This article will discuss the withdrawal process from alcohol dependence as a result of detoxification. Before doing so, there are several distinctions that need to be made. According to numerous sources, including textbooks such as Concepts of Chemical Dependency, the common use of the term detox to refer to withdrawal management is based on an incorrect assumption. Detoxification and withdrawal (and withdrawal management) are different things. In keeping with standard definitions regarding addiction medicine, the following definitions apply:
- Detoxification (Detox): The term detox is commonly used to denote a withdrawal management process from drugs or alcohol. However, detoxification is a natural physical process that occurs in the body and is ongoing. The body regularly cleans itself of toxins and waste products mainly through the liver and excretory system. This is a natural ongoing process that occurs whether one is actively using alcohol or other drugs, or whether they are trying to stop using alcohol or drugs. An individual’s system will continue to detoxify itself as a natural method of removing impurities from the system. The terms detox and detoxification refer to this process. The majority of professional organizations involved in the treatment of substance use disorders no longer use the term medical detox to refer to withdrawal management issues. Instead, these organizations use the term withdrawal management to refer to the process of medical supervision designed to reduce withdrawal symptoms that occur in individuals who have developed physical dependence on drugs and wish to stop using drugs. In this article, the terms detox and detoxification refer to the natural cleansing process of the body.
- Withdrawal: This process occurs when an individual has developed physical dependence on some drug. Physical dependence consists of both the symptoms of tolerance and withdrawal. In the withdrawal process, individuals who chronically used certain types of drugs alter the natural functioning of their system in such a manner that the system only functions normally when there are specific levels of the drug in their system. When individual stops using drugs and their system naturally goes through the detoxification process, the levels of these drugs decreases. When the level of the drug in the tissues is decreased beyond a certain point, the individual’s system is thrown out of balance. They experience a number of negative physical and emotional repercussions that are referred to as the withdrawal syndrome. The withdrawal syndrome only occurs when an individual has developed a physical dependence on a drug. The notion that someone can become psychologically dependent on a drug is a little bit controversial; however, it is certainly true that individuals with moderate to severe substance use disorders will experience a number of negative emotional and psychological effects when they stop using their drug of choice.
- Withdrawal management: This is the proper term for what many individuals refer to as “medical detox.” The detoxification process is a natural, physical process that occurs as a result of the body trying to cleanse itself of impurities. The withdrawal management process is a medical and psychological series of interventions designed to reduce the symptoms of withdrawal in individuals who have developed a physical dependency on a specific drugs or drugs.
An important factor in understanding the detoxification process is the half-life of the drug. The half-life of a drug refers to the amount of time it takes an individual to normally metabolize the original concentration of the drug to half its amount. Reported half-lives of drugs are based on general estimates of the “average” amount of time that the “average” individual’s system will take to metabolize the particular drug. Interestingly, alcohol does not conform to the notion of a half-life but instead has a steady rate of metabolism. So half-life estimates for the detoxification from alcohol that are published on some sites are useless and inaccurate.
Anywhere from 92 percent to 98 percent of alcohol is metabolized by the liver (a very small proportion is metabolized through the skin, breath, and by other means). A number of factors affect the rate that different individuals will metabolize alcohol, such as the person’s weight, gender, individual metabolism, amount of food eaten, etc.; however, in general, it can be estimated that an “average” individual’s blood alcohol content (BAC) will decrease by about 0.015 per hour due to alcohol in the system being metabolized. Thus, if an individual with a BAC of 0.08 (the legal limit) drinks no more alcohol, it would take a little over five hours for the BAC to be around 0 given this estimate.
The Process of Detoxification and Withdrawal from Alcohol
Certain factors will affect the system’s ability to detoxify itself from alcohol and how individuals will experience withdrawal symptoms from alcohol abuse if they have developed physical dependence on alcohol. The proposed timeline outlined in this article is based on a general estimate regarding alcohol withdrawal. The book Guidelines for the Treatment of Alcohol Problems reports that the process of detoxification and the process of withdrawal from alcohol depend on the severity of the individual’s alcohol use disorder. The severity of any individual’s alcohol use disorder can only be estimated by trained, licensed professionals who specialize in addiction. Thus, anyone who has an alcohol use disorder and wishes to stop using alcohol should consult with a trained mental health professional before discontinuing alcohol use, as individuals undergoing severe withdrawal symptoms from alcohol may experience potentially fatal symptoms. The severity of one’s alcohol use disorder is often measured by the number of symptoms that they present with and the length of time they been using the substance.
Individuals with mild alcohol use disorders will typically have fewer symptoms of alcohol use that individuals who have moderate to severe alcohol use disorders, and they will most often have not developed significant levels of tolerance and withdrawal. The detoxification process for these individuals may not be lengthy and severe. Individuals who are diagnosed with a mild alcohol use disorder for the most part can expect to experience mild withdrawal syndromes that will follow this general timeline:
- Onset: Withdrawal symptoms may begin as soon as six hours after discontinuation.
- Symptom peak: For most individuals with mild alcohol use disorders, the withdrawal symptoms will peak anywhere between 12 and 24 hours.
- Length: For individuals with mild alcohol use disorders, the average length of the withdrawal syndrome is 2-4 days but may extend longer.
- Most common symptoms: The most common symptoms that occur during a minor alcohol withdrawal syndrome include nausea, vomiting, sweating, nervousness, unsteadiness, mild tremors, increased heartbeat, severe headache, and mild mood swings. Individuals experiencing a mild withdrawal syndrome from alcohol typically do not experience issues with hallucinations and do not have seizures.
While the majority of individuals with minor alcohol use disorders will most likely display a course similar to what is depicted above, there is a bit of a gray area regarding how the withdrawal syndrome manifests in individuals with a moderate or severe alcohol use disorder. Some of these individuals may experience a minor alcohol withdrawal syndrome, whereas others may experience more severe withdrawal symptoms. It is for this reason that even individuals with mild alcohol use disorders should be supervised by a physician if they wish to discontinue their alcohol use.
Individuals who develop issues with confusion, hallucinations, delusions, seizures, or display the syndrome of delirium tremens require immediate medical management. These individuals may become disoriented or suicidal. If they develop seizures, the seizures can be potentially fatal. The risk for the development of seizures in individuals with severe alcohol use disorders typically peaks 6-12 hours after discontinuation; however, as mentioned above, these may appear much later in the course of the withdrawal syndrome. Individuals who have undergone withdrawal from alcohol and continue to experience issues with memory, confusion, and other cognitive issues beyond 30 days after discontinuation should undergo a professional assessment to determine the presence of any other disorders or conditions that may be contributing to these features.
The most common forms of medication used in withdrawal management from alcohol are benzodiazepines, which are drugs that produce similar physical effects to alcohol and also reduce the potential for issues with anxiety and seizures. A number of other medications can be used for other issues, such as hallucinations, cravings, nausea, etc.
The potential for dangerous symptoms is greatly reduced during a professional withdrawal management program. Individuals are typically closely supervised during the process in order to make sure they remain stable.