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Alcohol Use Disorder (AUD) Overview 

People with alcohol use disorder (AUD) can’t control or stop drinking, despite adverse consequences. AUD encompasses alcohol abuse, dependence, addiction, alcoholism, and other alcohol-related conditions.1

In 2019, 14.5 million U.S. adults aged 12 and older had AUD.2

To be diagnosed with AUD, people must meet at least 2 of 11 criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

  1. Drinking more or longer than intended
  2. Unable to stop drinking once started 
  3. Spending too much time drinking
  4. Craving alcohol 
  5. Drinking causes family, work, or school problems
  6. Continuing drinking even though it causes trouble with family and friends
  7. Cutting back on important or enjoyable activities to drink
  8. Drinking increases the chance of getting hurt (like drunk driving)
  9. Continuing drinking even though it causes depression, anxiety, or other health problems 
  10. The usual number of drinks has a weaker effect than before
  11. Withdrawal symptoms occur (like nausea, tremors, sweating, or seizure)

The severity of AUD is classified based on the number of met criteria:1

  • Mild: 2 to 3 
  • Moderate: 4 to 5
  • Severe: 6 or more

What is Alcohol Withdrawal?

Alcohol is a depressant. It affects several brain chemicals:  

  • Glutamate: Excitatory neurotransmitter that activates nerve cells to send signals 
  • Gamma-aminobutyric acid (GABA): Inhibitory neurotransmitter that blocks signals between nerve cells 
  • Dopamine: The "feel-good" neurotransmitter
  • Endogenous opiates (i.e. morphinelike neurotransmitters)
  • GABA: An anti-anxiety neurotransmitter
  • Serotonin: The neurotransmitter that makes you feel happy

Glutamate and GABA are balanced to keep the brain running at the right pace. Alcohol increases GABA activity, which then reduces nerve excitation and produces a calming effect. 

Regular drinking causes the body to become used to the constant effects of alcohol. Alcohol stimulates extra neurotransmitters, which reduces their normal release. Normal activities no longer produce the same "good" feelings, as they would have before. The body then craves alcohol to stimulate the release of these neurotransmitters to provide a sense of well-being. This makes the body work harder to keep the brain awake. 

This balancing mechanism becomes a problem when the person stops drinking. It also results in the following:

  • GABA drops to below-normal levels
  • Glutamate is left unchecked
  • The GABA-glutamate imbalance causes the brain to become hyperactive

This hyperactivity is manifested as alcohol withdrawal symptoms.3, 4

Alcohol withdrawal comprises four stages of varying severity: 

1. Minor Withdrawal

This stage starts 6 to 12 hours after the person’s last drink. Symptoms include:5, 6  

  • Anxiety
  • Tremors
  • Sweating
  • Insomnia
  • Nausea
  • Vomiting
  • Diarrhea
  • Increased heart rate
  • Increased blood pressure

2. Alcohol Hallucinosis

Most people going through alcohol withdrawal do not progress beyond the first phase. Only a small percentage experience the hallucinosis stage.

Hallucinations characterize this stage. They usually happen 12 to 24 hours after the person’s last drink. Minor symptoms from the previous stage may worsen if not treated.5, 6

3. Alcohol Withdrawal Seizures

Seizures happen to some people undergoing alcohol withdrawal. They usually begin 24 to 48 hours after a person’s last drink.6

4. Delirium Tremens (DTs)

DTs usually happen 48 to 72 hours after the person’s last drink. DT symptom include:3, 7 

  • Agitation
  • Nightmares
  • Confusion
  • Disorientation
  • Fever
  • Sweating
  • Hallucinations
  • Seizures
  • High blood pressure
  • Increased heart rate

DT has a mortality rate of 1 to 15%.8, 9

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How to Safely Detox From Alcohol 

Alcohol detox (detoxification) is a process that aims to:10

  • Manage alcohol withdrawal symptoms
  • Help the person achieve a stable, alcohol-free state
  • Treat co-occurring medical or mental health conditions
  • Prepare the person for other alcohol addiction treatment 

People with AUD may decide to quit drinking at some point. Doing so may put them at risk of experiencing alcohol withdrawal. For increased safety, stopping alcohol use should occur under medical supervision.

Alcohol detox can occur safely and effectively in inpatient and outpatient settings:

Inpatient Detox

Inpatient or residential detox:  

  • Requires people to stay in a hospital or treatment facility (usually for 5 to 14 days)
  • Offers 24-hour care and supervision
  • Provides treatment for severe symptoms
  • Prevents easy access to alcohol
  • Separates people from triggering environments

Inpatient detox’s main drawback is its high cost. People may also develop unnecessary dependence on facility staff.10

Outpatient Detox

Outpatient detox may not significantly disrupt people’s everyday routines. They can go home after treatment each day and may not need to leave their jobs or school.

It’s also less expensive and less time-consuming than inpatient detox.

Despite the convenience, outpatient detox does not separate people from access to alcohol. This can increase the risk of relapse, especially for people with severe AUD. 

People may also choose not to attend outpatient sessions, leading to treatment failure. In a study of 164 subjects, significantly more inpatients completed detox than outpatients.10

What to Expect During Detox 

Alcohol detox in an inpatient or outpatient setting initially involves medical assessment. 

The detox process is primarily about withdrawal management. It involves:11

  • Drinking lots of water to replace lost fluids from sweating and/or diarrhea
  • Taking supplements (particularly vitamin B1) to prevent cognitive impairments
  • Use of medications to treat acute withdrawal symptoms (typically only in severe cases)

Some medications used in medical detox include: 

  • Benzodiazepines: These drugs reduce seizures and prevent withdrawal symptoms from becoming severe. Examples include lorazepam (Ativan), and in rarer cases, diazepam (Valium) and chlordiazepoxide (Librium).5, 8, 10
  • Anticonvulsants: These are used with benzodiazepines to prevent seizures unrelated to alcohol withdrawal.10
  • Acamprosate: This is effective for people with severe alcohol addiction. It may reduce symptoms of long-lasting withdrawal like anxiety and insomnia.12

Alcohol detox also has non-medical components like education and counseling to prepare people for other treatments.10

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How Long Does Alcohol Detox Take?

Alcohol detox begins immediately after the person’s last drink. On average, it takes 5 to 7 days

Lighter drinkers may have shorter detox durations and fewer withdrawal symptoms. Heavier drinkers may have longer detox times and more severe symptoms.11

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Why is Professional Alcohol Detox Necessary?

People should always detox under professional supervision. If withdrawal symptoms become severe, medical professionals are available to provide immediate attention. 

Inpatient detox has a clear advantage over outpatient detox: medical assistance is available 24/7. It’s also safer for people with:10

  • High risk of life-threatening withdrawal symptoms (like DTs)
  • Medical conditions (like pancreatitis and cirrhosis)
  • Suicidal or homicidal tendencies
  • Adverse family or job situations
  • No access to transportation to the treatment facility
  • An unstable, unsupportive living/home environment, usually with people who drink/use at home

Risks of Self-Detox and Quitting “Cold Turkey”

At-home detox and quitting “cold turkey” seem more convenient than staying at or going to a treatment facility. People might prefer to perform self-detox in the comfort and privacy of their own homes. 

Unfortunately, these approaches have severe health risks. No health professional will be present if and when people experience severe withdrawal symptoms, such as seizures or even death. 

The risk of relapse is also high. People are constantly exposed to triggers at home, which makes it challenging to remain sober.

Updated on April 7, 2022
12 sources cited
  1. Hayashida: Hayashida, Motoi. “An overview of outpatient and inpatient detoxification.Alcohol health and research world vol. 22,1 : 44-6.
  2. Understanding Alcohol Use Disorder.National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed February 25, 2022.
  3. Alcohol Facts and Statistics.National Institute on Alcohol Abuse and Alcoholism (NIAAA). Accessed February 25, 2022.
  4. Carlson: Carlson, Richard et al. “Alcohol withdrawal syndrome.” Crit Care Clin vol. 28,4 :549-85.
  5. Kattimani: Kattimani, Shivanand, and Balaji Bharadwaj. “Clinical management of alcohol withdrawal: A systematic review.” Industrial psychiatry journal vol. 22,2 :100-8.
  6. DeSimone, Edward, Jennifer Tilleman, and Trenton Powell. “Treatment of Alcohol Withdrawal Syndrome.” U.S. Pharmacist, Jobson Medical Information LLC, Nov 17, 2014.
  7. Mirijello, Antonio et al. “Identification and management of alcohol withdrawal syndrome.” Drugs vol. 75,4 : 353-65. 
  8. Muncie, Herbert, Yasmin Yasinian Y, and Linda Oge'. “Outpatient management of alcohol withdrawal syndrome.” Am Fam Physician vol. 88,9 :589-95. 
  9. Perry, Elizabeth. “Inpatient management of acute alcohol withdrawal syndrome.” CNS Drugs vol. 28,5 :401-10. 
  10. Ferguson, JA et al. “Risk factors for delirium tremens development.” J Gen Intern Med vol. 11,7 :410-4. 
  11. 4, Withdrawal Management.Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 
  12. Treatment Approaches for Drug Addiction.National Institute on Drug Abuse. January 2019. 

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