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What Is Alcohol Detox and How Does It Work?

There’s a big difference between “sobering up” from one night on the town and full detox from alcohol addiction—and not realizing the difference can literally kill you. While “withdrawal” is invariably an unpleasant experience regardless of the drug involved, certain forms of withdrawal are considered particularly risky—and at the top of the list are benzodiazepine detox, cocaine detox (which can induce violent and irrational behavior), and, yes, alcohol detox.

If you have developed a physical addiction to alcohol, and want to get clean of the misery for a long-term sober life, there are things about alcohol detox you must know. 

1. Possible withdrawal risks include vomiting and/or heavy perspiration (which can lead to dehydration); headache; mental confusion; hallucinations; seizures; racing heart; high blood pressure; and fever.

Because alcohol detox comes with significant risk of cardiac disruption, seizures and irrational behavior, no one should ever attempt it without competent medical supervision. Getting inpatient care at an alcohol detox center will ensure any serious problems are noticed and treated immediately. (Do know the signs of potential trouble, as well as your own typical reactions to alcohol deprivation: often, your “inside knowledge” will sound the first warning before any outside observer notices unusual symptoms. If you even suspect something needs attention, ask for help immediately.)

2. Delirium tremens are a real threat.

Though some people apply the term to any case of alcoholic “shakes,” actual “DTs” affect only about 5% of detoxers. The heaviest and longest-term drinkers are at greatest risk, and other contributing factors include age, malnourishment and previous bad reactions to alcohol deprivation—but no one can afford to assume “it won’t happen to me.” If not promptly treated, DTs have up to a 35% chance of killing the detoxer.

Symptoms of delirium tremens usually appear 48–96 hours after the last drink (though cases have occurred as late as the tenth day of abstinence) and include:

  • Seizures (often emerging in the first 12–48 hours of abstinence to presage full-blown DTs—or they may be the only symptoms)
  • Shaking all over
  • Inability to think clearly
  • Violent mood swings and agitation
  • Visual or tactile hallucinations, and/or delusions
  • Rapid or irregular heartbeat
  • High blood pressure
  • High sensitivity to light, sound or physical contact
  • Becoming extremely fatigued, often to the point of passing out or falling into deep sleep

A detox patient who develops delirium tremens will have to have vital signs carefully monitored until the symptoms pass, which can take a week or more. If violent agitation occurs, the patient may be given a sedative.

3. Treatment at an alcohol detox center will involve keeping you comfortable and monitoring you for dangerous symptoms.

Whether or not they turn life-threatening, alcohol-detox symptoms are unpleasant enough (and affect rational thinking enough) that it pays to avoid anything that might make you feel even worse. Treatment centers will typically assign you a private room with low lighting to minimize the risk of unneeded stimulation that might increase uneasiness or mood swings. Human contact will likely be limited (let your treatment providers know how much or how little attention you typically feel comfortable with). Stay in bed as much as you can (face down or propped up to reduce risks from vomiting), even if you feel the urge to get up and move about—you could fall and injure yourself.

Keeping you hydrated and well-nourished (malnutrition is a common effect of alcoholism) will also be a primary concern. Let the center know if you have any diet restrictions, but do try to eat or drink everything you’re served—adequate food intake may reduce the risk of your withdrawal symptoms turning serious. If you’re having difficulty keeping food down, inform your medical supervisor—they may need to put you on intravenous feeding.

4. Alcohol detox medication may be administered to ease withdrawal effects.

If you do develop serious withdrawal symptoms, it’s a sign that your body is struggling hard to adjust to the loss of alcohol’s regular depressant effect. A sedative or antianxiety medication, typically a benzodiazepine, may be administered to help your body ease back into generating its own natural relaxants. Be warned that “benzos” are themselves extremely addictive, and should never be administered for long periods or without a licensed doctor’s prescription. (A similar problem exists with opiate detox: heroin was originally considered a treatment for morphine addiction, and today, heroin replacement detox centers are full of patients who became dependent on the very drugs originally prescribed to treat heroin addiction.) Inform treatment staff in advance if you or anyone in your family have ever had problems with benzo dependence, or if you have concerns about taking detox medication at all.

5. The acute stage of alcohol detox takes about a week, but doctors recommend a 90-day period of additional care.

The full acute-detox (withdrawal) stage for alcohol typically manifests in three stages, each with its own symptoms:

  • Stage 1: Begins as early as eight hours after the last drink and lasts up to three days. Symptoms include insomnia, nausea and strong feelings of anxiety.
  • Stage 2: Emerges 24–72 hours after the last drink and is likely to present the first serious symptoms, including rises in temperature and blood pressure, erratic heart rate and mental confusion.
  • Stage 3: Typically begins in the third or fourth day of sobriety and presents high risk of hallucinations and other extreme mental/emotional confusion. Temperature remains high: risk of seizures and other delirium-tremens symptoms increases.

After five or six days, symptoms begin to abate as your body adjusts to life without alcohol.

Even after you feel physically functional again, though, you aren’t fully “detoxed.” Physical withdrawal symptoms sometimes recur periodically for months; cravings for “a drink” almost certainly will. And if you return to your old life’s stresses without new methods for coping with them, the temptation to relapse into alcoholism will be near impossible to resist. For these reasons, treatment supervisors will recommend up to three months of inpatient care during which you can be observed for late-onset symptoms and, even more importantly, receive therapy and assistance for planning a long-term sober future.

Once official treatment is complete, there’s still a rest-of-life stage for which you should join Alcoholics Anonymous or another support group to get accountability for staying sober. Don’t let regular attendance slide, even after you’ve been “clean” for months or years. Because in one sense, you never fully detox from alcohol addiction: the risk of cravings being reactivated will continue to lurk in the back of your brain, probably for life.

Knowledge of your weakness needn’t keep you from making the most of your strengths, though. Like sobriety, life is to be taken and savored one day at a time.

Inland Detox, the top drug and alcohol rehab provider in southern California, is located two hours southeast of Los Angeles in the Temecula Valley. If you or a loved one are struggling with alcohol addiction, please call (888) 739-8296 to learn how we can help.