Detox – This is early sobriety

Alcohol changes every system of our bodies and effects every major organ.  Some of these changes have taken place over years and altered the chemistry in our body, the working of our intestines, the health of our liver for good.  Others may return to ‘normal’, but that return could take some time.

Learning to live without alcohol is both an emotional or psychological undertaking AND a physical change.  Even if you only drank once a week, your body has accommodated itself to processing that alcohol.  Once you quit, your body will slowly take up it’s natural balance.

Since the 1980’s, most detoxes occur on an outpatient basis.  Some 20% of detoxes take place in an inpatient setting.  Meeting with a doctor as soon as you decide to quit drinking will help figure out what your options are and what you should expect.

Do give yourself the benefit of medical help.  Most of us underestimate the severity of our problem.  Detoxing can be dangerous and sometimes fatal.  The emotional strain of detoxing alone can send people right back to the bottle.

What’s happening in detox?

withdrawal or detoxing begins as soon as drug or alcohol consumption is abruptly stopped.  As a general rule, the symptoms of withdrawal are the opposite of the ‘high’ the drug produces.  The severity of the withdrawal will be based on the type of substance used, frequency and regular dosage, the duration of use (how many weeks, months, or years), the physical health and the mental and emotional state of the user.

A toxin is anything that impedes the normal functioning of the body, particularly by causing stagnation, congestion, or dis-ease.  The circulatory system, lymph system, and digestive system process the body’s toxins.  In particular, the blood, heart, colon, liver, and urinary system including the kidneys and intestines – facilitate the body’s natural detoxification.  Blocking any of these systems, by making them work too hard, ultimately results in the accumulation of toxins in the body.

Detox, withdrawal, or detoxification refers to the period of time it takes for these accumulated toxins to leave the body.  This does not mean the body is healed; damage to the organs doesn’t disappear with the toxins.  The process of detoxification can last a week to a few months.  There are medications available (with their own risks and problems) for detoxing from opiates, benzodiazepines, alcohol and barbiturates.  With the last three drugs, medical supervision is recommended.  Untreated withdrawal may be medically dangerous.  All detoxes cause psychic strain and physical upheaval.

What to expect

We’ve been using our body as a war-zone.  The first few days of sobriety can be  very uncomfortable, very frightening, and full of uncertainty.  Please go gently, relax, and hang in: the symptoms of detox are temporary.  You can’t very well know what sobriety is, or judge whether its worth it, until you are clear headed.  Don’t give up because you feel awful – that will pass. For the most part, you will feel better in a few days and the most acute and distressing parts of the detox will ease up.  In two weeks, you’ll feel even better than that.  The detoxing process peaks between 3 and 6 months.  Again, the most uncomfortable are the first few days; between 3 to 6 months, though, your body performs a radical overhaul, leaving you a much healthier person than you were in the first few weeks.  Symptoms may return periodically for the first two or three years of recovery, though with less intensity.  Most people notice “detoxing” in the first week, notice some fuzzy headedness or irritability in the first month, and feel fine afterward.  The thing is, the body grows stronger and cleaner, more efficient, more productive, without our noticing.

For simplicity’s sake, tell yourself that there are stages of detoxing, and there are physical and psychological symptoms of each stage.  Not everyone experiences every symptom, and some people experience some symptoms acutely, while others are nothing but a mild noticing of the difference.  Don’t judge where your body is or should be; it’ll sort itself out for you.

The First Stage

Symptoms of detoxing will start 12 to 36 hours after the last drink.  Most of them will last anywhere from a few hours to a few days.

The symptoms of the first stage include:

  • Insomnia
  • Fast heart rate
  • Sweating, facial flushing
  • Muscle trembling or spasms
  • Numbness, tingling or burning sensation in the arms or legs
  • Nausea, vomiting
  • Ringing in the ears
  • Dry mouth
  • dehydration
  • itching

If you think you’ll experience anything more severe than the above, you should seek medical attention.  The more severe symptoms of detox usually start within five to ten hours of the last drink, get progressively worse for 2-3 days, and last up to a week.  Sometimes these symptoms don’t appear until the fourth, fifth, or sixth day sober.  If you experience any of the following, consider it a medical emergency and get the help you need:

  • Seizures
  • Chest infections
  • Severe pain in stomach
  • Poor balance when walking (extreme)
  • Hand and body tremors
  • Hallucinations
  • Paranoia
  • Confusion or blackouts

A person can have alcohol poisoning without having a history of drinking, or having a an ongoing pattern of ‘moderate’ drinking.  Alcohol posioning is a toxic reaction to a leathal amount of alcohol.  A blood alcohol count (BAC) of .4 or .5 would kill about half of us.  That’s the range of ‘leathal dose’.  For a woman at a hundred pounds, nine or ten drinks in less than an hour can get that BAC.  A two hundred pound man would have to consume  four or five drinks per hour for about four hours to reach .40.  Many alcoholics (and kids) dismiss the risk, because they have had that much to drink, that fast, or know they have had similar BAC.  Don’t dismiss it.  You were lucky to survive it the first time, don’t press your luck.

Alcohol poisoning is deadly, killing five times more teens than all other drugs combined each year.  More than one third of drug overdoses occur with co-incident alcohol abuse.   Using alcohol with certain drugs increases the risk of alcohol posioning:

  • Narcotic pain medications (such as codine, codine derivatives, vicodin, opium, heroin, and darvocet)
  • Sedatives (examples include barbiturates, tranquilizers, and cannabis)
  • Certain anti-seizure medications (such as phenobarbital and wellbutrin)

Alcohol poisoning usually happens to youth drinking  too much, too fast, without knowing what the risks are or that they have passed the limit.  Very young kids can poison themselves on their parents booze, and college kids do it at parties.  Alcoholics can also suffer alcohol poisoning, though; moments of complete loss of control lead to suicidal levels of alcohol consumption.  Late stage alcoholism also has a reverse tolerance: suddenly a person will not be able to tolerate any alcohol, and may float in a constant agony of not being able to get drunk, but never really getting sober.  It’s alcohol poisoning that kills.  Call 911 and get to the emergency room.

Signs of alcohol poisoning:

  • Nausea leading to vomiting
  • unconsciousness, “passing out”
  • absent reflexes
  • no response to pinching, yelling, or being shaken
  • difficulty awakening the person
  • inability to stand
  • seizures
  • rapid pulse rate
  • slow, shallow, or irregular breathing
  • blue-tinged or overly pale skin, clamminess

Seeing the above in a person you know to be consuming large amounts of alcohol should prompt you to intervene, even if the person resists.

  • If the person persists in falling asleep, wake him.  If he does not respond or appears incohearant, call 911.
  • Roll the person on her side so if she vomits, she won’t choke
  • Don’t assume the person will ‘sleep it off’ and would rather not be disturbed.
  • Getting a person home or to bed may not be the best idea, as they are no longer being observed.  If someone has consumed that much, you should keep them around other people or bring them to medical care.
  • Be sure to tell the ambulance driver or emergency room triage if the person has taken any drugs in addition to alcohol.

Inpatient Detox

In severe cases withdrawal brings serious and even life-threatening physical symptoms such as shaking or tremors, headaches, vomiting, sweating, restlessness, loss of appetite, insomnia, Delirium Tremens (DTs), hyperactivity and convulsions.  If you experience or expect to experience any of these, you should seek medical assistance.  Inpatient treatment also effectively separates patients from social and environmental influences that could trigger a relapse. Signs of a probable need for inpatient alcoholism detox include:

  • A history of severe withdrawal symptoms
  • A history of alcohol withdrawal seizures or DTs
  • Several past detoxifications
  • A medical or psychiatric illness accompanying the alcoholism
  • Recent high levels of drinking
  • A lack of a dependable support network
  • Pregnancy

Anticonvulsant and other medications, including antipsychotic drugs, are often prescribed to help the severe alcoholic withdrawal from alcohol safely and with as little physical and mental discomfort as possible. Detox can take anywhere from three to 14 days, depending on the circumstances.  Do note that changes to the healthcare industry mean that many public detoxes only last 24 hours.

The Second Stage

After the first few days, the majority of the toxins will be out of your system and you’ll feel markedly better.  Most people continue to notice rapid changes in their physical and emotional status for at least six months, but after the first stage the ‘discomfort’ is largely gone.  What you will notice will come more as a surprise or a discovery, more getting something back than a difficulty.  Our bodies have been impaired- healing takes time.

Physical symptoms in the second stage of detox include:

  • Insomnia or restlessness
  • Headache
  • Tiredness
  • Muscle trembles
  • Sexual problems
  • Menstrual changes
  • Psychological symptoms include anxiety, depression, mood swings, irritability, poor concentration, poor memory, impulsiveness, and difficult in making plans or decisions.  More on these in the section of on-going change.

Dealing with detox

The following have been found helpful to many people.  Again, follow your own hunches and trust your instincts.

  • Hot baths (with Epsom salts) can heal emotions as well as the body, soothing muscle fatigue, twitches, tiredness.
  • Drink plenty of clear liquids and water, just as if you had the flu.  The concept is the same: flush your body clear.  There are a number of herbal teas that are also good for this.  If you consider any detox pills, homeopathy, or diets, make sure you do so under the guidance of a doctor.  Most of those homeopathics were not made for alcoholics: your nutritional and chemical needs are different.
  • Cranberry juice has been used for years by recovery houses to help purify and cleanse the body.  It fights infections and helps the digestive tract function at its best.
  • Excessive sweating can deplete potassium.  Balance that with bananas, melons, leafy greens, and tomatoes.
  • Sweating/detoxing through exercise or sauna can help, but be aware of your limits and be sure to keep hydrated, replace potassium and minerals, and not over do it.
  • Fats are hardest on the digestive system.  Let it do its work by cutting back on them.  (on the other hand, fats are often a comfort food, and many in early recovery need them).
  • Most recovering alcoholics crave sugar – as alcohol has a tremendously high sugar content.  Some continue to crave sugar for years, others see it wane after a week or two.
  • Go easy on the coffee, even though you’ll crave caffeine.  Alcohol has been our ‘fuel’ for years, stimulating and motivating us psychologically and physically.  Your body has adapted to having alcohol in it, functioning as ‘normal’ with a baseline of alcoholic toxins in it.  Not only are you suddenly without that ‘fuel’, but the process of detox and life change are exhausting.  Caffeine is a toxin, too, but you may have to choose your poison.
  • The old fashioned glass of warm milk before bed helps a number of people.  There are also good herbal teas to use as a sleep aid.
  • Exercise helps process depression, stress, and anxiety and regulates brain chemistry.  It ups endorphins, which will help with your low levels of dopamine.  It works to purge emotions, calm anxiety and restlessness, and speed the body’s natural detoxification process.
  • “Healing Arts” such as yoga, tai chi, acupuncture and massage work wonders for detox, both physically and psychologically.
  • Many women experience their menstrual cycles very differently once sober – the emotions and hormones are felt like they haven’t been before.  It may take awhile for you to ‘level out’.  It is also possible for the menstrual cycle to stop during stress.  Be aware that your cycle can pose a trigger as much as a glass of wine will.  Eat chocolate, take ibuprofen, learn some gentle yoga stretches for pain.  And take the time and space you need.

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