For those going through the recovery process, one of the hardest challenges to overcome is the physical dependency on alcohol. Alcohol withdrawal symptoms are typically very uncomfortable and in some cases can be even fatal. Because of these circumstances, it is always advised people receive medication assistance during the detox and recovery process. We will take a look at why alcohol withdrawals are difficult and the different approaches and medications professionals use to solve this problem.
What Happens When You Stop Drinking
During the first hour after a person stops drinking, the body starts to run through its normal course of action. Its first course of action is circulating the blood to the liver in order to filter out the alcohol. The pancreas begins to create insulin to counteract the sugar of the alcohol, which is why many people crave starchy foods after they’ve been drinking. Over the next 48 hours, the body will go through fluctuations in glycemic levels.
The body treats alcohol like a toxin, and over the next 12 hours, it tries to remove it from the body using the liver and excretions. Water is the main component used in both of these processes; therefore the more a person drinks, the more they will become dehydrated unless they balance their alcoholic drinks with water. Dehydration is the primary cause of the classic hangover.
For those people who drink extensively and often, they will develop a physical dependence on alcohol. It after the 12-hour-mark that the first indications of chemical dependency appear. Common symptoms of alcohol withdrawal include:
The chances of serious alcohol withdrawal symptoms increase towards the 24-hour mark. During this stage, people might experience:
- Auditory and visual hallucinations
One of the most dangerous and lethal side effects of alcohol withdrawal is delirium tremens or DTs. DTs might only happen to about 5 percent of the population that goes through a full alcohol withdrawal process, but nonetheless, they should be taken seriously. DTs generally start around 48 to 72 hours after someone has had their last drink. Signs of Delirium Tremens include:
- Suffer mental or emotional confusion
- Develop a fever
- Feel their heart racing
- Begin sweating
- Have high blood pressure
Apart from delirium tremens, it is possible for alcohol withdrawals to lead to fatalities. Most deaths occur due to cardiovascular failure or respiratory collapse. In about 5 percent of the population during withdrawals from alcohol experience hyperpyrexia (high fever) and ketoacidosis (serious complication for diabetics). These two complications can inflict significant long-term effects on the brain or even cause death. While these symptoms are rare, mitigating these symptoms in a safe and effective manner requires proffessional help.
The detox process typically only lasts around one week, because after a week people are generally in the clear of the potentially fatal withdrawal symptoms. People can feel the health benefits of quitting drinking in about a week, these can range from feeling more energetic to sleeping better.
While many feel benefits after a few days of not drinking, the major physical improvements will be felt around one month. At this stage, liver fat levels (which is the most common cause of liver disease in alcoholics,) will drop by about 15 percent. By the one-year mark, major organs will be significantly recovered and weight loss is also very common.
Alcohol’s Effect of the Brain
On an interesting side note, many people believe that drinking kills brain cells. Research indicates that the amount of alcohol needed to kill brain cells would also be enough to kill a person. Much of the damage that alcohol affects is towards the white matter, which is responsible for spatial reasoning. Drinking does not kill gray matter cells, cells that handle more general thinking duties.
It appears that much of the brain damage from drinking is due to thiamine deficiency. This can lead to a failure of the body to absorb and metabolize a wide range of nutrients including amino acids. Amino acids are responsible for neurotransmission and cell division, therefore the lack of amino acids can cause brain damage that can take very long to reverse. Coalition Recovery offers amino acid therapy as a way to replenish many of the nutrients typically diminished during alcohol abuse. By replenishing these amino acids, the brain (and body) can overcome many of the deficiencies created during alcoholism.
The Role of Dopamine
Dopamine is the chemical in our brains responsible for making us feel good. Dopamine is responsible for rewarding the human body when it does something productive – like eating, sex, laughing with friends, and work and academic accomplishments. All of these things have been historically beneficial for humans and dopamine pushes us to keep doing these events. Drugs and alcohol on the other hand actually trick our dopamine reward system into thinking these actions are beneficial.
Unlike drugs such as methamphetamines and cocaine, alcohol does not directly hijack the dopamine production system in the body. Instead, alcohol triggers the dopamine receptors in a more external form. For example, cases like social media, video games, and sex all give us immediate satisfaction and therefore dopamine surges. Alcohol works in a similar way. It is known to relieve tension and stress and therefore make us feel relaxed and happy. Alcohol consumption typically happens during fun social gatherings. This combination tells the brain that alcohol is good and we should continue to engage in this activity.
One issue that pops up in the study of virtually every addictive process is the role that dopamine plays in habit formation. Unlike drugs like cocaine or methamphetamines, alcohol does not directly hijack the dopamine production systems in your body. Instead, alcohol consumption triggers a more subtle pathway for modifying behavior adversely.
Put simply, dopamine is a chemical that helps your brain learn that some activity is good. For example, the rush you feel after a long session of talking and laughing with good friends is, in part, the product of dopamine flooding into your system. This allows your brain to register that the experience was good and that you should do it again.
Dopamine with Alcohol Withdrawals
A lot of non-drug addictions are dopamine driven. We see this in cases involving video game or sex addictions, for example. So, how does this relate to alcohol withdrawal symptoms?
Alcohol often becomes the cause of the dopamine rush. Drinking it makes a user feel better, and that reinforces the behavior. The regular use of alcohol in social settings also tends to pile on the dopamine hit.
Therefore, when people detox from alcohol, they often feel sad and depressed because they lack the dopamine rush they are familiar with from alcohol. For this reason, it can be hard for people to truly see the positive effects of quitting alcohol. The first couple days/weeks of alcohol abstinence are the most difficult.
Treating Alcohol Withdrawal with Medications
Medications minimize the risks and discomforts of alcohol withdrawal increasing the chances of detox success. The typical drugs prescribed during alcohol detox are benzodiazepines. Without proper medication management, alcohol detox can induce:
- Panic attacks
- Anxiety issues
Benzodiazepines treat many of these effects. It is crucial that you or the person going through alcohol detox notifies the doctor of any and all recently used drugs. This is not limited to illegal substances, but maybe more importantly prescribed medications as well. If a person uses or has prescription benzodiazepines and then also prescribed additional benzodiazepines during detox, there could have serious consequences. These can include:
- Loss of coordination
- Bluish skin, especially at the extremities
- Troubling breathing
- Heavy dizziness
Do not take chances by not fully disclosing your usage with your addiction doctor. By being completely honest you can ensure you are receiving the safest care available making the process much more manageable.
Specific Drugs and Their Applications
There are a variety of drugs to help ease people through the detox process and minimize any negative side effects. A board-certified addiction psychiatrist is trained to know which medication can and cannot be used. Medications used in alcohol detox include:
Benzodiazepines or “Benzos” are preferable drugs used during the treatment of immediate alcohol withdrawals as it can limit many of the negative side effects of alcohol; unfortunately many can be susceptible towards abuse. This is why when a person stops drinking, they may also need to taper off their benzodiazepines before the detox is finished.
This drug stabilizes chemical signaling in the brain that would otherwise be disrupted by alcohol withdrawal. Doctors typically prescribe this drug post-detox as a means to minimize alcohol cravings during the beginning stages of treatment. Acamprosate is not effective without behavioral therapies.
Naltrexone curbs opioid cravings, but it can also help with alcohol cravings as well. While it is not very common, some doctors may prescribe it to patients who appear to have a strong desire for alcohol.
More commonly known as its trade name Antabuse, this drug can also deter alcohol drinking. If someone consumes alcohol after taking disulfiram, they will feel violently ill. The goal is to associate drinking with this sickness as a way to condition the mind into not wanting to drink. The effects of this drug vary, but disulfiram is mainly used as a last resort when a person has been through multiple relapses with a variety of different medications.
This is just a short list of the medications used during alcohol withdrawal and alcohol treatment. Doctors have access to a total of 75 different medications to treat alcohol withdrawal. For example, if someone cannot take benzodiazepine due to their medications or allergies, doctors can prescribe topiramate, an alternative to treating seizures, but considered an off-label use by the FDA. Psychiatrists can also prescribe additional medications for mental health conditions, but these medications are more associated with alcohol use disorder treatment rather than the withdrawals specifically.
It is important to trust your psychiatrist. If your psychiatrist is board-certified and you are completely honest with him/her about your medications and medical history, you can be sure your withdrawals will be managed in the safest and most effective manner.
Keeping the Recovery Process Going
As you begin the detox and eventually the recovery process, remember that these drugs are only supplements to the process and not the treatment itself. While medication-assisted treatment can help alleviate many of the adverse side effects of withdrawals, like panic attacks and cravings, it will not eliminate them completely. To fully address the problem, detoxing from the substance is not enough. Individuals are strongly encouraged to attend and engage in counseling sessions as well. This process involves identifying patterns of us, learning from them and how to manage them. This preclusive approach is much more manageable and effective than continually detoxing from the substance. Alcohol addiction does more social damage than it does physical.
No matter your prescribed medications, withdrawals can still be unpleasant. Even after detox, there is still a possibility of eventual relapse. It is important to continually stay focused on the goal of self-improvement and overall health. Thankfully alcohol withdrawals subside relatively quickly compared to other drugs like benzodiazepines which can take upwards of a couple months to finally feel normal again.
Many people have found their sobriety, both with abstinence and medication assistance. They have found that in a short period of time their life begins to bounce back. They look better, have more energy and motivation. Medication-assisted treatment (for both alcohol withdrawals and alcohol use treatment) can significantly improve people’s chances of treatment success; therefore improving their chances of long term recovery.
For more information on how medications can help you through your detox and treatment call Coalition Recovery today. We have representatives who are available 24/7 to assist you with any questions you might have about our program. Don’t wait – take back your life!