What to Expect During Alcohol Detox and Who Can Help You Get Sober

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What Does Alcohol Detox Involve?

Alcohol detoxification has no one-size-fits-all approach. It varies according to patient needs and institutional policies and protocols.²

Some examples of alcohol detox practices include:

Social support programs for abstinence
Counseling
Close monitoring and symptom prevention
Medical detoxification
Inpatient rehabilitation

Alcohol Withdrawal

Alcohol withdrawal refers to a physiological response to the absence of alcohol after regular and long-term use.

Alcohol withdrawal occurs between 6 and 24 hours after your last alcoholic drink.³ It can lead to dangerous physiological effects if not managed and usually requires clinical care. Symptoms of alcohol withdrawal can range from mild to severe.

Anxiety
Irritability
Dehydration
Sweating
Insomnia
Confusion
Lack of mental clarity

Tremors
Nausea and vomiting
Abnormal heart rhythms
Anxiety and irritability
Hallucinations
Seizures

Timeline of Alcohol Withdrawal

Withdrawal symptoms can vary from person to person, but the general timeline is as follows, with only more severe cases evolving into the later, more serious stages of withdrawal:⁷

6-12 hours after last drink: Anxiety, headache, upset stomach, restlessness.
12-24 hours: Hallucinations (can be auditory, visual, or tactile).
24-48 hours: Seizures.
48-72: Delirium tremens, fever, high blood pressure, fast heart rate, sweating.

Delirium Tremens

You may have heard people use the term “the DTs” to describe withdrawal. This stands for delirium tremens, the most severe form of alcohol withdrawal.It is a life-threatening condition that requires immediate treatment and hospitalization.

A small percentage of people who go through alcohol withdrawal experience delirium tremens. If you have a history of previous alcohol withdrawal, whether treated or not, you are at higher risk of having a more severe withdrawal in the future.³

Where to Detox from Alcohol

A qualified provider should assess your need for detoxification when you quit drinking. Your primary care provider may be able to connect you to local resources for detoxification and treatment if they believe you are at-risk for severe withdrawal symptoms. Rehab centers often have detoxification programs that are typically offered in inpatient and outpatient settings, depending on the severity of your addiction.

What Type of Detox Program Do You Need?

In most cases, figuring out which detox program you need involves a brief review of your drinking history and an appraisal of your current state.

Today, many detox programs rely on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) to determine what may be the best detox program for you. This scale rates your symptoms and provides a score that guides clinical decision-making about your risks related to withdrawal.⁵ You will also be assessed for any co-occurring medical or mental health concerns that may complicate your withdrawal.

Detox from Alcohol Without Medication

Individuals with mild symptoms may remain at home or participate in a medically supervised program that can include inpatient or outpatient care. Not everyone requires medication for alcohol detox.

Some non-pharmacological measures that can be extremely helpful during detox include:

Nursing supervision
Reduced sensory stimulation
Reassurance measures
Reality orientation
Social peer support
Relapse prevention counseling

These non-pharmacological treatments are the “first line” treatments for alcohol withdrawal.⁶

Detox from Alcohol with Medication

Individuals with moderate to severe addiction, who have a history of previous relapse or have experienced seizures or delirium tremens, often require a medically supervised detox program. A medically supervised program offers close monitoring and medication support, if needed. Some medications that are commonly used to ease withdrawal symptoms include:

Sedatives
Anti-nausea medication
Anti-seizure medication
Muscle relaxers
Intravenous fluids
Vitamin and electrolyte supplementation

While going through alcohol withdrawal, medical staff will closely monitor the stability of your vital signs and overall physical and mental condition. Nutritional supplementation and IV fluids are often used. If you have a history of problematic drinking, you may have nutritional deficiencies and electrolyte imbalances that improve through vitamin and electrolyte infusion.

In very severe cases, such as liver disease or delirium tremens, high-acuity care, like the intensive care unit, may be indicated.

Who Needs Medical Detox?

The extent to which you are at risk for withdrawal varies among individuals. Factors that may influence your need for medical detoxification include:

How much and how often you drink
How long you have been drinking
History of previous withdrawal
Your age
Your health status and health history

Chronic overuse of alcohol increases both the likelihood and severity of withdrawal.² Although you may only experience mild to moderate symptoms, the course of alcohol withdrawal can be very unpredictable and, in some cases, dangerous.

It is advisable to see your doctor if you’re having concerns about going through alcohol withdrawal. Call 800-948-8417 Sponsored now.

Drinking After Detoxification

Part of the alcohol detoxification process includes honest conversations with caregivers regarding the extent of your drinking and its effect on your life. After detoxification, abstinence from alcohol is encouraged to avoid the increased risk of more severe withdrawal in the future.

Other Programs to Help You Stay Sober

Ever-increasing resources are available today for issues related to alcohol and substance use, including:

Counseling
Group program (e.g., 12-step programs)
Inpatient rehab
Outpatient rehab
Primary care management

For the acute withdrawal phase, hospitalization is usually recommended for at least 24 hours to initiate detoxification if you have a substantial history of drinking.³

You can find information about local detox programs through your insurance provider or primary care provider, as well as via multiple local and federal hotlines, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator. You can also call 800-948-8417 Sponsored to discuss detox/rehab options.

References

National Library of Medicine. (2020). Alcohol withdrawal.
Hoffman, R.S. & Weinhouse, G.L. (2021) Management of moderate and severe alcohol withdrawal syndromes. In S.J. Traub & J. Grayzel (Eds.) UpToDate.
US Department of Health and Human Services: Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol[Brochure]. Rockville, MD: Author.
Bayard M, McIntyre J, Hill KR, Woodside J Jr. (2004) Alcohol withdrawal syndrome. Am Fam Physician. 69(6):1443-1450.
Sullivan, J.T.; Sykora, K.; Schneiderman, J.; Naranjo, C.A.; and Sellers, E.M. Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction 84:1353-1357, 1989.
Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543