What is Alcohol Withdrawal & Treatment Options
Alcohol withdrawal is not as black and white as most people think. Really, when we talk about alcohol withdrawal, it is important to consider a couple of things: 1) Physical withdrawal from the substance; 2) Mental/Emotion withdrawal from not having the substance to alter one’s perception of reality; and 3) Overall physical health. Physical withdrawal is dependent upon how physically addicted someone is to the substance, meaning how much alcohol they have been consuming and for how long as well as other medical conditions which may be affected by alcohol withdrawal. A typical withdrawal period for a normatively healthy person who is younger (age range 20’s to mid-30s) is 3 days minimum from the last drink they finished. The longer period of time a person has been drinking, the more you have been consuming, the greater the damage done to every organ in the body, the more addicted/dependent you become, and the longer the withdrawal can take. This time period can range anywhere from 3 days to 7 days.
During withdrawal, emotions most likely will feel very out of control and uncomfortable. Most people experience mood swings, irritability, anger, even rage, restlessness, high levels of anxiety that can lead to panic attacks, excessive crying, poor sleep or an inability to sleep, nightmares, feelings of boredom, isolation, loneliness, feelings of guilt, remorse and shame will likely appear. Alcohol withdrawal can look a lot like the symptoms of depression and various anxiety disorders.
Once physical withdrawal ends the intensity of the emotions will likely increase since there is no longer being employed as a way numb or disconnect from them. Once a person begins to be more clear-headed and think more lucidly, they can experience a deepened depression and heightened feelings of guilt and remorse over the choices made, harm caused, friends or relationships lost, and perhaps the loss of a job or marriage has also occurred and now they are facing the reality of the consequences of their drinking for the first time without being able to disconnect and forget about it with more alcohol. There are also others who experience what is known to be the “pink cloud” where they feel extremely happy, joyful, elated and relieved from the need for alcohol. This period doesn’t last forever and what can follow is the aforementioned depressive-like and anxiety-filled state of being.
Treatment for Alcohol Use Disorder
The most effective treatment for alcohol use disorder is not just one type of treatment but a combination of treatments working in unison. The Combining Medications and Behavioral Interventions for Alcohol Dependence (COMBINE) study showed that no one treatment option was as effective alone or for each individual person, and participants show improved outcomes with a combination of more than one treatment and including medication management.
First, it is imperative behavioral changes occur and programs such as an AA or 12-step model of recovery combined with counseling can be exceptionally beneficial. Behavioral treatments share certain features, which can include developing skills needed to stop drinking, building a strong social support system, working to set attainable goals, and coping with and/or avoiding triggers that can lead to relapse. Medication Assisted Therapy (also known as “MAT”) offers prescribed directly for alcohol dependence that is FDA approved and include: naltrexone which can help people reduce heavy drinking, acamprosate makes it easier to maintain abstinence, disulfiram blocks the breakdown (metabolism) of alcohol by the body, causing unpleasant symptoms such as nausea when combined with alcohol. It is important to remember that not all people will respond to medications, but for a subset of individuals, they can be an important tool in overcoming alcohol dependence.
What are the different options for treatment?
There are various levels of care for treatment: starting with the least restrictive is outpatient (think of this as, you sleep at your own home). This includes AA and other 12-step meetings which take place daily and are available in person in many areas in the USA and abroad as well as online, individual counseling, family and group counseling which generally take place on a weekly basis. The next level of care, still outpatient, is known as Intensive Outpatient of “IOP,” which is a combination of individual, family, and group counseling as well as medication management if needed. IOP’s generally take place 3 days a week for several hours per day. The last outpatient setting is called Partial Hospitalization Programs (PHP’s) are very similar to the structure of IOP but meetings take place daily, anywhere from 5-7 days/week. The most contained setting is an inpatient setting (this is where you can think of it as sleeping away from home) which includes medical detoxification (also known as “detox”), rehabilitation, and residential levels of care. Medical detox is sometimes necessary as alcohol is a physically addictive substance and withdrawal symptoms are on a wide spectrum and can include elevated heart rate, elevated blood pressure, sweating, vomiting, nausea, dizziness, insomnia, irritability, depression, anxiety, and seizures. It’s important to have a physician assist you with monitoring the withdrawals symptoms in order to assess need for medical intervention. Alcohol withdrawal can be fatal if not done safely under medical supervision. Residential and inpatient rehabilitation can range anywhere from 7 days to 90 days.
What will treatment accomplish?
One of the first things that will occur in a treatment setting is establishing a plan of care or a treatment plan. A treatment plan is often made, in part, as a collaborative process between the provider/treatment facility and the individual that guides recovery and outlines the therapies you will participate in and the reachable goals desired as well as the action an individual will take to recover. Some goals may include identifying triggers that lead to drinking alcohol and will include strategies to avoid or manage them, developing a support system, and manage physical symptoms such as withdrawal and mood or sleep issues. Objectives are also part of the treatment plan and are small, more specific accomplishments that can assist in moving toward a goal. An objective is also simple to achieve, even if it’s not easy.
Lastly, alcohol use dependence will likely require a lifetime of treatment for success. It is more of a developing a way and manner of living so that a person no longer has to drink. There is hope as many have recovered.
