How to Detox from Alcohol

Alcohol Use Disorder (AUD): An Overview 

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

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

1. Drinking more or longer than intended
2. Unable to quit 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 occurs (like nausea, tremors, sweating, or seizure)

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

• Mild AUD: two to three
• Moderate AUD: four to five
• Severe AUD: six or more

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What Does Drinking Alcohol Do to the Body?

Alcohol is a depressant that affects several brain chemicals, including:

• 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: such as 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. This calming effect is temporary and comes at the expense of various side effects, such as:

• Nausea
• Vomiting
• Lack of inhibition
• Hangovers

What is Alcohol Withdrawal?

Drinking heavily causes the body to become used to the constant effects of alcohol. The body craves alcohol to stimulate the release of 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

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

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

3. Alcohol Withdrawal Seizures

Seizures may 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
• Low blood sugar

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 eventually quit drinking. While it’s the right decision, it may put them at risk of experiencing withdrawal. For their safety, stopping alcohol use should be handled under medical supervision.

Alcohol detox can occur safely and effectively through inpatient and outpatient treatment.

Outpatient Detox

Outpatient detox may not significantly disrupt a person’s everyday routines. After receiving treatment, people can go home and may not need to leave their jobs or school. It’s also less expensive and less time-consuming.

Despite the convenience, outpatient detox does not separate people from access to alcohol, potentially increasing the risk of relapse.

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

Inpatient Detox

Inpatient or residential detox requires people to stay in a hospital or treatment facility (usually for 5 to 14 days). It offers the following rehab services:

• 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 However, Inpatient detox has a clear advantage over outpatient detox since it provides medical assistance 24/7.

Inpatient detox is best 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 facility
• An unstable, unsupportive living/home environment, usually with people who drink/use at home

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Why is Professional Alcohol Detox Necessary?

While self-recovery from alcohol is possible, people should always detox under professional supervision. If withdrawal symptoms worsen, medical professionals can provide immediate attention through inpatient detox services.

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

Risks of Self-Detox and Quitting “Cold Turkey”

Some people prefer to perform self-detox in the comfort and privacy of their own homes. At-home detox and quitting “cold turkey” seem more convenient than working with a rehab facility, but these approaches have severe health risks.

No health professional will be present if and when people experience severe withdrawal symptoms, such as seizures or death.

The risk of relapse is also high with at-home detox since people are constantly exposed to triggers at home. This makes it challenging to remain sober enough to overcome alcohol withdrawal symptoms.

What to Expect During Detox

Detoxing 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 (typically only in severe cases)
• Consuming detox drinks to flush alcohol and all the toxins out of your system

In severe cases, a patient may need to get their stomach pumped. A stomach pumping is a medical procedure that eliminates gastric substances and toxins via suction.

Some medications used in medical detox include:

• Benzodiazepines: These drugs reduce seizures and prevent withdrawal 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 that will prevent relapse.¹⁰

How Long Does Alcohol Detox Take?

Alcohol detox begins immediately after the person’s last drink. On average, it takes 5 to 7 days to detox fully.  Lighter drinkers may have shorter detox durations and fewer withdrawal symptoms, while heavier drinkers may have longer detox times and more severe symptoms.¹¹

How long it takes for the body to feel “normal” after quitting drinking alcohol may vary according to the frequency of use, medical history, and other factors.

Generally, people stop experiencing the adverse effects of withdrawal by the second week. Most people experience improved blood pressure, clear skin, and weight loss by the first month.

How to Prevent Relapse

Relapse is a normal part of recovery, and it’s essential to consider it a normal part of behavioral change. While it isn’t always avoidable, there are some things you can do to prevent a relapse:

• Switch to other drinks: Replace your usual bottle of beer or glass of wine with healthier alternatives, such as herbal tea, fruit juices, and electrolytes. Beverages rich in sodium and potassium help the body retain internal moisture, keeping you from dehydrating.
• Eat well: When you eat well and avoid processed foods, your body feels better and is less likely to crave alcohol. Eat plenty of leafy green vegetables, brown rice, and lean protein like fish and chicken, as they promote brain function and a healthy immune system. In addition, foods rich in vitamin C help flush out harmful toxins.
• Know what triggers you: Consider what makes you crave alcohol. Perhaps being around a particular group of people, visiting a specific bar, or eating certain foods triggers your desire to drink. Learn to identify what causes binge drinking, how they present, and how to control them.
• Get regular support: Keep attending your support group, even if you think you don’t need to. Social support can make you feel heard and understood.

Summary

Alcohol Use Disorder (AUD) is a condition that prevents people from stopping themselves from their drinking habits. This can lead to substance dependence that may require a person to quit drinking.

Abruptly stopping alcohol consumption isn’t advised, especially for heavy drinkers. Withdrawal symptoms can range from mild to severe side effects. It’s best to detox from alcohol under medical supervision in inpatient rehab facilities.

If you or someone you know needs to detox from alcohol, contact an addiction specialist to determine the best treatment options.