Any potentially deadly disease will have something called an end-stage, when the disease starts to threaten your life in severe ways. Alcoholism, like all substance use disorders, can be a progressive disease. That means it can get worse over time if it’s not treated. Addiction and alcohol dependence can start to take over your life, threatening your health, straining your relationships, and burdening your finances.
Around 14 million people met the criteria for an alcohol use disorder in 2019, according to the National Survey on Drug Use and Health. It’s important to recognize the signs of the disease, especially if it’s getting progressively worse. What is end-stage alcoholism, and what are the stages of alcohol withdrawal?
What is End-Stage Alcoholism?
In the early stages of an alcohol use disorder, you may start to use alcohol to mask negative emotions, you may drink alone and at odd times, and you may find yourself developing a tolerance to alcohol. In the middle stages of alcoholism, you may find that managing your alcohol use disorder is demanding more of your time and that you need to drink more just to feel normal.
End-stage alcoholism often comes after years of alcohol misuse. It may result in serious medical conditions or complications that require medical care or hospitalization. It may also cause other problems in your life like job loss, financial issues, strained relationships with loved ones, homelessness, and other issues.
Someone in end-stage alcoholism will have a chemical dependence on alcohol that’s so severe, quitting alcohol abruptly can be deadly. Quitting may need to be done through tapering with the guidance of a medical professional. Tapering may be done with benzodiazepines, which are central nervous system depressants like alcohol.
What is Alcohol Withdrawal?
Alcohol withdrawal is a set of symptoms that occur in someone who stops using alcohol after becoming chemically dependent. Chemical dependence is when your brain chemistry adapts to the presence of a foreign chemical in your system. As your brain comes to rely on the drug, it may alter your natural chemicals to balance out your brain chemistry. When you take a psychoactive drug or drink alcohol, your brain is temporarily thrown out of homeostasis, which is the balance between excitatory and inhibitory effects on your nervous system.
Alcohol is a depressant, so it slows down your nervous system, which allows it to achieve positive and negative effects. Slowing down the nervous system allows you to feel relaxed, and you may find relief from anxiety. However, it can also make you feel depressed. You may also feel physical symptoms like dizziness and drowsiness.
When it comes to alcohol dependence, the brain will adapt by creating more stimulating chemicals to counteract the depressing effects of alcohol and achieve homeostasis. After some time managing a dependence on alcohol, you’ll start to experience a growing tolerance. To achieve the same effects that alcohol once gave you, you’ll have to drink more. Eventually, you may feel like you need to drink to feel normal rather than as a means of recreation. When you stop using alcohol, your brain will be thrown out of homeostasis once again. This time, because your body is missing the alcohol it was used to. This is when withdrawal happens.
Instead of depressing effects, you may actually feel stimulation. The central nervous system depressing effects of alcohol are removed, and your brain’s stimulating adaptations leave you feeling overstimulated. This can cause insomnia, anxiety, tremors, jitteriness, and general discomfort.
The Stages of Alcohol Withdrawal Explained
Your experience with alcohol withdrawal may not be the same as someone else’s. There are several variables that may affect the stages of your withdrawal and the timeline on which you experience them. Your size, the size of your typical dose, the amount you took in your last dose, and the length of time you’ve been dependent on alcohol all play a role. People who are used to drinking a lot of alcohol consistently for years will experience more severe withdrawal symptoms more quickly when they quit.
Another big variable if you quit cold turkey or taper gradually. Quitting cold turkey will cause you to feel symptoms more quickly, but it may also risk more severe symptoms like seizures. It’s generally recommended that you don’t quit cold turkey on your own after a period of dependence on alcohol. Tapering may mean a longer withdrawal period with mild symptoms. Tapering is usually done with a prescription benzodiazepine and a doctor’s guidance. It may be difficult and even dangerous to taper on your own.
Alcohol withdrawal often lasts for a week to 10 days, depending on those previously mentioned factors. While the stages of your withdrawal timeline may not be identical to the following, it may have some resemblance.
The First Day
The first day may feel like a typical hangover. Even if you’ve been dependent for a long time, you may be familiar with these symptoms. Headaches, fatigue, lack of concentration, forgetfulness, and general discomfort. For most people, this stage comes with increased heart rate and body temperature. It may also cause tingling sensations, especially in your hands and feet. In severe cases, people may not be able to sleep, and they may experience night sweats, nausea, and anxiety.
Over the first four days, your symptoms will gradually become more severe. You may feel jittery, restless, and even paranoid. Some people feel like bugs are crawling all over their skin. Sweating, shaking, and nausea will continue as you approach peak symptoms. This is the time when your risk for a seizure may be the highest, and it’s important to be under medical supervision.
In some cases, people experience a condition called delirium tremens, which is the sudden onset of extreme symptoms like panic, confusion, rapid heart rate, sweating, and chest pains. Sometimes, delirium tremens results in a heart attack, stroke, or coma. However, the risk of fatal delirium tremens is significantly lowered with medical attention.
After five days, your symptoms may have reached their peak, gradually getting better after that. You may start to feel relief, especially when it comes to physical symptoms like headaches and sweating. You may still have trouble sleeping, anxiety, racing thoughts, and mental fatigue. While your withdrawal phase isn’t over, it will start to get better. It’s still possible to experience a sudden seizure, so it’s wise to have medical help or at least another person nearby.
After about a week, many of your symptoms will be gone, but a few may remain. It’s common for you to still feel cravings to drink after you’ve quit drinking for a week. Detox gets you past chemical dependence, but the end of withdrawal doesn’t mean the end of addiction. To address cravings and compulsions to use will mean a continued commitment to recovery. Addiction treatment can help you develop the skills to prevent relapse to safeguard your sobriety.
10 Days And Beyond
After 10 days, your worst withdrawal symptoms will be behind you, but some symptoms may linger. It’s common for some psychological symptoms to continue for weeks and even months after detox. You may need to address psychological symptoms like anxiety and depression in treatment for you to manage them properly.