Alcohol Dependence and Withdrawal
If you are dependent on alcohol, there is a chance you will experience alcohol withdrawal when you stop. This can be painful and may even become life-threatening.
Read on to understand the different types of alcohol dependence and everything you need to know about alcohol withdrawal.
Alcohol dependence happens when we start to rely on alcohol. There are two types of alcohol dependence: psychological dependence and physical dependence. Let’s take a look at precisely what they mean.
When someone is psychologically dependent on alcohol, they have an emotional or mental attachment to it. Drinkers with a psychological dependence feel compelled to drink, and if they do not get alcohol, they can become overwhelmed and emotional.
This dependence is caused by someone repeatedly using a substance to make them feel a certain way or to block out thoughts or emotions.
A woman with a high-powered job might come home after a long day and drink half a bottle of wine every night. A man might go out with friends and have a few drinks to unwind every night after work. These are both examples of psychological dependence.
People without addictive personalities may find it easy to break this kind of dependence. They may realise that they are damaging their body and mind, that their hangovers are getting worse, or their boss may comment on their poor performance at work. After this happens, some people may stop or moderate drinking and not look back.
For people who have addictive tendencies, putting the booze down may not be so easy. Rather than stopping drinking when the warning signs start to show, they may begin to hide drinking, so that others don’t notice that they are dependent. This is a dangerous place to be in, and can easily lead to the next stage of dependence, physical dependence.
Physical dependence on alcohol
When someone has been psychologically dependent on alcohol for a long time, they can develop a physical dependence. This means that a person must drink, otherwise, they will experience alcohol withdrawal.
Once someone reaches this stage, things can spiral out of control pretty quickly. A person with physical dependence on alcohol will experience withdrawal whenever they stop drinking. They will need to drink every day to feel “normal”.
This constant use of alcohol leads to an increasing need to hide their consumption. Someone with a physical dependence to alcohol may hide a bottle of vodka in their car, or in their desk at the office. They may start frequenting a wide variety of off-licences, so the people working there do not realise they have an Alcohol Use Disorder.
As physical dependence worsens, a person's tolerance to alcohol also increases. They will need to drink increasing amounts of alcohol to stave off alcohol withdrawal symptoms. Their health begins to deteriorate, they miss responsibilities, lose friendships, have marital issues, get fired and may eventually become homeless.
Of course, not every story of physical dependence is like this, and many people manage to pull themselves out of the slippery slope before their lives are completely destroyed.
Length of alcohol withdrawal symptoms
Alcohol withdrawal symptoms start to emerge within hours after the last drink of alcohol. They worsen steadily before peaking at around two days after alcohol consumption has ceased.
The duration of alcohol withdrawal varies depending on the severity of the addiction and other factors involved. However, most people experience withdrawal symptoms for a few days to a week or so.
Treating alcohol withdrawal at home
If you want to do an alcohol detox and think you will only experience mild alcohol withdrawal symptoms, it is okay to do a home detox.
There are a few things you can do to make a home alcohol detox easier:
- Acquire painkillers. When you go through withdrawal, your body will ache and you will probably have a headache. Having non-addictive painkillers on hand such as ibuprofen and paracetamol will help alleviate some of the discomforts.
- Drink plenty of water. The diarrhoea and vomiting that you may experience will cause you to get dehydrated. The amount that you drink depends on how much water you are expelling from your body. Try to stay well hydrated by drinking a minimum of 2 to 3 litres a day.
- Take electrolytes. You will also lose electrolytes when you are in withdrawal. Taking electrolytes drinks will regulate nerve and muscle function, hydrate the body and balance your blood pressure.
- Rest. Withdrawal is hard on your body, so make sure that you do very little when you are detoxing. If you have children, if possible, should seek out childcare for a few days while going through the worst of it.
- Sleep. You might not get much sleep when you are in alcohol withdrawal, but remember that every little helps. Don’t despair if you have insomnia. When your body is tired enough, you will sleep.
- Eat. You may not feel like eating much, but it is essential to eat something to keep your energy levels up and sugar levels balanced. If you cannot get down solid food, try eating soups and take a multivitamin.
Severe alcohol withdrawal symptoms
The most severe alcohol withdrawal symptoms that someone can experience are known as “Delirium Tremens,” or DTs.
The DTs happen to between 3% to 5% of people who stop drinking heavily. The DTs can be fatal, so if you feel like you may experience them, you must seek professional help before attempting a detox.
Symptoms of delirium tremens include:
- Extreme agitation
- Extreme confusion
- High blood pressure
Your chance of experiencing DTs increases if you have experienced them before, are prone to seizures, were taking drugs while drinking, or have been drinking for more than ten years.
Post Acute Withdrawal Symptoms
Post-acute withdrawal symptoms (PAWS) are symptoms that can occur after someone stops drinking alcohol. These symptoms can include anxiety, depression, irritability, insomnia, and fatigue. PAWS can last between a few months to two years. While they are not as severe as the acute withdrawal stage, they can be unpleasant enough to cause relapse in newly sober people. If you experience post-acute withdrawal symptoms it is important to seek out medical help and ongoing support.
Why do people get Post Acute Withdrawal Symptoms?
PAWS results from changes in brain chemistry that happen when someone stops drinking. Alcohol abuse can cause changes in the levels of some chemicals in the brain, and it may take some time for these levels to return to normal. Alcohol addiction can also cause substantial and lasting changes to the brain. However, many of these can be reversed with continued abstinence and reprogramming, achieved through therapy and an alcohol treatment programme.
How long do Post Acute Withdrawal Symptoms last?
In general, PAWS will last for a few months to a couple of years after someone stops drinking. The severity of the symptoms will also vary, depending on how long and how much they were drinking, whether they have pre-existing physical and mental conditions and their levels of stress. Some people may only experience mild symptoms, while others may have more severe symptoms that make it difficult to function.
How can PAWS symptoms be treated after alcohol withdrawal?
There are some things that can be done to help reduce the severity and length of the symptoms. These include:
Get plenty of rest and sleep.
Alcohol addiction is tough on the body and mind. When you get sober, it is time to take it easy for a while. Getting some downtime and ideally, 6 to 8 hours of sleep a night will help speed up the recovery process.
Eat a healthy diet.
When you were drinking, you may not have had the most nutritious diet. In sobriety, it is important to eat plenty of fruits and vegetables and get enough healthy oils and fats in your diet.
It is also important to make sure that you replenish the vitamins and minerals that become depleted during alcohol addiction. Alcohol depletes the body’s stores of vitamin B12, and being under stress can reduce levels of trace minerals in your body. Getting B12 injections and taking trace mineral drops can help you to feel better, faster.
Exercise helps to get your body working well, and it also assists with the mind. When you have PAWS, getting a few sessions of strenuous exercise in can have you feeling better right away. It also has the benefit of increasing the quality of your sleep.
Limiting stress in early recovery is an important part of keeping PAWS to a minimum. Remember to focus on yourself. Now is the time to work on your boundaries.
During early recovery, you should get plenty of “me” time. Try and set aside a little time each day when you can be by yourself and process the day.
Participate in therapy, do step work and attend meetings.
If you have anything on your mind, it can contribute towards PAWS. Any of these will help you to feel a little lighter, which will in turn alleviate some of the PAWS symptoms that you experience.
If you or someone you know is experiencing PAWS, it is vital to seek professional help. PAWS can be a challenging experience and can lead to relapse if left untreated.
Alcohol withdrawal in a professional environment
If you feel like you will experience severe alcohol withdrawal symptoms, please seek out professional help and do not attempt to detox yourself.
Hospitals and most rehabilitation centres have staff who are trained to treat patients who are experiencing DTs and severe alcohol withdrawal. They can monitor your vital signs and will know when something is wrong.
Safe treatment includes Medication Assisted Treatment (MAT), which involves prescription drugs that reduce the risk of fatal seizures. The most common medications used are benzodiazepines such as Diazepam and Chlordiazepoxide (librium).
How to quit drinking
If you drink large amounts over a long time, eventually you will encounter alcohol withdrawal. It is inevitable. Once you start experiencing this when you stop drinking, it can make it more challenging to quit booze.
If you know that you have a problem with alcohol, you do not need to wait until you start feeling withdrawal to stop drinking. Help is available.
If you are likely to experience severe withdrawal, going to a hospital can help. Staff at a hospital can help you to detox by providing you with the medication that you need. There will not be any program of recovery, and you will leave as soon the worst of the detox is over.
If you decide to detox at the hospital, you should follow this up with a programme of recovery. Without looking at the root problems of why you were drinking, it will be unlikely that you can stay stopped.
Going to rehab means that you can go through a complete medical detox and it also provides you with the tools you need to stay sober in the long term. At most rehabs, you will do one on one and group counselling. This will help you to deal with the issues that kept you drinking to dangerous levels.
Rehab is the most convenient and effective way of getting sober, but it is also expensive and time-consuming. Most people go to rehab for a minimum of one month.
Recovery groups like Alcoholics Anonymous (AA) and SMART Recovery can give you the tools you need to quit drinking. There are meetings worldwide, where members share their experiences to other people who attend.
AA also involves going through the 12 steps, a programme of recovery that is designed to heal you from the inside - out and create a sober and happy life.
SMART Recovery also offers a science-based programme of recovery
Counsellors are not trained to help you through withdrawal, but once you have been through it, they can help you look at the reasons why you were drinking.
Once you have detoxed, you can consider going to therapy as part of your treatment programme. It is important to get to the root causes of alcohol addiction and address the reasons why you drank.
Severe alcohol withdrawal can kill
Alcohol use can cause dependence. If you drink for long enough and in large enough amounts, you will become physically dependent and experience withdrawal when you stop. Severe withdrawal can kill. Whilst it is rare that this happens, it is something that can be easily prevented with the right medical help and support
You can never seek help too soon, only too late
It is never too soon to start seeking out help for a problem with alcohol. Alcohol support groups such as AA and SMART Recovery are literal life savers. You do not even have to have stopped drinking to attend, but you do need a desire to stop.
If attending meetings is something you are interested in exploring, you can join our online meetings within our platform. You can also connect with other like-minded members and build your own . All you have to do is join and ask for help.
- Alcohol dependence and mental health: https://ukhsa.blog.gov.uk/2020/11/17/alcohol-dependence-and-mental-health/
- Post-Acute Withdrawal Syndrome (PAWS): https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS
- Treatment for Alcohol Problems: Finding and Getting Help: https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol-problems-finding-and-getting-help
- Understanding alcohol use disorder https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
- Delirium tremens. (2022, September 8). In Wikipedia. https://en.wikipedia.org/wiki/Delirium_tremens
- Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers https://pubmed.ncbi.nlm.nih.gov/16877950/