How do I withdraw from alcohol safely?

If you have a drinking problem, people around you will probably be saying things like "you should stop drinking". Of course in practice, it is not so easy at all to just "stop drinking" - the main reason why is withdrawal.

Alcohol is classified as a depressant. It slows down the rate at which your brain functions. If you drink too much, too often, your brain and liver get used to having alcohol in the blood. This is called "tolerance". You have to drink more and more over the months and years to get the same effect. But the problems really start when you try to come off the alcohol. That's when you can get withdrawal, and the first symptoms can come on within just a few hours of your last drink.

Here is a list of commonly reported alcohol withdrawal symptoms. Do any of these sound familiar?

Shakes
Sweating
Hangovers
Headaches
Nausea and vomiting
Stomach pains and cramps
Sex problems
Poor appetite
Poor sleep
Anxiety
Feeling "down"
Sudden mood changes

In a few people the withdrawal symptoms can be very serious indeed. The most frequently occurring of these are:

Hallucinations *
Paranoid ideas *
Disorientation *
Psychosis *
Severe memory problems
Clinical depression
Epileptic fits

* Possible sign of "DT's" or Delirium Tremens

In fact, the withdrawal symptoms associated with alcohol are often more severe than with drugs such as "Heroin" and they can persist for up to ten days. So, if you carry on drinking it is dangerous, but if you stop that can be dangerous too. What should you do?

The answer is to withdraw from alcohol in a safe way. To do this you really need "one to one" expert advice and a full medical examination. But here are some guidelines to let you know what options are available in principle.

There are three main ways of withdrawing from alcohol. These are to stop drinking all at once, ("cold turkey"), to stop drinking gradually by reducing your consumption over a number of days, or to change over onto medication which replaces the alcohol for a few days ("Detoxification"). Each of these has its own advantages and disadvantages.

Stopping At Once

If you stop drinking all at once you are greatly at risk from withdrawal symptoms. It is not a good idea to do this. However, millions of people go through this sort of withdrawal every year. For example, if they are arrested and end up in a prison where the staff are unaware of the symptoms of alcohol withdrawal, if they find themselves on an international flight which does not allow drinking, or even if they wake up without alcohol and money in the house.

Unless you are very well motivated and have the support of people around you it is all too easy to start drinking again before the symptoms subside. But if you do get through it you have a golden opportunity to get your life back on the rails.

If you choose to use this method of withdrawal you must let the people around you know what you are doing!

Alcohol Based Withdrawal

If you reduce your drinking gradually over a few days, it is usually possible to avoid the worst withdrawal symptoms. This is because your body has the chance to adapt gradually to the reducing level of alcohol in your blood.

It is best to begin by cutting your alcohol consumption in half; if for example you drink a full bottle of spirits each day, you should limit yourself to half a bottle for a start. Keep it at this level for four days. Then halve it again for four days, and then stop altogether. By doing this you can be off the drink within eight days. Many people withdraw from alcohol in this way. This method is widely used in Britain under professional community supervision.

Some people who drink spirits choose to change over to wine or beer first and then reduce.

The main thing is to gradually reduce your alcohol intake over a number of days. To do this you must be aware of the concentration of alcohol in your drinks - read the labels to judge the percentage alcohol content.

As you can imagine it is not easy to use this method. You need to be a very strong and well motivated person to set your own limits and keep to them. Get support from people around you.

Medication Based Withdrawal

This method is called "Detoxification" by health care professionals and "Drying out" in common language. You have to have professional supervision with this method because you need to use drugs that are only available on prescription. With this method the person stops drinking alcohol and goes over instead onto prescribed medication which has a similar effect on the nervous system as alcohol. The prescribed dose is then reduced over a number of days and then stopped altogether. At this point you are off both the alcohol and the medication.

Very heavy drinkers will need to start on a high dose which will be reduced over a maximum of 10 days. People who have been drinking less heavily can start on a lower dose and take the medicines for a shorter period of time.

There are several drugs which can be prescribed for detoxification and they are all reasonably safe if you take them as prescribed, though they all tend to make you feel drowsy as a side effect. They are not very expensive. Which sort of medication may be appropriate for you can only be decided in consultation with a health care professional according to your own personal needs. Family doctors in many parts of the world are able to describe drugs for detoxification. However, it is more usual for this method of withdrawal to be available only following admission to a hospital or clinic.

If you are allowed to stay at home during your detoxification you must have sufficient professional support. In Britain it is usual for a community nurse or social worker to keep in touch with you during your withdrawal if you are able to stay at home. They should give you emergency phone numbers in case you have problems outside of office hours. Home based detoxification is much less common in other parts of the world.

If you choose this method to come off alcohol you must never try and take the medication together with alcohol. You have to make a clear choice to change over onto the medicines as prescribed. If you do mix these medications with alcohol you can suffer very severe and unpleasant side effects. There is also a risk that you may become addicted to both alcohol and prescribed medication, with all the additional problems that involves.

For more information on prescribed medications, go to the Prescribed Medications section of this website.

Additional points:

If you know from your own experience that you tend to suffer from severe withdrawal symptoms, you should only withdraw from alcohol in a supervised setting such as a hospital or clinic.

Whichever method of withdrawal you use, the first three days are usually the worst.

Don't be on your own if you can possibly avoid it, particularly for the first few days. Keep in regular touch with your health care professionals.

Make sure that you do not drive a vehicle or operate any machinery while you are withdrawing. If you get sudden complications you could cause a serious accident. Be careful if you are working in the kitchen too; even simple things like boiling a kettle of water can be dangerous if you have "the shakes" or feel faint.

When you go to the bathroom, do not lock the door behind you. If you were to be taken ill, valuable time would be lost in breaking down the door! If you are embarrassed that someone might walk in, pin a note to the door.

If you feel nauseous try to eat a light diet. Many people find toast is the only thing they can face for the first couple of days. If you feel really sick, try to carry on drinking water until your stomach settles down - this will avoid dehydration. After the first three days you should be able to eat a more normal diet. Get on to a good balanced diet as soon as you can.

Consider taking vitamin supplements, particularly ones that contain vitamin B 12 and Folic Acid. This will help you replenish the vitamins you may have missed in the past.

Get plenty of rest, but try to sleep only for short periods during the day. That way you are more likely to sleep better at night. If you sleep badly or can't get to sleep at all, don't worry, it normally passes after the first few days.

Keep blankets handy in case you get "the shivers".

It is not normal during withdrawal to have a fever (raised temperature). If this happens you may have an infection. Get medical advice.

If you wake up in a dark room you are much more likely to "see things", so keep a light on in your bedroom if you can.

Whichever form of withdrawal you choose, it is a good idea to reduce the amount of caffeine that you use. Caffeine will only make you feel more irritable and may well interfere with your sleep. The things to avoid or go easy on are coffee, cola drinks and chocolate. Try decaffeinated coffee or tea. Tea contains far less caffeine than coffee and most people can drink it without problems.

Remember, once you have stopped drinking you have only got over the first hurdle. You then still have to decide whether you are ever going to try and drink again, or whether you should aim to abstain. Make sure that you have enough support from your family, friends, work colleagues and health care professionals so that you make the right decision. If you are really serious that you want to abstain, think about contacting your local AA group.

It is not "normal" to have withdrawal symptoms. People who drink moderately can always stop drinking without any problems at all. If you experience withdrawal symptoms it is a sign that you have a drinking problem and that your body is physically dependent on alcohol.

If you have hallucinations it is best to keep the lights on full in the room you are in until help arrives; bright light stimulates your brain. Keep talking to the people with you, it will help you to stay in contact with reality. Many people find that leaving the radio on also helps. Remember, hallucinations or DT's do not mean that you are "going mad", only that your brain is suffering from severe withdrawal symptoms. You can make a full recovery with the correct treatment. It is extremely rare to continue having hallucinations once the withdrawal period is over.

Epileptic fits can occur in people withdrawing from alcohol - and during the first three weeks following withdrawal. Epileptic fits are relatively unusual, but if you have one fit, you are at risk of having another during your present and subsequent withdrawals If you are at risk you must not drive or operate machinery until your specialist tells you that it is safe to do so.

If you experience hallucinations, fits or other serious symptoms during or after your withdrawal - you must seek local expert advice at once.

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