My brother-in-law, Mike, who works as a nurse in California’s wine country, recently told me that one of his patients reported, during a post-surgical health interview, that normally he drinks “just a bottle of wine a day.” The admission made Mike worry that this patient might go into alcohol withdrawal, which could cause him to die while recovering. The hospital staff released the patient early so he could go home, drink, and thus avoid withdrawal symptoms, including possibly delirium tremors (the DTs).
“The problem is that alcohol withdrawal can kill you,” Mike explained. “Withdrawal from most any other drug won’t be fatal, not even from heroin. You’ll suffer, but you won’t die. But alcohol withdrawal is much more dangerous.”
Now, there is certainly some debate as to whether a bottle of wine a day is too much,1 Ben Yakas. “Go Ahead And Drink A Bottle Of Wine A Day, Says Alcohol Scientist.” gothamist. Apr 19, 2014. (Accessed 12 Oct. 2018.) http://gothamist.com/2014/04/19/go_ahead_and_drink_a_bottle_of_wine.php but, regardless, Mike’s story struck me on several counts. First, his patient hadn’t a clue that his alcohol addiction might be at the level where he could suffer from severe withdrawal upon quitting. He considered himself a wine connoisseur, not an alcoholic. Like this patient, so many people drink regularly without realizing that they’ve crossed a safety threshold. The USDA and Centers for Disease Control (CDC) suggest that moderate drinking for women is one drink daily (no more than seven a week); for men, two drinks.2 https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking Heavy drinking is eight or more drinks per week for women, and 16 plus for men.3 https://www.cdc.gov/alcohol/faqs.htm
Anyone who drinks heavily, according to the above definition, may experience symptoms of alcohol withdrawal upon stopping. The more a person drinks and the longer they’ve been drinking, the more likely that they’ll go through withdrawal, and the more severe their symptoms likely will be. A woman who has just eight drinks a week probably won’t endure severe withdrawal, but at eight drinks a day, dangerous withdrawal is probable. It’s key to note, though, that vulnerability to withdrawal is highly individual. Some people have no symptoms, while others land in the hospital. The severity of withdrawal symptoms depends on overall health, sensitivity to alcohol, time period over which heavy drinking has occurred, age (elderly drinkers are more susceptible), stress levels, family history, eating patterns, and the amount of alcohol consumed. If you’ve had a previous withdrawal experience, you’re more likely to go through another even if you’re drinking less this time. Binge drinkers whose binges last two weeks or longer are at particular risk. Also, concurrent use of other drugs enhances the probability of going through withdrawal.
Withdrawal occurs because the nervous system has adjusted to the depressive effects of alcohol and comes to depend on those effects. Alcohol slows down brain function and nervous system functioning, and when you are drinking, the brain and nervous system work overtime to compensate for the depressive effects.4 “What is Alcohol Withdrawal?” WebMD. 12 October 2018. https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#1 When you stop drinking, the system is still working overtime, but without the dampening effects of alcohol. Also, when you quit drinking, your body tries to rid itself of the toxins that have built up, which also contributes to symptoms.
Withdrawal symptoms fall into several categories and may occur over a prolonged period of several weeks. Symptoms usually begin within two to eight hours after stopping drinking, but they can start later.5 “Understanding the Dangers of Alcohol Withdrawal.” 16 August 2012. Addiction.com. 9 October 2018. https://www.addiction.com/4060/alcohol-withdrawal-dangers/ The symptoms typically are at their worst anywhere from 24 to 72 hours after they begin and usually begin to taper off after five to seven days.6 Buddy T and Fogoros, Richard MD. “Common Alcohol Withdrawal Symptoms.” 26 September 2018. Very Well Mind. 11 October 2018. https://www.verywellmind.com/symptoms-of-alcohol-withdrawal-63791 Those who develop delirium tremens (DTs) may not incur these symptoms until three to five days after stopping drinking.7 “Alcohol Dependence and Withdrawal.” 4 October 2018. Drugs.com. 11 October 2018. https://www.drugs.com/cg/alcohol-dependence-and-withdrawal.html
Mild symptoms, also called Stage 1 symptoms, include an array of psychological and physical issues such as anxiety, insomnia, nausea, abdominal pain and/or vomiting, loss of appetite, fatigue, tremors, depression, bad dreams, shakiness, foggy thinking, mood swings, and heart palpitations. These are the symptoms that manifest first and are usually unpleasant enough to drive the person to take another drink.
Stage 2 symptoms include raised blood pressure, sweating, increased respiration rate, fever, irregular heartbeat, mental confusion, and more severe mood disturbances.
Stage 3 is where things get dangerous. These symptoms, called Delirium Tremens, or DTs, usually manifest two to four days after quitting drinking, after all, alcohol has left the system. Only a small percentage of those withdrawing get DTs, which is fortunate because DTs are fatal in up to 15 percent of those who develop them. Delirium tremens is a severe form of alcohol withdrawal. It involves a rapid onset of confusion along with sudden and severe mental or nervous system changes. The person may have seizures that can last for hours or vivid hallucinations that can last days, and they typically come on without warning. Other symptoms include skyrocketing blood pressure, out-of-control fast pulse, profuse sweating, fever, shallow breathing, dehydration, extreme confusion, irrational behavior, and unconsciousness.
Again, not all drinkers experience alcohol withdrawal syndrome, but of those who do, about 60% will have multiple seizures without proper treatment. Thirty to 40% of those patients will eventually develop DTs, and of these, at least one in 20 will die, particularly among those who don’t get medical care. Because it’s such a health risk, it may be a good idea to have medical supervision when undergoing detox, particularly for very heavy users. Another advantage of having medical support is that it may lessen the possibility of relapse, since many find withdrawal so miserable that they end up drinking again to end the agony.
Even if you decide to detox at home, it’s imperative to have someone around to monitor the process in case you develop more severe symptoms.
In some cases, medical professionals will suggest gradually weaning off alcohol instead of cold-turkey quitting. In others, they may prescribe various medications and supplements that can reduce symptoms of withdrawal. One of the more common medical withdrawal protocols uses Benzodiazepine tranquilizers, such as Valium or Ativan, to help dampen nervous system overactivity. Because users can get addicted to such tranquilizers, creating a new problem, prescriptions must be short term. Other common drugs used in detoxing include anti-seizure medications, anti-nausea medications, antipsychotics, and blood pressure medications.
From a natural health point-of-view, it’s essential to eat in a way that promotes elimination of toxins when quitting. Drinking plenty of water and warm liquids and getting light proteins helps during alcohol withdrawal, as does supplementing with magnesium and the full range of B-vitamins including thiamine and folic acid. Natural relaxants such as valerian and chamomile may provide support, as well as anti-inflammatory herbs such as turmeric and cayenne. Digestive enzymes may also be useful. In fact, so many herbs, vitamins, and enzymes can support alcohol detoxification that an entire blog could be written on the subject. In the meantime, an internet search of “natural alcohol detox” will yield plenty of information.
The bottom line is that if you drink regularly, it would be wise to assess if you’ve become a heavy drinker. If you don’t want to quit, remember that you could not only find yourself in the hospital for various health problems, as did my brother-in-law’s patient, but you could also be at risk of developing alcohol withdrawal symptoms. If you do decide to quit, be wise and get support to help you through the process.
References [ + ]
|1.||↑||Ben Yakas. “Go Ahead And Drink A Bottle Of Wine A Day, Says Alcohol Scientist.” gothamist. Apr 19, 2014. (Accessed 12 Oct. 2018.) http://gothamist.com/2014/04/19/go_ahead_and_drink_a_bottle_of_wine.php|
|4.||↑||“What is Alcohol Withdrawal?” WebMD. 12 October 2018. https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#1|
|5.||↑||“Understanding the Dangers of Alcohol Withdrawal.” 16 August 2012. Addiction.com. 9 October 2018. https://www.addiction.com/4060/alcohol-withdrawal-dangers/|
|6.||↑||Buddy T and Fogoros, Richard MD. “Common Alcohol Withdrawal Symptoms.” 26 September 2018. Very Well Mind. 11 October 2018. https://www.verywellmind.com/symptoms-of-alcohol-withdrawal-63791|
|7.||↑||“Alcohol Dependence and Withdrawal.” 4 October 2018. Drugs.com. 11 October 2018. https://www.drugs.com/cg/alcohol-dependence-and-withdrawal.html|