Thinking of quitting alcohol? Cutting it off right away might seem like a good idea, but it may be dangerous due to the potential for severe withdrawal symptoms. Photo / 123rf
If you’ve decided it’s time to change your relationship with alcohol, here’s what you need to know about dependency and withdrawal
If your drinking is having a negative effect on your life, it’s hardly surprising if it’s taken some time for you to decide to do anything about it.
“Alcohol is a social lubricant and is embedded in our society,” says Sally Marlow, a professor of practice in the public understanding of mental health research at King’s College, London. “Many people have some of the best times of their lives when they are consuming alcohol. But in order to accept this we also need to be aware of the harms it can cause. Dependence is when your alcohol intake becomes so normalised that your body can’t function without it.”
For those who’ve decided it’s time to quit, there are rising numbers making that same decision. Here is how to do it safely.
The most affected group for alcohol dependence is people in their 40s, 50s and 60s who have had several decades of drinking to build tolerance and dependence.
How to tell if you might be alcohol dependent:
David Nutt, a professor of neuropsychopharmacology and the director of the neuropsychopharmacology unit at Imperial College, London, explains that people who drink to achieve a psychological “buzz” can become dependent quickly, while people who drink to deal with everyday stress will build tolerance more slowly.
“When they stop drinking and go to work, they have a hangover and more anxiety. And that will make the work [stress] worse, so they’ll drink more in the evenings, which starts the vicious cycle of dependence,” he says. “A lot of people don’t even realise they’re dependent and don’t seek help until they develop a physical problem.”
Dependent drinkers who stop drinking may experience withdrawal symptoms which range from cravings and headaches, to seizures, hallucinations and delirium, depending on the level of dependency.
Prof Marlow explains: “Alcohol disrupts neurotransmitters. If you’ve been a heavy drinker for several years, it’s as if you’ve put a squeeze on the electrical activity in your brain. If you take the drinking away, your neurological processes are like a coiled spring with masses of electrical activity and that’s why the medical advice for heavily dependent people is not to go cold turkey without medical assistance, because you can end up fitting [ie, having alcohol withdrawal seizures] and it can be fatal.”
A 2008 paper published in the journal Alcohol Research and Health describes the processes behind dependence, withdrawal and relapse.
“In general, alcohol acts to suppress central nervous system (CNS) activity, and, as with other CNS depressants, withdrawal symptoms associated with cessation of chronic alcohol use are opposite in nature to the effects of intoxication.”
It lists typical features of alcohol withdrawal as:
Prof Nutt explains that someone drinking two units of alcohol a day would experience minor withdrawal symptoms such as disturbed sleep and anxiety, so for them quitting would be easier than for someone with greater tolerance who would experience more severe withdrawal symptoms.
Depending on the level of dependence, Prof Marlow advises starting by accessing information from organisations which support mindful drinking.
People with higher dependence should contact their GP who can offer advice and a referral, should medical help be required.
Alcoholics Anonymous holds open meetings, so attending one could be your first step.
Prof Marlow advises taking time off from work as sick leave or holiday. “It is an illness and withdrawal is a period of ill health,” she explains. “You will come out the other end but need to look after yourself.”
It is a good idea to stock up on alcohol-free alternatives for any social events where cravings for alcohol might be triggered. For example, Sentia GABA spirit is a mood-enhancing drink which uses plant-based ingredients that have been scientifically proven to activate “GABA” in the brain, which is the neurotransmitter responsible for sensations of sociability.
If you’re dependent on alcohol to function, it’s recommended you seek medical advice to manage your withdrawal.
Some people may be prescribed medication to help achieve abstinence. You may also choose to attend self-help groups, receive extended counselling, work with a coach who specialises in alcohol addiction or use a talking therapy such as cognitive behavioural therapy (CBT). There are also private rehab services available.
Everyone is different, and different pathways work for different people depending on a range of factors, including level of dependency, environment, access to services and personal relationships.
When you stop consuming alcohol your body goes through a period of detoxification, which is when the withdrawal symptoms are at their most acute. How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases, you should be able to detox at home without the use of medication as your withdrawal symptoms should also be mild. Always seek professional advice before attempting to give up alcohol if you are alcohol-dependent.
If your consumption of alcohol is high (more than 20 units per day) or you’ve previously experienced withdrawal symptoms, you may also be able to detox at home with medication under the supervision of a healthcare professional. A tranquiliser called chlordiazepoxide is usually used for this purpose.
If your dependency is severe, you may need to go to a hospital or clinic to detox.
Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes three to seven days from the time of your last drink.
Withdrawal and detox are first steps, but further treatment and support is usually needed for long-term sobriety.
Prof Marlow recommends: “Identify what your triggers are and avoid people who may encourage you to drink or who may also have problematic drinking patterns. Exercise can help. Keep busy and find a community of people you can speak to to help you stay focused. That may be supportive family and friends or online communities.”
Let’s take a look at the science.