Quitting Alcohol Cold Turkey vs. Medical Detox
From 1920 to 1933, America witnessed an unprecedented event: Prohibition.
Considered a “failed experiment,” the ultimate repeal of Prohibition revealed that many Americans were seriously in favor of having access to alcohol. The reality today is that many people can enjoy alcohol without abusing it; however, millions of Americans have lapsed into an alcohol use disorder.
The National Institute on Alcohol Abuse and Alcoholism provides reliable and recent statistics on alcohol use and abuse in the US.
The following are some relevant facts and statistics that illuminate the popularity of alcohol use, as well as its dangers:
- In 2014, an estimated 16.3 million American adults in the 18+ age group (6.8 percent of this population) had an alcohol use disorder. Broken down by biological sex, this statistic translates to 10.6 million males (9.2 percent of this age group) and 5.7 million females (4.6 percent of this age group).
- In 2014, of those in need of treatment for an alcohol use disorder, 1.5 million received help at a specialized center (8.9 percent of the group in need of treatment). In terms of biological sex, 1.1 million males (9.8 percent of the total in need) and 431,000 females (7.4 percent of the total in need) received treatment.
- In the 12-17 age group, an estimated 679,000 American adolescents (2.7 percent in this age group) were experiencing an alcohol use disorder in 2014.
- In 2014, of the group of Americans in need of treatment aged 12-17, an estimated 55,000 received treatment at a specialized center.
- Each year, almost 88,000 Americans (an estimated 62,000 males and 26,000 females) die due to an alcohol-related cause.
- In the US, alcohol use or abuse is the fourth leading cause of all preventable deaths.
- In 2014, alcohol-involved driving accidents caused 9,967 deaths, which equals 31 percent of all driving fatalities.
The many negative side effects associated with alcohol abuse highlight the need for individuals who are experiencing an alcohol use disorder to get help.
Irrespective of how a person arrives at treatment, one thing is certain: The recovery process has to start with detox. Many people think detox means mean going cold turkey, but this approach is not advisable when it comes to alcohol. Rather, the prevailing advice in the field of addiction treatment is that a person should undergo medical detox in order to safely transition from an alcohol use disorder to sobriety.
Withdrawal from an Alcohol Use Disorder
As the National Institute on Drug Abuse explains, the withdrawal process is part of a larger biological phenomenon known as physical dependence. Alcohol, as is well known, is an addiction-forming substance. As such, with repeated use of a sufficient amount, a person will habituate to the presence of the alcohol in the body. Due to a natural process known as tolerance, which is also part of physical dependence, a person will require an increasing amount of alcohol over time in order to experience the familiar level of intoxication. When the person stops drinking alcohol, or significantly reduces the familiar amount, the body goes into withdrawal, and symptoms of varying intensity emerge. The following factors influence the severity of the withdrawal process:
- The length of the alcohol abuse
- The familiar volume of alcohol abuse
- Whether alcohol was abused in combination with another drug of abuse
- The recovering person’s specific physiological factors
- Whether there are any environmental stressors present
The withdrawal process may occur within as little as eight hours after the last drink or days later. Symptoms will typically peak within 24-48 hours, but may persist for weeks (and longer in some cases).
The following are some of the known symptoms of alcohol withdrawal:
- Enlarged pupils
- Shakiness or jumpiness
- Clammy skin
- Loss of appetite
- Rapid heartrate
In some instances, a person may experience delirium tremens, a severe form of alcohol withdrawal. The following are some of the more common symptoms associated with delirium tremens:
- Significant confusion
In addition to having an understanding that the foregoing symptoms may emerge during alcohol withdrawal, it is critical to know that this process can be fatal. It is well observed within the medical community that alcohol withdrawal can lead to loss of life. Stated simply, when a person with a pattern of alcohol abuse suddenly stops drinking, shock registers in the body in ways that can be dangerous.
It is truly never known how a person will react during alcohol withdrawal. For instance, a person can slip into a coma and not recover. For this reason, there is a general advisement in the medical community against quitting alcohol cold turkey. The recommendation is that a person withdraw from alcohol during medical detox, which occurs under the supervision of a doctor in a qualified rehab facility or other clinical setting.
Medical Detox for Alcohol Abuse
Speaking in broad strokes, the alcohol abuse recovery process at a rehab center that offers a full continuum of services has three main phases. First, of necessity, the person must safely detox. Second, since detox alone is never sufficient to address the complexities of alcohol addiction, the recovering person must receive primary care services for the addiction (comprised mainly of therapy). Third, to help support a lasting recovery after completion of a rehab program, the recovering person must develop and maintain an aftercare plan (which should be adjusted over time as necessary). The focus of this discussion is on the first phase.
There are numerous differences between a person detoxifying cold turkey versus undergoing medical detox. The cold-turkey approach is not equipped to handle the severe symptoms that may emerge. In addition, there is always a risk of relapse during the withdrawal phase. Individuals who are going through uncomfortable or painful symptoms, as well as cravings for alcohol, are highly susceptible to using alcohol again, if only to stave off these undesirable side effects. Rather than focus on the numerous shortcomings and hazards involved in a cold-turkey detox, it is more helpful to discuss the many benefits of medical detox.
A main goal of medical detox is to safely help individuals eliminate alcohol from their body. This approach necessarily involves preventing and managing withdrawal symptoms. For example, individuals who suddenly stop drinking alcohol after a pattern of chronic abuse may experience dangerous seizures or other serious side effects. Medical detox provides the professional expertise and supervision to ensure that the process is not fraught with danger.
The supervising doctor may use medication in order to manage the withdrawal process. The most commonly used alcohol withdrawal medication is chlordiazepoxide, a benzodiazepine. The following are some additional examples of benzodiazepines (i.e., prescription sedatives) that may be used:
- Xanax (generic: alprazolam)
- Ativan (generic: lorazepam)
- Valium (generic: diazepam)
- Klonopin (generic: clonazepam)
Depending on the doctor’s treatment plan, which must be tailored to the recovering person, an antipsychotic may be used in addition to a benzodiazepine during the withdrawal process. The use of an antipsychotic may be limited to instances when a person is experiencing severe alcohol withdrawal symptoms. The antipsychotics olanzapine and haloperidol have proven to be effective, at least for some individuals in withdrawal from alcohol. In addition to prescription drugs, a supervising medical doctor and attending staff may provide a recovering person with over-the-counter medications to make the withdrawal process more comfortable.
The use of benzodiazepines during alcohol withdrawal, and in some instances adding an antipsychotic, is not only an accepted medical practice but also government-approved. At this juncture, a person may question the validity of using drugs to detox a person off alcohol, a drug. Also, it is well established that benzodiazepines are an addictive group of drugs. However, the use of benzodiazepines during a medically supervised detox process does not present a serious risk of the person becoming addicted to sedative drugs. This discussion is limited only to using benzodiazepines during detox, without considering what may happen if a person becomes a prescribed user of a benzodiazepine after withdrawal is complete. The reality today in the medical field is that many drugs simultaneously have a therapeutic value and addiction potential – such is the case with benzodiazepines. These drugs are indicated for the treatment of alcohol withdrawal, while at the same time, there is a strong warning against their abuse. This complexity aside, it is important to understand that many accredited and highly regarded rehab centers use benzodiazepines to treat clients during the alcohol withdrawal process.
Medical detox is considered the safest way to undergo withdrawal from alcohol.
The risks of cold-turkey detox are too great to pursue any at-home or do-it-yourself detox attempts. Professional help is needed.