How to Detox from Alcohol: Is Going Cold Turkey a Bad Idea?

What happens when you detox from alcohol “cold turkey”? Read about alcohol withdrawal symptoms and the safest way to detox from alcohol.

man refusing alcohol
If you’re a heavy drinker, abruptly quitting alcohol without the help of medical professionals — known as going “cold turkey” — can be painful and dangerous. Here’s what you should know if you’re considering detoxing from alcohol on your own.

What Happens if I Quit Drinking “Cold Turkey?”

If you’re a regular or heavy alcohol user, quitting alcohol without the help of medical professionals puts you at risk for a number of complications from alcohol withdrawal symptoms.

The severity of these alcohol withdrawal symptoms depends on factors like:

  • How long you’ve been abusing alcohol
  • How much alcohol you’ve been abusing
  • Your physical and mental health
  • Co-occurring physical and mental conditions

Approximately 50% of people who are addicted to alcohol have severe withdrawal symptoms when they stop drinking that can only be effectively eased with medical treatment.You may have an alcohol use disorder, which puts you at risk for alcohol withdrawal symptoms, if you meet two or more of the following criteria:

  1. Drinking alcohol in larger amounts or for longer time periods than intended
  2. Repeated failed attempts to quit alcohol or cut down on alcohol abuse
  3. Spending large amounts of time obtaining alcohol, using it and recovering from it
  4. Craving alcohol and experiencing strong urges to drink
  5. Ongoing failure to fulfill school, work and personal obligations due to alcohol use
  6. Continuing to abuse alcohol despite negative effects on relationships and social interactions
  7. Decreased involvement in occupational, recreational and social activities
  8. Using alcohol in physically dangerous situations
  9. Continuing to drink alcohol despite knowing it has caused a physical or psychological condition
  10. Needing more and more alcohol to feel buzzed or drunk
  11. Experiencing withdrawal symptoms in the absence of alcohol or using alcohol or other substances to help ease withdrawal symptoms 2

If you have an alcohol addiction, quitting alcohol “cold turkey” may send you into alcohol withdrawal within about six hours after your last drink.

detox infographic

What Is Alcohol Withdrawal Like?

When you abuse alcohol, your brain gets used to having it around. Alcohol in your system becomes the new normal. When you quit drinking, the brain and central nervous system go into high alert trying to restore balance. In regular and heavy drinkers, the body compensates for the depressive effect of alcohol by increasing hormones and brain chemicals such as serotonin, epinephrine and dopamine. If you stop drinking alcohol cold turkey, the body becomes flooded with abnormally high levels of these chemicals in an effort to re-establish balance and normal functioning without alcohol.3 That’s why quitting cold turkey can put you at risk for the following alcohol withdrawal symptoms:


Seizures


An alcohol withdrawal seizure is frequently the first sign of alcohol withdrawal. It usually involves convulsions alternating with involuntary muscle contractions. Withdrawal seizures can occur within six to 48 hours of alcohol cessation. Without medical treatment, multiple seizures occur in 60% of people. The duration between the first and last seizure is usually less than six hours.

Hyperactivity in the body’s neurons are thought to contribute to alcohol-related seizures, but researchers have yet to pinpoint precisely how it works. Several studies over the last decade suggest altered calcium channel activity is a key contributing factor. 5

Delirium Tremens (DTs)


About 30-40% of people who experience seizures get the DTs. Considered a medical emergency, DTs typically occurs 24 to 48 hours after the last drink and is characterized by confusion, delirium, high blood pressure and shakiness. Without medical help and supervision, the DTs can put you at risk for head injuries, lethal dehydration, heart attack or stroke, and choking on vomit. In an estimated 15% of cases, DTs causes death.4


Abnormal Heart Rhythms


As part of delirium tremens, the heart beats erratically. Unusual shifts in breathing, temperature and circulation may contribute to a racing heart. You may also experience blood circulation issues like high blood pressure.


Nausea and Vomiting


Symptoms like nausea and vomiting may linger for a week after you stop drinking. Like other alcohol withdrawal symptoms, these issues occur as the brain tries to rebalance chemicals in the absence of alcohol.


Dehydration

Alcohol is a diuretic that increases your urine output and may also increase sweating. You may already be dehydrated going into alcohol withdrawal. During alcohol withdrawal, you may get even more dehydrated due to vomiting and diarrhea, which can lead to dangerous electrolyte imbalances. This can throw off the central nervous system, causing DTs, seizures, mental confusion, anxiety and suicidal thoughts.6

Other alcohol withdrawal symptoms may include insomnia, headaches, diarrhea and irritability.

How Long Does it Take to Detox From Alcohol?

The time it takes to detox from alcohol depends on the severity of your alcohol addiction and your individual physical and psychological make-up. Physical symptoms typically peak over the first few days with psychological symptoms decreasing over several months.

Alcohol withdrawal symptoms usually follow three phases:

Phase one (acute withdrawal): The first phase occurs over a period of a few days and is the most dangerous. It’s within the first 72 hours that you’re at the greatest risk for major alcohol withdrawal symptoms. During acute withdrawal, you may experience anxiety, visual and auditory hallucinations, convulsions, whole body tremor, nausea, vomiting, insomnia, profuse sweating, shakiness, convulsions, DTs, hypertension and heart failure.


Phase two (early abstinence): The second and longer phase of alcohol detox occurs over months as the brain slowly begins to regulate and get back to normal functioning. Lingering symptoms may persist during this phase, but they are usually not life-threatening. Anxiety is a common symptom during this period, but usually subsides after about six weeks.


Phase three (protracted abstinence): Sometimes known as “the wall,” this final phase happens months after alcohol has been eliminated from your body. As your brain continues to repair itself you may experience anxiety to a lesser degree as well as irritability, low mood and low energy. It’s important to keep on track with support meetings, therapy and self-care to stave off urges to self-medicate these symptoms with alcohol.7

Alcohol Addiction with Dr. David Sack

How Much Alcohol Causes Withdrawal?

The amount of alcohol it takes to cause withdrawal symptoms varies from person to person. Binge drinking or heavy drinking, even for just one night, can cause symptoms like headaches, dehydration, nausea and gastrointestinal issues the next day. If you drink regularly, your body begins to require alcohol to keep alcohol withdrawal symptoms like delirium tremens, nausea, and headaches at bay. You may need alcohol to feel “normal.”

Heavy drinkers and binge drinkers are at most risk for alcohol withdrawal symptoms. The National Institute of Alcoholism and Alcohol Abuse reports drinking levels as:

Moderate drinking – No more than one drink a day for women and two drinks a day for men.

Binge drinking – Five or more drinks for men and four or more drinks for women on one occasion.

Heavy drinking – Five or more days of binge-drinking episodes in one month.

Low-risk drinking – People who are at low risk for developing alcohol addiction are defined as women who drink no more than three drinks in one sitting and no more than seven drinks in one week and men who drink no more than four drinks in a single day and no more than 14 drinks in one week.8

How Do I Safely Detox From Alcohol?

The safest way to detox from alcohol is in a medical setting with specially trained physicians, nurses and other detox specialists.

Here’s what alcohol detox is like in an addiction treatment center:

  • Medical staff eases painful alcohol withdrawal symptoms with the safest and most effective doses of research-backed medications. Benzodiazepines, a class of drug considered the gold standard pharmacotherapy is commonly used for alcohol withdrawal symptoms. Benzodiazepines can also reduce the risk of seizures and DTs.9
  • You’re monitored around the clock to make sure you’re safe and as comfortable as possible. Your treatment team swiftly attends to discomfort from alcohol withdrawal symptoms.
  • 24/7 medical staff immediately intervenes if you experience any life-threatening alcohol withdrawal symptoms.
  • Medical staff may help you begin repairing the physical damage of alcohol abuse with treatments that restore B12 and thiamine deficiencies, which are common in people who abuse alcohol.This may include nutritious, well-balanced meals and vitamin supplementation.10

Alcohol detox is followed by addiction treatment that helps you understand the biological, emotional and social reasons you’ve abused substances. You’ll learn what triggers you to drink and develop healthy coping skills with the support of addiction professionals and sober peers.

Why Is Alcohol Detox Necessary?

When you abuse a substance like alcohol for a long period of time, you become physically and mentally dependent on it. Drinking large amounts of alcohol or drinking for long periods of time makes it more difficult to deny your body the substance it feels it needs to function without sending it into a state of shock.

Regular alcohol abuse causes chemical changes that alter the way the brain functions. These changes lead to agonizing withdrawal symptoms and powerful alcohol cravings that can feel impossible to resist when you don’t have the proper medications to ease them. That’s why it’s extremely challenging to simply quit drinking alcohol at home and not relapse. In fact, research suggests 65-70% of people who detox in this way relapse within one year, and many within the first three months of abstinence.

Handling alcohol withdrawal symptoms on your own like tremors, anxiety, convulsions, seizures, dehydration and hallucinations isn’t safe. Even if you think friends or family can help, only trained professionals have the skills to safely assist you through the detox process. Self-detox can be fatal. Rely on medical staff and detox specialists to safely and comfortably get you past this difficult first hurdle on the path to recovery. 

Still struggling with alcohol? Start a new chapter.

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Sources

1.     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.

2.     American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

3.     Trevisan LA, Boutros N, Petrakis IL, Krystal JH. Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World. 1998;22(1):61–6.

4.     Delirium Tremens (DTs) Clinical Presentation. Medscape website.http://emedicine.medscape.com/article/166032-clinical Updated: April 27, 2018. Accessed July 19, 2018. 5

5.     N’Gouemo P. Altered voltage-gated calcium channels in rat inferior colliculus neurons contribute to alcohol withdrawal seizures. Eur Neuropsychopharmacol. 2015;25(8):1342-1352. doi:10.1016/j.euroneuro.2015.04.008.

6.     Becker, HC. (2008). Alcohol dependence, withdrawal, and relapse.Alcohol Research & Health, 31(4), 348-361.

7.     Heilig M, Egli M, Crabbe JC, Becker HC. Acute withdrawal, protracted abstinence and negative affect in alcoholism: Are they linked? Addict Biol. 2010 Apr; 15(2): 169–184. doi: 10.1111/j.1369-1600.2009.00194.

8.     Drinking Levels Defined. National Institute of Alcohol Abuse and Alcoholism https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

9.     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.

10.     Martin PR, Singleton CK, Hiller-Sturmhofel S (2003). The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health 27:134–142

11.     Kadam M, Sinha A, Nimkar S, Matcheswalla Y, De Sousa A. A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian J Psychol Med. 2017;39(5):627-633. doi:10.4103/IJPSYM.IJPSYM_356_17.

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