Tapering Off Alcohol

What Does it Mean to Taper Off Alcohol?

When individuals decide to reduce drinking, two different options are available:

• Tapering 
• Quitting suddenly

While quitting suddenly (or quitting cold turkey) is self-explanatory, tapering may raise some doubts. 

Tapering is an approach focused on diminishing the intensity of withdrawal symptoms by reducing the intake of a substance little by little. It is a strategy that, in combination with other treatments, healthcare professionals prescribe for individuals who live with an opioid use disorder.

In this case, however, when individuals say they are tapering off alcohol, they’re referring to drinking less and less alcohol over time to avoid symptoms associated with alcohol withdrawal. 

Tapering may be a suitable option for individuals who have the following characteristics:

• Consume alcohol on a moderate basis 
• Are worried about drinking habits and wish to cut down
• Count on a healthy emotional support system, such as friends or family, throughout this process

According to the U.S. Dietary Guidelines, moderate alcohol consumption is one standard drink (14 grams of pure alcohol) per day for women and 1 to 2 standard drinks for men. 

However, it is important to remember that any concerns about drinking alcohol should be discussed with a medical professional. Tapering is not recommended for individuals who abuse alcohol, have developed a physical dependency, or live with an alcohol use disorder. These individuals face a higher risk of relapse, overdose, and serious health consequences. 

Is it Better to Taper Off Alcohol or Quit “Cold Turkey?”

If individuals moderately consume alcohol, tapering off alcohol may be a good option to help build long-lasting, improved drinking habits.  

Different tapering possibilities exist, such as:

• Combining weaker drinks with less alcohol content
• Drinking a glass of water after each alcoholic beverage 
• Consuming a less preferred alcoholic drink 
• Gradually cutting down the overall number of drinks 

Interestingly, individuals who decide to taper off alcohol should take environmental cues, like the clinking of ice cubes or social parties, into account. These cues may act as stimuli (triggers) to drink due to repeated associations with alcohol consumption. If individuals build awareness of such stimuli, they may be more likely to find an alternative scenario that helps them stave off an alcoholic drink. 

Individuals who would like to taper off alcohol may also want to consider mental health therapy, such as cognitive-behavioral therapy. This behavioral health treatment may help explore the reasons for certain drinking habits and reinforce positive changes in behavior and decision-making processes. 

In any case, if such habits raise concerns, it is always best to speak with a healthcare provider. Each individual has unique needs, and tapering off may not be an adequate solution to reduce or stop drinking. 

For individuals who suffer from alcohol abuse or have developed an alcohol use disorder, neither quitting cold turkey nor tapering alone is advisable. Alcohol addiction is cyclical. Without proper medical supervision and prescribed medication during the withdrawal process, symptoms may become too intense. Individuals may then relapse, drink excessively, even overdose, and fall into a more profound addiction. 

Pros and Cons of Tapering Down Alcohol Intake

Tapering alcohol intake has its pros and cons. 

For example, some of the advantages of such an approach include:

• Decreased risk of AUD — binge drinking and heavy drinking have been associated with a higher risk of alcohol use disorder. 
• Improved immune system — excessive drinking can weaken the immune system, increasing the body’s likelihood of developing an infection. Diseases like pneumonia and tuberculosis are more frequent in individuals who chronically drink.  
• Decreased risk of alcohol-related death — alcohol is the third leading preventable cause of mortality in the United States, with approximately 95,000 people dying from alcohol-related causes each year. 
• Saved costs and time — inpatient treatment may be an expensive option in terms of time and money. However, with tapering, individuals can maintain their everyday lives while improving their drinking habits step by step. 

Drinking a lot in just one event can slow the body’s ability to fight off infections for up to 24 hours after becoming drunk. 

Some of the disadvantages of tapering include:

• Unsupervised medical care — individuals do not have the guided support by medical professionals who have knowledge and experience of such matters. This may make it more difficult for individuals to adhere to a plan in the long term and reduce overall drinking. 
• Tapering does not work — some individuals may find that tapering is not a suitable option to stop drinking. This may prove discouraging and underlie a deeper problem, such as weak support groups or stronger alcohol dependence. 

Alcohol Withdrawal Symptoms: Side Effects of Tapering

For heavy drinkers, it may take the brain some time to return to its normal state. When individuals decide to stop or reduce drinking, they may experience alcohol withdrawal syndrome. Fortunately, when alcohol withdrawal symptoms arise, there is a predication pattern. Although, it is important to mention that not every individual will experience all symptoms of alcohol withdrawal. 

• Tremors — individuals may begin shaking within 5 to 10 hours of consuming their last alcoholic beverage. Individuals may also experience rapid heart rate and breathing, sweating, nausea and vomiting, irritability, intense dreaming, trouble sleeping, and hypertension (high blood pressure). These symptoms often peak within 24 to 48 hours. 
• Alcohol hallucinosis — after 12 to 24 hours have passed since the last alcoholic drink, individuals may begin to hallucinate. Alcohol hallucinosis may last up to 2 days, and individuals may report seeing crawling insects or coins dropping. 
• Seizures — within 6 to 48 hours of the last drink, individuals often suffer from several seizures. The risk of seizures peaks at 24 hours. 
• Delirium tremens — individuals with delirium tremens will experience a dramatic change in breathing, circulation, and temperature control. The heart rate quickens and blood pressure increases, resulting in serious dehydration. This health condition can also limit the amount of blood flow to the brain for a short period. Delirium tremens often occur within two to three days of the last alcoholic beverage but could arise after a week has passed. Symptoms of this life-threatening condition also include stupor or loss of consciousness, disorientation, irrational beliefs, drenching sweats, hallucinations, and more. 

How to Safely Taper Off Alcohol (Medical Detox)

For individuals with mild to moderate withdrawal symptoms, two different options are available:

• Outpatient care 
• Inpatient care

In general, outpatient detoxification is a safe and effective alternative to inpatient care, with fewer costs.  However, healthcare providers should consider optimal care treatment on a case-by-case basis, as some individuals may require inpatient treatment instead, regardless of symptom severity.

Individuals who are more suitable for outpatient detoxification, combined with safe tapering, include:

• Those who lack a history of severe withdrawal symptoms, withdrawal seizures, or delirium tremens 
• Those without multiple prior detoxifications or a healthy, reliable support system
• Those without psychiatric or medical illness connected with drinking habits in some form
• Those with recent excessive drinking 
• Those who are pregnant

Similarly, to increase tapering efficacy, healthcare providers may prescribe withdrawal medication, supplements, such as thiamine and a multivitamin, and electrolytes. In outpatient care, healthcare providers may recommend a fixed tapering schedule to ensure adherence. 

Drinking alcohol lessens gastrointestinal absorption of many nutrients, such as thiamine, otherwise known as B1 vitamin. An estimated 80% of individuals who consume alcohol chronically will have a thiamine deficiency. 

Medications Used in Tapering Off Alcohol

Healthcare providers may prescribe benzodiazepines to reduce the effect of alcohol withdrawal symptoms. Benzodiazepines affect the central nervous system and can prevent complications, such as combativeness, hallucination, or agitation. 

The most commonly used benzodiazepines include:

• Lorazepam (Ativan®)
• Chlordiazepoxide (Librium®)
• Oxazepam (Serax®)
• Diazepam (Valium®)

In general, the benzodiazepines, as mentioned earlier, work effectively in treating alcohol withdrawal. However, diazepam does have the shortest time to peak effect and the longest elimination half-life. The elimination half-life is the amount of time the body takes to metabolize at least half of the drug doses. The benefit of such an elimination half-life is that the withdrawal can be smoother, with a lower incidence and severity of symptoms and rebound risk. 

If you or a loved one are considering quitting alcohol or changing your drinking habits, it is important to seek medical advice first and foremost. A healthcare provider can evaluate your case and determine what treatment program is most suitable and discuss other treatment options.