long-term alcohol abuse, especially at high levels, can lead to:
- Heart disease, high blood pressure, or drooping of the heart muscle
- Stroke, pulmonary embolism, or blood clotting disorders
- Learning and memory problems, including dementia
- Mental health problems, especially a higher risk of depression and anxiety
- Social issues, including legal problems, financial instability, and job loss
- High risk of cancer, including esophageal, throat, mouth, liver, breast, etc
- Digestive issues, including ulcers
- Liver disease, cirrhosis, fatty liver, liver cancer, and liver failure
- Renal problems, including kidney damage
The National Institute on Drug Abuse (NIDA) reports that anyone struggling with addiction suffers from a chronic illness, meaning the condition will require ongoing treatment and maintenance. While between 40 percent and 60 percent of people who abuse drugs or alcohol will suffer a relapse, the idea of relapse means that symptoms return, new symptoms appear, or symptoms get worse.
NIDA compares addiction relapse rates to those of people who have other chronic illnesses. For example, people with diabetes have a 30 percent to 50 percent rate of relapse, while people with asthma have a 50 to 70 percent relapse rate.
Getting treatment to overcome alcohol abuse means that you will have medical supervision during detox, which can prevent you from suffering severe discomfort or even dying while your body stabilizes itself without the presence of alcohol.
After detox, you can get a referral to a rehabilitation program, which will provide group and individual counseling to help you recognize and change compulsive behaviors around alcohol. Oftentimes, comprehensive treatment programs provide a seamless transition between detox and ongoing treatment.
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(January 14, 2017). Alcohol Withdrawal. Medline Plus. from https://medlineplus.gov/ency/article/000764.htm.
(2016). Alcohol Withdrawal. The Ohio State University Wexner Medical Center. from https://evidencebasedpractice.osumc.edu/Documents/Guidelines/AlcoholWithdrawal.pdf.
(1989). Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction. from https://umem.org/files/uploads/1104212257_CIWA-Ar.pdf.
(1999). GABA Receptor Physiology and Pharmacology. American Society for Neurochemistry. from https://www.ncbi.nlm.nih.gov/books/NBK28090/.
Alcohol Use Disorder. National Institute on Alcohol Abuse and Alcoholism (NIAAA) from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders.
(June 3, 2015). Alcohol Use Disorder is Widespread, Often Untreated in the United States. Journal of the American Medical Association: Psychiatry. from https://www.sciencedaily.com/releases/2015/06/150603124342.htm.
(January 3, 2018). Fact Sheets – Alcohol Use and Your Health. Centers for Disease Control and Prevention (CDC). from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm.
(January 2018). How Effective is Drug Addiction Treatment? National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment.