Alcohol appreciates a unique status in the United States.
Although alcohol is a drug, it’s legal to manufacture, distribute, and consume it. Alcohol use is incredibly prevalent, and it’s associated with nearly every social event, from weddings to ball games to dinners with friends.
According to the 2018 National Survey on Drug Use and Health (NSDUH), more than half of adults aged 26 or older (55.3%) were current alcohol users. This percentage corresponds to about 118.8 million adults in this age group who drank alcohol in the past month.
But not all Americans can simply enjoy an alcoholic beverage from time to time. Rather, an estimated 15.1 million Americans over the age of 18 have an alcohol use disorder, according to NSDUH. Per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), a person can be diagnosed with an alcohol use disorder if two or more of the 11 listed criteria, which includes psychological, physical and behavioral symptoms, are present within the same 12-month period.
How Withdrawal Symptoms Factor In
Individuals with an alcohol use disorder will typically find it difficult to achieve and maintain sobriety. This is due in part to the withdrawal symptoms individuals with an alcohol use disorder experience when they stop drinking or significantly reduce the familiar amount of intake.
Withdrawal symptoms generally appear within hours of when a person who has a history of chronic alcohol abuse stops drinking or lowers the amount of alcohol consumed. The most common symptoms are:
- Cravings for alcohol.
- Vivid dreams.
- Loss of appetite.
Severe alcohol withdrawal symptoms may begin appearing after 1 or 2 days and can include hallucinations (auditory, visual, or tactile) and seizures (i.e. generalized convulsion involving shaking of the arms and legs and loss of consciousness). Delirium tremors (DTs) are another severe withdrawal symptom. DTs may last up to 3 or 4 days and are characterized by disorientation, coarse tremor, severe agitation, rapid heartbeat, high blood pressure and fever.
Approximately 5% of individuals in withdrawal from alcohol abuse will experience DTs, which can cause life-threatening metabolic or cardiovascular complications, trauma or infection. Most alcohol withdrawal symptoms, however, aren’t life-threatening but should be taken seriously. It’s important to understand that a symptom can subside, but there’s also the possibility that it will worsen. However, help is available to lessen the severity of these symptoms and make relapse less likely.
Necessary Treatment Elements to Avoid Relapse
Within the addiction treatment community, there’s a universal advisement that individuals who are experiencing an alcohol use disorder, especially one with a severe grade, start the recovery process with medical detoxification.
Medical detox can occur at a rehab center with an onsite detoxification facility, at a hospital, or at a standalone detox center, among other qualified places. During this medically supervised phase, an attending doctor may recommend that the recovering person take medications to help minimize symptoms and prevent complications such as seizures or delirium tremens.
It’s critical to note, per the National Institute on Drug Abuse, that detox alone is never enough to help a person avoid a return to drinking, or “relapse,” after treatment.
In fact, there’s a 40-60% relapse rate for alcohol and other drug abuse. It’s most likely to happen during periods of stress or when a person is exposed to people, places, or circumstances associated with drinking.
After medical detox, the next step is primary treatment for the alcohol abuse, which mainly includes therapy, group recovery meetings, and additional supportive services, such as family therapy. Medical detox plus primary addiction treatment is considered the gold standard to help a person maintain abstinence.
After completion of a treatment program for alcohol abuse, it’s universally recommended that the recovering person engage in different aftercare services, such as continuing to go to therapy, attending group recovery meetings, and possibly living in a sober living home, among other options. Aftercare is critical to avoiding relapse as it provides ongoing support of sobriety.
Relapse prevention strategies are learned during treatment and reinforced as part of aftercare. Medications that are effective in helping to prevent cravings may be used to aid in reducing the risk of relapse. Naltrexone, either oral or injected in an extended-release formulation, have both been shown to help prevent relapse in patients being treated for alcohol use disorders.