A period of detoxification is a standard first step toward recovery for anyone affected by alcoholism. Addiction experts break the detox process down into three separate stages[i]: evaluation, stabilization and preparation for active alcohol treatment.
No one knows in advance exactly how long it will take to complete these three stages. Some people make it through detox in a matter of days, while others may need weeks to recuperate from lingering effects of alcohol withdrawal.
During the evaluation stage, doctors assess the severity of drinkers’ alcohol problems and create a plan designed to help the detoxification process go as smoothly as possible[ii]. Standard steps used to gather the necessary information include:
- Checking current blood alcohol content
- Taking the time needed to reduce blood alcohol levels well below legal drunkenness
- Checking for the presence of major physical health problems
- Checking for the presence of suicidal thoughts or other major psychiatric problems
- Looking for a history of previous alcohol withdrawal
- Looking for a history of withdrawal complications such as seizures or delirium tremens (the DTs)
- Gauging the severity of current withdrawal symptoms
- Discounting other factors that could mimic the effects of alcohol withdrawal
To gauge the severity of withdrawal, doctors commonly rely on a tool called the revised Clinical Institute Withdrawal Assessment for Alcohol scale (known as CIWA-Ar)[iii]. People with a CIWA-Ar score of eight or less are suffering from mild withdrawal symptoms. People with a score of anywhere from nine to 15 have moderate symptoms, while people with a score of 16 or higher have severe symptoms. As a rule, severe withdrawal leads to a longer detox process and greater risks for seizures and the DTs.
Alcohol Detox Stabilization
Stabilization is the core of alcohol detoxification. During this stage, the effects of alcohol withdrawal run their course until patients reach a steady, alcohol-free medical state. To reach this state, people with mild withdrawal symptoms may need nothing more than basic support in the form of:
- IV (intravenous) fluids
- Regular monitoring of vital signs
- Vitamin supplementation
However, to make it through withdrawal, people with moderate or severe symptoms may require more active assistance in the form of medication.
The standard medication option for people going through alcohol detox is a group of prescription sedatives called benzodiazepines[iv]. Benzodiazepines help doctors accomplish two important goals. First, they help ease anxiety and other unpleasant withdrawal symptoms. In addition, medications in this category help reduce the chances that detoxification participants will experience seizures or delirium tremens.
Doctors may also use non-benzodiazepine medications. Common options include:
- Adrenergic drugs
- GABA agonists
Whenever a doctor oversees the detoxification process, that process is referred to as medically assisted detox[v]. Experts at the National Institute on Drug Abuse and other public health agencies view this medical oversight as standard for all but the mildest forms of alcoholism. That’s true, in large part, because of the unpredictable nature of alcohol withdrawal.
While under a doctor’s care, people going through alcohol detox retain a safety net that protects them from harmful outcomes. On the other hand, people who quit drinking on their own “cold turkey” lack this protection. In turn, they leave themselves at risk for unforeseen or unrecognized complications. Medical detox can take place on an inpatient or outpatient basis.
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Preparation for Alcohol Treatment
Not everyone who detoxes from alcohol will follow-up by entering a treatment program. This is unfortunate, since people who fail to enter treatment have a greater chance of relapsing. In fact, addiction specialists view detox as just the first step in a longer road to eventual recovery. For this reason, detoxification facilities strongly encourage their patients to make plans for enrollment in an addiction treatment program. To make the transition into treatment easier, many facilities provide lists of licensed programs or even help make the arrangements needed to enroll in active treatment.
How Many Days to Detox from Alcohol?
There is no way to set a precise timeline for the number of days needed to detox from alcohol. However, it is possible to make some general predictions. Most people will enter withdrawal within six to 24 hours after they stop drinking, experience the worst of their symptoms in three to five days, and complete the withdrawal process within five days to a week[vi].
Some people may take a shorter period to complete detoxification. However, others may take longer, and in some cases, withdrawal may continue to exert its effects on the brain and body for 14 days or more.
In addition, a significant number of people detoxing from alcohol will develop a condition called post-acute withdrawal syndrome (PAWS) or protracted withdrawal[vii]. In a person with PAWS, the underlying brain changes associated with alcoholism remain a powerful force for months, or even up to one year, after alcohol use comes to an end. A short list of the possible lingering symptoms includes:
- Sleep apnea
- Depressed or anxious moods
- Unexplained mood swings
- Unusual tiredness
- Poor mental focus
- A reduced ability to think clearly
- Unexplained pain or other physical problems
- Lack of sexual interest
Eventually, these symptoms will come to an end. Doctors can provide crucial assistance by doing such things as:
- Prescribing a protracted withdrawal medication called Campral (acamprosate)
- Encouraging an increase in physical activity
- Checking for the presence of any co-existing mental health problems
- Making sure that any sleep problems do not stem from another source
Summit Detox helps patients safely detox from drugs and alcohol in a comfortable and medically supervised environment. Once the detoxification process is complete patients can transfer to an addiction treatment facility, such as Transformations Treatment Center, for further treatment.
[i] Substance Abuse and Mental Health Services Administration: Treatment Improvement Protocols – Detoxification and Substance Abuse Treatment: 1. Overview, Essential Concepts and Definitions in Detoxification https://www.ncbi.nlm.nih.gov/books/NBK64119/
[ii] Journal of General Internal Medicine: Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification
[iii] American Association of Family Physicians – American Family Physician: Alcohol Withdrawal Syndrome
[iv] Journal of Clinical & Diagnostic Research: Alcohol Withdrawal Syndrome – Benzodiazepines and Beyond
[v] National Institute on Drug Abuse: Understanding Drug Abuse and Addiction – What Science Says – 8: Medical Detoxification
[vi] U.S. National Library of Medicine – MedlinePlus: Alcohol Withdrawal https://medlineplus.gov/ency/article/000764.htm
[vii] Substance Abuse and Mental Health Services Administration: Substance Abuse Treatment Advisory – Protracted Withdrawal