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Alcohol Detox

Detoxing from alcohol can be difficult, uncomfortable, and in some cases, dangerous. If you or someone you care about is struggling with alcohol use disorder (AUD), medically supervised alcohol detox helps many people to more safely and comfortably manage alcohol withdrawal.

What is Alcohol Detox?

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), AUD involves a pattern of alcohol use that causes significant impairment and distress.3 Alcohol dependence (and the associated withdrawal syndrome) is a key feature of many cases of AUD and is one of the most frequently encountered problems in medical settings, second only to depression.1

A period of supervised alcohol detox is often the first part of treatment or rehabilitation for AUD. It involves a set of interventions, which often includes medication, that is designed to help you stop drinking and safely withdraw from alcohol. In addition to keeping you stable throughout withdrawal; detox programs help prepare you for additional treatment for AUD.1

The course of any given individual’s alcohol withdrawal symptoms is sometimes unpredictable. Additionally, it is not always easy to identify those at risk for an eventually severe or complicated withdrawal. The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that, in addition to these reasons, given the ever-present possibility of an adverse withdrawal experience, hospitalization (or some form of 24­ hour medical care) is commonly the preferred setting for acute alcohol detoxification.2

Alcohol Detox Process

Alcohol detox may be the first step in the recovery process before you enter an ongoing treatment program. Though alcohol detox can occur on an inpatient or outpatient basis, an inpatient medical setting may be advisable for people who are heavy alcohol users, or those with a history of significant alcohol withdrawal symptoms, a history of withdrawal seizures or delirium tremens, or co-occurring serious medical or psychiatric illnesses.1

In many detox programs, you can expect to experience three important elements of care, which include:2

  • Evaluation. You receive a comprehensive evaluation to assess your overall health and the severity of the problem to determine the appropriate detox setting for your needs.
  • Stabilization. This is the active detox phase where you undergo withdrawal with medications, medical supervision, and support.
  • Fostering entry to treatment. You receive assistance with entering the appropriate substance abuse treatment setting once detox is complete.

Alcohol Detox and Withdrawal

People may experience different symptoms during the detox phase. In some cases, the symptoms of alcohol withdrawal will be relatively mild, while others may experience severe and possibly life-threatening withdrawal complications.1

The acute alcohol withdrawal syndrome may include:2,6

  • Autonomic hyperactivity (sweating, elevated heart rate, increased blood pressure).
  • Tremors
  • Anxiety
  • Headaches
  • Insomnia
  • Gastrointestinal upset (nausea and vomiting).
  • Appetite loss.
  • Impaired concentration.
  • Poor judgment and poor memory
  • Increased sensitivity to light or noise.
  • Delusions (meaning you believe something that isn’t true).
  • Hallucinations (meaning you see, feel, or hear things that aren’t there).
  • Grand mal seizures (the kind most people think of when they think of seizures).
  • Delirium tremens (DTs), a severe and potentially deadly form of withdrawal that may involve a cluster of symptoms including hallucinations, severe disorientation, and agitation.

In some cases, people may also develop a more protracted withdrawal syndrome, which involves persistent symptoms that last beyond the more typical duration for alcohol withdrawal.7 These protracted symptoms can include tremor, insomnia, anxiety, depression, and lack of energy, as well as increased breathing rate, body temperature, blood pressure, and pulse.7 In some cases, these symptoms can last up to a year or more. Though not everyone experiences them, they remain a particular concern in those who do, since they can promote relapse as an attempt to mitigate their troublesome nature long after drinking first stops.7

How Long Does it Take to Detox From Alcohol?

An exact timeline for alcohol withdrawal symptom onset, severity, and symptom resolution can vary from person to person. In many cases, physically uncomfortable symptoms such as insomnia, tremors, gastrointestinal upset, or nausea start between 6-12 hours after your last drink.1 Hallucination can start 12-24 hours after your last drink; seizures can start 24-48 hours after the last drink; more rarely, DTs can start anywhere from 1-4 days after the last drink, should they develop.1, 7

It is important to note, people can progress through symptoms at different rates.2 Generally speaking, symptoms start to subside after a few days, but DTs can last up to 5 days.7 ,8

Undergoing detox with medical supervision can not only help you remain safe and comfortable, but it can also provide immediate medical care if you develop serious and potentially dangerous complications like seizures or DTs.

What Happens During Alcohol Detox?

People often want to know how long does it take to detox, but this timeline is different for everyone.2 Your age, health, nutritional factors, and any co­occurring medical or psychiatric conditions can affect the character and severity with which you experience withdrawal.2 For some people, mild to moderate symptoms might resolve almost right away, while other symptoms, such as seizures, can remain a risk for longer periods of time.2 Below is a general timeline of what you can expect during the detox process.

Day 1 of Alcohol Detox

Between 6-12 hours after your last drink, you may experience mild symptoms such as insomnia, tremors, mild anxiety, gastrointestinal upset, headache, sweating, or loss of appetite. These symptoms tend to resolve in a few days.7  Between 12-24 hours after your last drink, you can have a risk of developing hallucinations. Hallucinations usually resolve in 48 hours.7,2

Day 2 of Alcohol Detox

During the second day of detox, you may experience continued symptoms from day 1 that could possibly worsen. You may have an increased risk of developing hallucinations as well as additional withdrawal symptoms such as seizures or DTs.1,7 

Day 3-7 of Alcohol Detox

Over the course of the week, your symptoms may fluctuate. Certain withdrawal symptoms may slowly improve, while others may resolve quickly.2 The risk for DTs can be higher starting at 48 hours after your last drink, and seizures can also occur and recur, which is why it’s important to receive medical supervision during detox.1

After 1 Week of Alcohol Detox

Many of your symptoms may begin to taper off by this point.6 However, some people may experience more persistent symptoms as part of a more protracted withdrawal syndrome.7

Alcohol Detox Medications

During the course of acute alcohol withdrawal, many troublesome symptoms can be medically managed.1

Some of the medications that are currently used to treat alcohol withdrawal include:1, 6

  • Benzodiazepines, such as diazepam or chlordiazepoxide. Benzodiazepines are often used in treatment of alcohol withdrawal and can help to minimize symptoms and decrease the likelihood for and severity of withdrawal complications. For example, they are helpful for decreasing seizure and delirium risks.
  • Anticonvulsants like carbamazepine. These can help minimize withdrawal symptoms and reduce the potential for seizures.
  • Adrenergic medications like clonidine. These can be used as adjunct therapy to manage autonomic withdrawal symptoms like increased blood pressure and rapid heart rate, but do not prevent seizures or delirium.

Beyond the acute withdrawal period, additional FDA-approved medications may be initiated to help people prevent relapse and maintain abstinence during treatment for alcohol use disorder.2 These drugs are not considered detox medications, as they are typically not started until a period of abstinence from active drinking has first been achieved.5 Medications that may be used in the longer-term to manage AUD include:2, 5, 9

  • Naltrexone. By blocking some of the rewards associated with alcohol use, naltrexone can help people maintain abstinence from drinking.
  • Acamprosate. Through a mechanism thought to involve a balancing of certain brain chemistry previously disrupted by chronic alcohol use, acamprosate can help prevent relapse and reduce urges to drink.
  • Disulfiram. Although disulfiram doesn’t reduce cravings, when used daily, it discourages drinking by resulting in unpleasant symptoms when you ingest alcohol.

What Happens After Alcohol Detox?

Alcohol detox is often the first step on the path to recovery .10 Recovery is an ongoing, lifelong process that requires commitment and dedication. This is why it’s important to have a treatment plan in place once detox is complete. Treatment can address the underlying issues that may have contributed to the addiction, prevent relapse, and help you regain control of your life.

Depending on your unique needs, you may enter inpatient or outpatient treatment. Inpatient treatment means you live onsite and receive round-the-clock care. It can be helpful for anyone who needs highly supportive care, people with more severe addictions or co-occurring mental health disorders, or those without supportive home environments.10

Outpatient treatment means you live at home but travel to a rehab facility anywhere from one to several times per week.10 Some people first start out in inpatient treatment and transition to outpatient care as their recovery journey progresses.

If you’re ready to take back control of your life, American Addiction Centers is ready to help you find a treatment option that’s suited to your needs. Call our free, confidential, 24/7 helpline at 1-888-966-8152 to find out more about your rehabilitation options.

Sources

  1. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol withdrawal syndrome: benzodiazepines and beyond. Journal of clinical and diagnostic research, 9(9), VE01–VE07.
  2. Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  4. National Institute on Alcohol Abuse and Alcoholism. (2021, April). Understanding alcohol use disorder.
  5. Substance Abuse and Mental Health Services Administration and National Institute on Alcohol Abuse and Alcoholism. (2015). Medication for the treatment of alcohol use disorder: A brief guide. HHS Publication No. (SMA) 15-4907. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  6. Bayard, M., McIntyre, J., Hill, K. R., & Woodside, J., Jr (2004). Alcohol withdrawal syndrome. American family physician, 69(6), 1443–1450.
  7. Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol health and research world, 22(1), 61–66.
  8. Rahman A, Paul M. (2021, August 27). Delirium Tremens. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing.
  9. Winslow, B. T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder. American family physician, 93(6), 457–465.
  10. Substance Abuse and Mental Health Services Administration. (2019, October). Treatment options: Types of treatment.