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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):
The severity of AUD is classified based on the number of met criteria:1
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Alcohol is a depressant. It affects several brain chemicals:
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:
This hyperactivity is manifested as alcohol withdrawal symptoms.3, 4
Alcohol withdrawal comprises four stages of varying severity:
This stage starts 6 to 12 hours after the person’s last drink. Symptoms include:5, 6
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
Seizures happen to some people undergoing alcohol withdrawal. They usually begin 24 to 48 hours after a person’s last drink.6
DTs usually happen 48 to 72 hours after the person’s last drink. DT symptom include:3, 7
DT has a mortality rate of 1 to 15%.8, 9
Alcohol detox (detoxification) is a process that aims to:10
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’s main drawback is its high cost. People may also develop unnecessary dependence on facility staff.10
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
Alcohol detox in an inpatient or outpatient setting initially involves medical assessment.
The detox process is primarily about withdrawal management. It involves:11
Some medications used in medical detox include:
Alcohol detox also has non-medical components like education and counseling to prepare people for other treatments.10
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
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
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.
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