Understanding alcohol toxicity, withdrawal & detoxification

One of the essential products of global addiction demand is alcohol or its relative beverages. In developing countries like India, this trend has led to significant alcohol consumption issues because of our nation’s socio-cultural practices. This has also led to major addiction problems, especially in the younger generations. A joint report by the Ministry of Social Justice and Empowerment and AIIMS suggests that 14.6% of the Indian population between 10 to 75 years of age consume alcohol. It also says that for every one woman consuming alcohol, 17 men are using the same. Out of this 14.6% of the Indian population, 2.7% of people are dependent users, while most of the remaining population suffers from multiple ill-effects.

While many get addicted to the drinking socio-culture of modern times, most of them take the detoxification route once they understand the problem. An individual must realise the need for alcohol detoxification as soon as they start seeing symptoms. 

A person typically goes through withdrawals when they quit drinking at once after prolonged use. Since alcohol has a sedating effect, people can observe the brain’s slowing down. However, the human brain adapts to the chemical changes once it realises abstinence. An individual’s brain produces serotonin (relevant to adrenaline) in significant quantities that are generally more than average to compensate for the major chemical change. 

However, an individual may not experience such things if their prolonged use of alcohol has already done significant physical or psychological damages. It then becomes a case of alcohol toxicity.

What is Alcohol Toxicity?

Every person is aware of the dangers of consuming regular or large alcohol quantities, whether alone or in a social setting. This substance can affect the main parts of the human body, leading to deterioration in severe cases. 

At first, one might enjoy drinking for the pleasure it brings, but the same becomes the reason for its dependence in the long run. Once the consumption levels reach the stage of toxicity, where a person must drink at least once a day, it can lead to instability and slurred discourse, including muscle coordination loss. 

Alcohol creates a dependency through its sedation effect, highlighting a broad scope of early neurological illnesses. Drinking large quantities can also pose a threat to a person’s life and affects breathing, sleeping, and eating patterns on a daily basis. A person suffering from alcohol toxicity or poisoning must get immediate medical attention to avoid extreme consequences like coma or death.

Symptoms of Alcohol Toxicity or Poisoning

In the case of acute alcohol toxicity, symptoms progress proportionately to Blood Alcohol Content or BAC that vary with tolerance.

In a typical alcohol user:

• 20-50 mg/dL – mild sedation, reduced muscle coordination, tranquillity
• 50 -100 mg/dL – impaired judgement, significantly reduced muscle coordination, mild to severe sedation
• 100 – 150 mg/dL – slurred speech, loss of self-consciousness, involuntary movement of eyes (nystagmus), unsteady limb movement 
• 150 – 300 mg/dL – lack of energy or enthusiasm and hysteria/dementia

In the USA, intoxication is considered anything above 80mg/dL. BAC 0.08% is most commonly used as a parameter, but it can vary for different states across the globe.

BAC of 300 – 400 mg/dL often causes unconsciousness and may lead to coma in extreme cases. BAC of above 400 mg/dL is known to be fatal for every individual consuming alcohol. It can also occur when alcohol consumption is rapid in a short period. 

While the visible effects may differ for social drinkers and high functioning alcoholics, the final results remain the same.

Symptoms of Mild Alcohol Withdrawal Syndrome

• Weakness, persistent headaches, inconsistent sweating, over-responsive reflexes, gastrointestinal problems, raised blood pressure, seizures
• Alcoholic hallucination (auditory illusion, frightening dreams) in dependent users
• Symptoms related to schizophrenia
• Delirium tremens during alcohol withdrawal – include severe anxiety attacks, increased scepticism, poor sleep patterns, depression, suicidal ideation, copious sweating, irregular body temperature and raised heartbeats)
• Vertigo

CDC defines excessive drinking as eight drinks per week for women and 15 for men or four consecutive drinks for women and five for men in one sitting. Most of these people may or may not be alcohol dependent; however, its ill-effects remain the same for all.

When a person chooses to home-detox, they presumably face withdrawal symptoms during the process.

For social drinkers, these symptoms are not likely to last longer than four to five days. For heavy drinkers or dependents, withdrawals depend upon the severity of their addiction and its previous quantity of use.

What to Expect From Alcohol Detox?

If people suffering from alcohol addiction opt to detox, they can expect the following timelines with some withdrawals along the way.

Initial Six Hours

You can experience minor withdrawal symptoms in the first six hours of detox. This period is usually counted starting from your last drink. If someone is a heavy drinker or alcohol dependent, they can suffer body tremors.

First 12 to 24 Hours

Heavy drinkers may experience some audible or visual hallucinations. If it continues for a more extended period, it is advisable to contact a medical practitioner or ask someone for help.

For others, headaches, light body tremors, upset stomach are common signs. Minor withdrawals will start decreasing as the days pass (usually 4-5 days).

First 48 to 72 Hours

Heavy drinkers may experience delirium tremens (frequent shaking, sweating, hallucinations, fever, high blood pressure, seizures).

For others, general symptoms continue to surface. 

Beyond 72 Hours

For casual drinkers, symptoms may start reducing after their peak. However, symptoms worsen after 72 hours, i.e. three days, for heavy drinkers and can last several days upto a month. It is advisable under these conditions to contact a medical professional while continuing the self-detox process. Quitting it immediately may have fatal impacts.

Dangers of Detoxing Alcohol Alone At Home

Many people might be under the impression that alcohol detoxification is easy and can be carried out at home without anyone noticing. The belief that alcohol is not as harmful as other drugs (chemical drugs like opioids and other psychostimulants) couldn’t be further from the truth. Self detox can pose a threat to life when it goes unadministered, especially for a heavy drinker. 

When individuals stop drinking at once, they are likely to face minor or extreme withdrawal symptoms depending upon their previous use. These symptoms are capable of causing painful experiences and can become unbearable at a certain point while lasting up to multiple days or weeks. The process may become unbearable for heavy drinkers without medication and supervision. 

As the body receives no alcohol, the possibility of experiencing hallucinations, seizures, and chest pain increases. In extreme cases of withdrawal, fatality may become the last consequence. Additionally, if a person has consumed drugs along with alcohol in the past, the withdrawals only become more life-threatening. 

However, no one knows beforehand what they may or may not experience while detoxing alone. If an individual is sceptic about withdrawals, they can always opt for supervised detoxification in a medical or rehab facility over self-detox at home. If someone doesn’t want to stay in rehab or a medical facility, home detox with supervision is the best way to go.

There can be many dangers to self-detox, especially for a heavy drinker. Since alcohol causes sedation, mental illnesses like anxiety and depression are common among other withdrawals. In such a case, one must consider getting outside help.

Among other things, if you see someone experiencing extreme withdrawals like seizures, call for immediate medical help. Do not leave the person alone at any point. Lay them on the side and keep their head on a soft cushion. Keep assuring the person until medical help arrives. 

Different Treatments Used for Alcohol Detox

Clinical Institute Withdrawal Assessment of Alcohol Scale (revised – CIWA-Ar) is often used for monitoring withdrawal symptoms that can lead to getting the appropriate treatment. The maximum score on this scale is 67. The patients scoring ten or less do not need any medication or even medical supervision for detox. For others, medical supervision becomes a necessity to counter mild to extreme withdrawals. The CIWA-Ar scale, however, must not be used for self-diagnosis. Professional opinion is crucial for mild to severe withdrawal symptoms.

Individuals can also opt for personal therapy sessions or join support groups like Alcoholics Anonymous (AA) to share their story and learn from other’s experiences. 

If suffering from mild to severe withdrawals, as discussed above, doctors may prescribe the following:

• Benzodiazepine
• Nutrition Support
• Neuroleptic Medication

Alcohol Detoxification and Recovery

It is always difficult to decide when someone needs medical intervention or self-detox. There are set parameters for anyone facing the problem as discussed above. Another factor can be how a person feels about themselves regarding alcohol or its presence in their bodies. You can also contemplate when you should stop drinking or go for self-detox. Nothing is easy at first; however, constant efforts to better your physical and mental health from the ill-effects of alcohol pushes you through. 

Do not be afraid to talk about your alcohol addiction, for it is only a medical condition you do not control. Asking for help is the best way to pull through. There are also anonymous treatment facilities available for detox and further processes if you do not want to be public about your problem. Your road to recovery begins as soon as you ask for help.

Sources:

https://www.mayoclinic.org/diseases-conditions/alcohol-poisoning/symptoms-causes/syc-20354386

https://www.msdmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/alcohol-toxicity-and-withdrawal

https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

https://www.healthline.com/health/alcoholism/how-long-does-it-take-to-detox-from-alcohol#takeaway

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z