The irony of alcohol consumption is that a substance often used to relax and unwind can be responsible for a keyed-up state of anxiety and poor mental health. In severe cases where alcohol becomes a coping mechanism, people can begin to feel withdrawal symptoms. In some cases, the signs of withdrawal are severe enough to warrant medical advice and attention.
If people regularly engage in excessive drinking, alcohol withdrawal can be expected when they don’t have a drink. While most common in adults with a history of being dependent on alcohol, withdrawal symptoms can appear in anyone who drinks excessively.
Binge drinking is when someone consumes multiple drinks in a short period. About four to five drinks in a few hours is considered binge drinking. It is important to note that excessive alcohol consumption does not automatically mean alcohol dependency or an alcohol use disorder – but it does mean people who engage in this behavior are at a higher risk for the symptoms of withdrawal.
So, what are the signs, causes, and treatments of alcohol withdrawal syndrome? Read on to learn more.
Despite alcohol being a social tool intended for enjoyment, this substance is a depressant that slows brain function and influences how nerves communicate with each other. When a person regularly consumes excessive amounts of alcohol, the central nervous system becomes accustomed to it and expects it. The body adapts chemical functions to account for the continuous presence of alcohol. If you drink heavily – even without being an alcoholic – you will experience some level of withdrawal when you stop drinking suddenly.
Alcohol is often consumed to help people relax and relieve anxiety. This effect is achieved by amplifying GABA, a neurotransmitter that creates euphoria and calm. It also decreases glutamate, a neurotransmitter responsible for excitability. Alcoholics and heavy drinkers will find it challenging to reduce glutamate and increase GABA over time – requiring more alcohol to achieve the same effects.
To combat the depressive effects, your body works harder to keep your brain awake, and the lines of communication between nerves open, especially with the two neurotransmitters, GABA and glutamate.
Take away the alcohol suddenly, and you see your brain continuing to work in this keyed-up state, overproducing GABA and under-producing glutamate. The mind is attempting to communicate to your body, but the chemical balance is disrupted and struggling to adapt as alcohol leaves the system. This is the point where severe withdrawal symptoms begin.
While some might think of a hangover as a mild withdrawal, they are not the same. The causes behind a hangover and withdrawal syndrome are different and worth understanding.
Hangovers occur when you drink too much at once. Too much alcohol causes dehydration, stomach irritation, and inflammatory physical response. As the alcohol leaves your system after your last drink, hangover signs of nausea, headache, and fatigue appear. This is common with people who had a little too much fun on a single night out – but not a sign of regular alcohol abuse if it is not occurring regularly over an extended period.
Alcohol withdrawal syndrome occurs when alcohol use disappears or decreases drastically. Alcohol use has to be over a prolonged period, at least long enough for the body to become dependent on having some amount of alcohol in the system at any point. The central nervous system has time to adapt to the presence of alcohol and change neurotransmitter production. Once the supply of alcohol is cut off or decreased, alcohol withdrawal symptoms begin to appear.
So, do not confuse a hangover with withdrawal. They are not the same, especially when it comes to treatment.
Once withdrawal begins, the symptoms will range from severe to mild. The severity will be contingent upon your history of alcohol abuse, how long you drank, and how much. Alcohol withdrawal symptoms are commonly associated with ‘the shakes’ – but the list of symptoms stretches much further than body tremors and an increased heart rate.
People can see mild symptoms appear in as little as six hours after consumption ends. The mild symptoms include:
· Shaky hands
· Dilated pupils
· Pale skin
· Mood swings
Roughly twelve to twenty-four hours into withdrawal is when the more severe signs will occur.
More severe signs of withdrawal include:
· High blood pressure
· Racing heart/increased heart rate
· Cardiac arrest
· Extreme agitation
The entire detoxification process of withdrawal can take between five to ten days and begins just hours after consumption ceases. Once you stop drinking, the liver starts to metabolize ethanol and move alcohol through the system. As the alcohol leaves your body, the symptoms outlined above begin to appear.
Typically, withdrawal follows the following timeline for severe cases:
· 6-8 hours: First signs appear, usually shaking, stress, anxiety, headaches, nausea, trouble sleeping
· 1-3 days: Symptoms begin to peak. Hallucinations, irritability, seizures, and high blood pressure can occur. There is a risk of cardiac arrest.
· 5-10 days: Symptoms begin to subside, but cravings may be present for weeks
The severity of withdrawal depends upon the severity of the dependency. It also depends on the length of time in which alcohol was being heavily consumed.
In the most severe cases, a person may experience delirium tremens, a syndrome characterized by changes in mental states and automatic nervous system excitation.
Delirium tremens is likely to occur in people who have a history of alcohol withdrawal, drink daily for months, or who have abused alcohol for years. While it is the most severe symptom of withdrawal, it only appears in less than 5% of people experiencing withdrawal.
It usually shows up a day or two into withdrawal as all alcohol leaves the bloodstream. It can appear suddenly, which is why monitoring vitals and safety is essential in the detox process. Delirium tremens occurs when the brain suddenly loses the alcohol depressant after long periods of suppression and vigorously springs into a dangerous rebound.
The signs of delirium tremens include:
· Body tremors
· Disorientation or severe confusion
This is a severe symptom and requires immediate medical attention and could be fatal without proper care. If a person has been dependent on alcohol for a long time, the risk of developing delirium tremens is higher than usual.
Depending on the severity, you may be able to handle alcohol withdrawal symptoms without medical assistance. For most people, a supportive, healthy environment is enough to navigate this process. The following is recommended to recover from mild cases:
· Soft lighting
· Quiet environment
· Supportive, positive atmosphere
· Limited contact with others
· Fluids and healthy food
If you have a preexisting health condition or a history of severe symptoms of withdrawal, you might require professional assistance. If the pulse rises, you have high blood pressure, or temperature increases or you experience hallucinations or seizures, emergency medical aid is needed. From there, your doctor can advise on drug treatment and inpatient care options.
Some treatments simply require medications like benzodiazepines for insomnia, anxiety, and seizures. These medications can alleviate some withdrawal symptoms, but should be used under medical supervision as they can be addictive themselves.
While alcohol dependency is not a prerequisite to experiencing withdrawal, severe withdrawal symptoms are a sign of more serious underlying issues. These symptoms can shift violently and quickly, with a mild case becoming severe within hours.
There are several professional treatment options to assist in navigating this situation. Various alcohol treatment programs seek to aid individuals to address drinking problems. Some treatment specialists and facilities can even help alleviate severe alcohol withdrawal symptoms while providing 24/7 support in a medical detox process.
Professional treatment is necessary for alcohol withdrawal because there is not a single solution that works for everyone, especially for addiction treatment. Expert advice will give the full scope of options so patients can find what works.
The options include:
· Inpatient treatment, which provides a supervised, safe environment to battle alcohol addiction. This is the most intensive treatment option and requires 30, 60, or 90-day programs.
· Outpatient treatment allows you to continue with daily responsibilities while recovering and is well-matched with mild cases of alcohol abuse. This is a good option if you can handle continuing to be around influences and drinking triggers in your daily routine.
· Individual counseling focuses on mental health and helps to discover underlying factors behind alcohol addiction and identifying tools to cope and work through alcohol withdrawal.
· Medication-assisted therapy can be helpful with prescription medication that can alleviate uncomfortable symptoms, freeing the focus for other recovery elements.
· Support groups like Alcoholics Anonymous provide a supportive environment to focus on treatment goals and challenges with peers who have been in the same situation.
Some people do not have a supportive, safe environment conducive to detoxification. Utilizing professional assistance can mitigate this concern and prioritize mental health in the process. Professional aid means professional standards, and the detoxification process has high standards in the medical professional field. If you detoxify with medical supervision, you will see the following:
· Protection of dignity in the withdrawal process and humane treatment
· Safe withdrawal process and treatment aiming to help you live alcohol-free
· Preparation for ongoing treatment for alcohol dependence even after withdrawal ends
Navigating withdrawal can be painful and requires an in-depth look at your innermost self as you struggle to understand the causes behind alcohol abuse once you stop drinking. The range of treatment options and support spheres shows you are not alone in this process.
Set down that last drink and contact the experts here at the Virginia Center for Addiction Medicine or your medical provider to learn more and determine what treatment option is the next step to a healthier you.