How to Detox from Alcohol: Is Going Cold Turkey a Bad Idea?
Alcohol dependence is one of the most common psychiatric disorders, second only to major depression.1 In the U.S., alcohol use disorder affects an estimated 17.6 million Americans annually, although only a small fraction of people with alcohol problems seek professional help.2 Detox is the first step in overcoming alcohol addiction. Many people struggling with alcohol abuse wonder how to detox from alcohol and may contemplate tackling this alone. However, anyone with a serious dependency on alcohol should never consider going “cold turkey” at home.
In regular and heavy drinkers, the body compensates for the depressive effect of alcohol by increasing production of hormones and brain chemicals such as serotonin, epinephrine and dopamine. When a person stops drinking alcohol cold turkey, the body becomes flooded with abnormally high levels of these chemicals. This causes the brain to undergo rapid adaptive changes in an attempt to maintain normal function. Severe complications include dehydration, vomiting, abnormal heart rhythms and a condition called delirium tremens (DTs).3
About 30% to 40% of people who experience seizures progress to DTs.4 Considered a medical emergency, delirium tremens typically occurs 24 to 48 hours after the last drink and is characterized by confusion, delirium and seizures. Unattended, people can suffer head injuries, lethal dehydration, heart attack or stroke and can choke on their own vomit. In an estimated 15% of cases, DTs results in death.3
Alcohol Withdrawal Symptoms
Approximately 50% of people with alcohol dependence experience withdrawal symptoms. Severe alcohol withdrawal is often refractory to standard doses of medication and requires aggressive treatment.5 The severity and extent of withdrawal symptoms from alcohol vary depending on an individual’s history of abuse and overall health, including any exacerbating co-existing medical and/or psychological disorders. Alcohol withdrawal syndrome (AWS) is the term given for a cluster of symptoms that occur when somebody detoxes from alcohol. Withdrawal symptoms usually start about six hours after alcohol cessation. Clinical diagnosis of AWS is made based on the following criteria:
- Clear evidence of recent cessation or reduction of alcohol after prior regular excessive use.
- Symptoms of alcohol withdrawal cannot be attributed to any co-occurring medical or mental health disorders.
- Significant distress or decrease in functioning in socio-occupational or other important areas due to withdrawal symptoms.1
AWS is divided into four clinical categories: minor withdrawal, major withdrawal, withdrawal seizures and delirium tremens (DTs). An alcohol withdrawal seizure is frequently the first sign of alcohol withdrawal. In fact, no other signs of withdrawal may be present after the seizure abates. Withdrawal seizures can occur within six to 48 hours of alcohol cessation. In the absence of treatment, multiple seizures occur in 60% of people. The duration between the first and last seizure is usually less than six hours.4
Detoxification from alcohol is a three-phase process. The first phase occurs over a period of a few days and is the most dangerous. It is within the first 72 hours that individuals are most at risk of suffering major withdrawal.1,5 Signs and symptoms include anxiety, visual and auditory hallucinations, convulsions, whole body tremor, nausea, vomiting, insomnia, diaphoresis (profuse sweating), shakiness, convulsions, DTs, hypertension and heart failure.
The second and longer phase of alcohol detox occurs over months, as the brain slowly begins to regulate and resume normal functioning. There may be lingering symptoms during this phase, but they are usually not life-threatening.
During the final phase, elevated anxiety and dysphoria (profound state of unease or dissatisfaction) may not be apparent. However, normally insignificant challenges can provoke negativity, craving of alcohol and relapse.
Medically supervised detox typically includes the administration of benzodiazepines, a class of drug that is considered the gold standard pharmacotherapy for alcohol withdrawal. Prompt pharmacological treatment is indicated in all cases of AWS. The absence of treatment or inadequate treatment can be fatal, which is yet another reason why a person should never try to detox on his or her own. Benzodiazepines that have been studied extensively for AWS include diazepam, chlordiazepoxide and lorazepam.1
The Goals of Detox
As defined by the American Society of Addiction Medicine, the three goals of drug and alcohol detoxification are as follows:
- To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug-free.
- To provide a withdrawal that is humane and thus protects the patient’s dignity.
- To prepare the patient for ongoing treatment of his or her dependence on alcohol or other drugs.1
Co-occurring Alcohol and Drug Detox
For people suffering from both alcohol and drug abuse, detox is a complex and dangerous process. People who abuse alcohol and drugs should never attempt to detox cold turkey. In addition to the alcohol withdrawal symptoms discussed above, drugs are associated with equally frightening detox side effects.
Cocaine: Prolonged use of cocaine can result in “crashing,” which is characterized by anxiety, depression, fatigue, irritability and thoughts of suicide. Other common cocaine withdrawal symptoms include restlessness, nightmares, a general feeling of discomfort and extremely strong cravings for the drug.6 Cocaine dependent users have a statistically higher risk for other substance use disorders, as well as personality disorders, post-traumatic stress disorder and depressive disorders. That makes the mental health aspects of cocaine withdrawal particularly complex.7
Tranquilizers: Benzodiazepines such as Ativan, Valium and Xanax work in an opposite manner than stimulants like cocaine. They are a class of psychoactive drugs used to treat anxiety, insomnia and a range of other conditions. When tranquilizers are suddenly stopped, symptoms include insomnia, feeling jittery, shakiness and nerves that are extremely sensitive to any type of stimulus.8
Opiates: The nervous system of a heroin abuser’s body is so accustomed to chronic exposure of this opiate narcotic that abrupt withdrawal can cause excruciating withdrawal symptoms. Heroin withdrawal symptoms include abdominal and body pain, anxiety, chills, diarrhea, nausea, vomiting and weakness. While heroin is the most commonly abused opiate drug, there are other opiates including morphine, codeine, opium and oxycodone (the primary active ingredient in OxyContin). Withdrawal symptoms can begin within six hours of cessation and include agitation, abdominal pain, blurry vision, rapid heartbeat, high blood pressure, nausea, vomiting and diarrhea.9
Getting Off the Addiction Roller-Coaster and Into Recovery
The truth is that you can learn to overcome your substance dependence or addiction and achieve sobriety. The key point to remember is that it is never safe to attempt to detox from alcohol or drugs or a combination of alcohol and drugs on your own. Those at highest risk for complications from alcohol withdrawal are people who drink frequently to excess and then routinely go through their own version of detox.3 Even if you believe that friends or family can help, only trained professionals have the skills to safely assist you through the arduous and potentially dangerous detox process. Self-detox is a bad and very dangerous idea that can prove fatal.
Inpatient and residential treatment facilities with detox programs are especially beneficial for individuals with chronic addiction. Outpatient facilities are typically better suited for those with less severe addiction problems. Select a treatment facility that offers a safe, medically supervised detox environment. There you will find trained professionals that devote their lives to helping people address and overcome addiction. Start your recovery today by speaking confidentially to a Promises recovery advisor.
- Sachdeva A, Choudhary M, Chandra M.Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015 Sep;9(9): VE01–VE07. Published online 2015 Sep 1. doi: 10.7860/JCDR/2015/13407.6538.
- New NIAAA resource gives guidance on treatment options for alcohol problems. National Institute on Alcohol Abuse and Alcoholism website. https://www.niaaa.nih.gov/news-events/news-releases/new-niaaa-resource-gives-guidance-treatment-options-alcohol-problems Published November 13, 2014. Accessed July 23, 2016.
- Parker-Pope T. Amy Winehouse and the Perils of Alcohol Withdrawal. The New York Times. http://well.blogs.nytimes.com/2011/08/03/amy-winehouse-and-the-perils-of-alcohol-withdrawal/?_r=1 August 3, 2011. Accessed July 24, 2016.
- Delirium Tremens (DTs) Clinical Presentation. Medscape website. http://emedicine.medscape.com/article/166032-clinical Updated: April 14, 2016. Accessed July 24, 2016.
- Schmidt KJ, Doshi MR, Holzhausen JM, Natavio A, Cadiz M, Winegardner JE. Treatment of Severe Alcohol Withdrawal. Ann Pharmacother. 2016 May;50(5):389-401. doi: 10.1177/1060028016629161. Epub 2016 Feb 9.
- Cocaine withdrawal. Medline Plus website. https://medlineplus.gov/ency/article/000947.htm Updated April 13, 2015. Accessed July 24, 2016.
- Haasen C, Prinzleve M, Gossop M, Fischer G, Casas M. Relationship between cocaine use and mental health problems in a sample of European cocaine powder or crack users. World Psychiatry. 2005 Oct;4(3):173-6.
- Tranquilizer Detox Withdrawal Can Last Years. ABC News website. http://abcnews.go.com/Health/DepressionNews/story?id=6354685&page=1 Published December 1, 2008. Accessed July 24, 2016.
- What Is Opiate Withdrawal? Healthline website. http://www.healthline.com/health/opiate-withdrawal#Symptoms3 Published October 20, 2015. Accessed July 24, 2016.