What is Alcohol Detox?
There are many terms and concepts related to breaking an alcohol dependency. It can sometimes be hard to know what people mean when they refer to rehab, sobriety, being “on the wagon,” or detox.
“Detox”, or “detoxification”, should be taken somewhat literally. It refers to two main obstacles: getting alcohol out of one’s system and getting ready to either go through a full rehabilitation program (such as a twelve-step program) or to remain sober by other means. Alcohol detox refers to removing alcohol from one’s system by stopping use altogether, but it can also refer to the detoxification of the bodily system when it experiences withdrawal symptoms. Detox is essentially the frightening early efforts in a road to amazing and life-changing recovery.
The Experience of Alcohol Detox
A person needs detox (and may be hit by withdrawals) if he or she has gone beyond simply “partying hard”, and has subsequently developed a tolerance. Becker (2008) recognizes tolerance of alcohol as follows; having to drink more and more to feel the pleasurable effects, and getting less of the pleasant or uninhibited sensations from a particular amount of alcohol. Tolerance indicates a need to detox as soon as possible.
When a person has reached the point at which s/he knows it is time to quit, s/he is susceptible to withdrawals.
Withdrawals Make Detox Necessary
One of the main components of a detox program is to help a person through withdrawals. Let’s discuss how exactly withdrawals work.
The blissful and excited feelings one gets from alcohol are caused by changes in our brain’s chemistry. Alcohol itself mediates, potentiates, and increases the release of a number of neurotransmitters (or chemicals in the brain) which create pleasurable, sedative or disinhibited effects (McIntosh & Chick, 2004). These chemicals include:
- Dopamine – creates “pleasure”
- Noradrenaline – contributes to the “party effects” of alcohol
- Endogenous opioids – pain and stress-relief
- GABA – causes sedation
- Serotonin – adds to pleasurable effects.
However, when a person stops drinking for an extended period of time, brain chemistry is thrown into chaos. Cells die, and the inhibitory function of alcohol via GABA is erased. Alcohol also usually inhibits the NMDA receptors and, without this inhibitory function, the brain goes into a sort of panic. An excitatory neurotransmitter known as glutamate increases from disinhibition of the receptors, as does the overall sympathetic activity (McIntosh & Chick, 2004).
The end result is a list of symptoms one associates with withdrawals. These include sweating, an increase in blood pressure and an increase in heart rate. Essentially, the “fight or flight” mechanism has been triggered (McIntosh & Chick, 2004). Please read our article on alcohol detox for more information on alcohol withdrawals.
Withdrawals also include non-specific signs and symptoms such as headaches and nausea. However, dangerous symptoms include seizures as well as the infamous complication known as delirium tremens (or DTs). Delirium tremens is due to abrupt dysregulation of brain neurotransmitters and hyperactivity of the sympathetic nervous system, resulting in seizures, hallucinations, profound confusion and even death (Mehta, Prabhu, Swamy, Dhaliwal & Prasad, 2004).
One jerk reflex that many alcohol-dependent users have, when suffering from withdrawals, is to start drinking to make the pain go away. This is reason enough to justify checking into a rehabilitation program to detox from alcohol as opposed to going alone. Furthermore, because the symptoms of alcohol withdrawal present an obvious danger, and can sometimes be life-threatening, it’s important to have professional help during this crucial time. The peak incidence for seizures is usually within 3 days (but occurring most commonly between 12–48 hours) and around 72 hours for delirium tremens (McIntosh & Chick, 2004).
Detoxing in a Facility
One doesn’t necessarily have to check into an inpatient program to detox. It depends on how severe symptoms are and how healthy one’s emotional life is overall. Naturally, these decisions are made in consultation with professionals at a recognized center. Please read our articles on inpatient and outpatient detox to find more research and information on this topic.
The first thing that healthcare professionals at a facility will do is determine the extent of your withdrawals and the severity of your addiction. This will include a blood test (sometimes including a drug screen as well) and an interview with you to discuss your alcohol habits (WebMD, 2019). The experts on substance abuse treatment will then proceed with the particular type of detox that is appropriate for you.
Medication During Detox
One of the decisions that your healthcare professional will make immediately is whether or not to use medication for you. Medication is usually used in a closely supervised inpatient setting but may be given to certain candidates at very well supervised, low doses in an outpatient setting (Bayard, McIntyre, Hill & Woodside, 2004). One of the most common drugs for alcohol withdrawal symptoms is the class of drugs known as benzodiazepine. The doctor will almost certainly use these for delirium tremens in an inpatient setting, yet these medications are sometimes used even when symptoms aren’t so severe. In plain English, these medications help alleviate the abrupt decline in GABA that is caused by alcohol withdrawal (Sachdeva, Choudhary, Chandra, 2015). Ideally, once detox has been achieved, medication won’t be used beyond that point.
Why Can’t One Detox at Home?
Denial forms a large part of alcohol abuse. Once people admit to themselves they have a problem, they must clear the larger hurdle of seeking professional help for it. To some people, that means admitting the problem was bigger than they’d thought. Now, it’s probably clear that a person undergoing DTs or having serious withdrawal symptoms has little choice other than to check into a facility. However, it’s important to take this step sooner rather than later. The withdrawal symptoms described above begin in just a few hours after a person goes cold turkey.
Leaving aside the dangers of withdrawals, being in the care of professionals is crucial when transitioning out of alcohol dependency. As described above, one’s “fight or flight” system is distorted and overactive during this time. This can even manifest itself into psychological symptoms, such as anxiety and paranoia (Bayard, McIntyre, Hill & Woodside, 2004). It’s self-evident that being alone, or surrounded by bad choices and influences, is dangerous in this situation.
A recovery center puts you in a calm and supportive environment. Furthermore, you’ll be in the care of professionals who can intervene swiftly if problem arises. Perhaps this is why WebMD (2019) suggests that “you’re more likely to stick with a detox program when you have lots of hope.”
Bayard, M., McIntyre, J., Hill, K.R., & Woodside, J. (2004). Alcohol withdrawal syndrome. Am Fam Physician, 15;69(6):1443-50.
Becker, H. C. (2008). Alcohol dependence, withdrawal, and relapse. Alcohol Research & Health, 31(4), 348-61.
McIntosh C., & Chick J. (2004). Alcohol and the nervous system. Journal of Neurology, Neurosurgery & Psychiatry, 75:iii16-iii21.
Mehta, S. R., Prabhu, H., Swamy, A. J., Dhaliwal, H., & Prasad, D. (2011). Delirium Tremens. Armed Forces India, 60(1), 25-7.
Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research, 9(9), VE01-VE07.
WebMD. (2019). Alcohol Detox and Rehab Programs: What to Know. Retrieved March 7, 2019 from https://www.webmd.com/mental-health/addiction/alcohol-detox-programs#1