Alcohol Detox Centres

Detox is a shortened version of detoxification, which involves cleansing the body of alcohol and all the accompanying negative chemicals.

These chemicals can have a detrimental effect on people’s physical and mental health.

Alcohol is a very damaging and dangerous substance. As well as physically causing harm, its chemicals interfere with several aspects of our brain and central nervous system.

This results in us being caught in a situation where we are enslaved by our internal biology.

When people attempt to give up alcohol the strong cravings that people experience when withdrawing can sometimes be too powerful to resist and people end up relapsing.

Detox can be pharmacological which involves using substitute drugs or, non-pharmacological where the rehab centre will support patients without the use of any specialist medication and manage withdrawal symptoms as they arise. (7,9)

What are Alcohol Detox Centres?

Patients who have been diagnosed with an alcohol use disorder (alcohol addiction) are usually required to attend a residential setting as part of their recovery programme for alcohol addiction.

These settings can be referred to as detox centres as a main component of the treatment they offer to patients is detox treatment to eliminate the harmful effects of alcohol from their bodies.

This is caused by their persistently high blood alcohol levels that cause them to experience withdrawal symptoms when they either, attempt to stop drinking alcohol or go 1-2 days without consuming alcohol. (7)

Rehab4Alcoholism work with several treatment centres throughout the UK that have acquired a great deal of skill and knowledge and a high degree of professionalism.

Why do People Require an Alcohol Detox?

All patients diagnosed with alcohol use disorder have become dependent on alcohol and so require detox treatment to help them overcome their physical dependence so it ceases to compromise their health.

Physical alcohol dependence develops when a person has been regularly consuming large amounts of alcohol over several weeks.

After slowly increasing alcohol consumption, t he body adapts to its presence to ensure they still function adequately each day.

Their increased tolerance towards alcohol means that they will need to consume a greater volume of alcohol to experience the same effects they previously did.

This can result in unpleasant withdrawal symptoms such as nausea, headaches, insomnia and anxiety when they go longer than 24 hours without an alcoholic drink.

then it is safe to say that they require detox treatment to eliminate all the toxic chemicals from their bloodstream. (7,12)

Who Needs an Alcohol Detox?

If 2/3 of the following apply to you then you should consult with your GP. They may well refer you to an alcohol rehab/detox service for treatment before your condition worsens:

The volume of alcohol you have consumed on average each week over the last 3-4 months has exceeded 14 units and has slowly increased
You have tried to stop or reduce your alcohol intake, but all your attempts have failed, indicating you have lost control of your alcohol use
Your tolerance to alcohol has increased meaning that it takes longer for alcohol to affect you than it previously did
You experience withdrawal symptoms when you go without alcohol for 1-2 days
Your performance at work has deteriorated as a result of your alcohol use
You no longer engage in pleasurable activities because of your alcohol use
Aspects of your physical health have deteriorated in recent weeks, you may have more colds, and infections and your overall fitness have declined (5)

Physical Consequences of Alcohol Addiction

Alcohol is a very poisonous drink if consumed in high amounts and can do untold damage to your physical and mental health, including:

High blood pressure and cardiovascular problems
Damage to the liver which is a vital main organ in the human body
Inflammation and infection of the pancreas, which is a key organ for governing the functioning of our digestive system
Increased risk of stroke
Immune system damage
Increased vulnerability to dementia
Breast, stomach and mouth cancer
Osteoporosis

However, despite being aware of this many people are unable to give up alcohol and have lost the ability to control their drinking.

When they have reached this stage they must seek help for their condition before it is too late to reverse any negative effects. (5)

Alcohol Detox Usually Occurs in an Inpatient / Residential Setting

It is very important that patients diagnosed with an alcohol use disorder who require detox treatment attend a residential setting to have their treatment.

It’s of the utmost importance for people to be monitored by qualified medical staff for the duration of their treatment.

Alcohol detox centres offer a calm, caring and supportive environment for people seeking to recover from alcohol dependence.

It is very stressful and challenging attempting to give up alcohol and any withdrawal symptoms that appear are likely to be much worse if the patient is experiencing high anxiety and stress.

For people who live in unstable environments and/or have a lot of negative influences that can easily tempt them back into alcohol use the detox/rehab centres offer a safe, protective haven.

This can help to focus on giving up alcohol as this environment shuts out all the troublesome environmental triggers that bombard them every day.

Regular monitoring by the staff will mean that any physical problems or mental health crises can be dealt with very quickly. (4)

Does Everyone Diagnosed With Alcohol Addiction Need to Attend an Alcohol Detox Centre?

Anyone who has been diagnosed with an alcohol use disorder or alcohol dependence would benefit from receiving treatment in a residential setting.

This is because it provides a stable alcohol-free environment to stabilise and find some mental space away from stress and negative influences.

However, anyone recovering from alcohol addiction should be aware that withdrawing from alcohol can cause many unpredictable and life-threatening symptoms.

Therefore, they should ensure they are medically supervised when attempting to give up alcohol. (1,4)

The following patients are recommended to receive residential care for their alcohol treatment:

Those with several failures behind them as an outpatient
Patients diagnosed with delirium tremens
Patients that have a history of trauma
A mental health condition that requires medication
Patients who experience severe withdrawal symptoms after 1-2 days without alcohol
Patients living in unstable living environments and/ or with no family support
Patients who are deemed to be vulnerable to outside influences

How Long Does Detox Treatment Last?

Patients requiring alcohol detox will usually be in treatment for a period of seven to ten days, depending on the severity of their condition and their personal circumstances.

In severe cases where patients have also been diagnosed with another mental health condition, the detox treatment process may take slightly longer, but the vast majority of patients will face no more than 10 days in detox. (4)

Is Detox the Same as Alcohol Rehab Treatment?

Alcohol detox treatment is only part of an addiction treatment programme and not a cure in its own right.

Clients who enter rehab for addiction will still have several psychological and social therapies to work through before their spell in rehab is complete.

Overall patients will spend 28 days in rehab. (3)

Admissions to Alcohol Rehab Centres

Anyone seeking to enter alcohol rehab for alcoholdetox treatment will have to go through an admissions process.

This needs to take place before the rehab centre’s management team is satisfied that they are fully able to meet the treatment needs of the patient.

Screening criteria

There will be s screening process carried out by rehab centre staff to check if the person expressing an interest in treatment is a suitable match for the treatment centre.

The screening criteria can differ between rehab centres but most centres will check for basic information such as:

The rehab centre will check you are at least 18 years old
Ask questions to assess if you are physically and psychologically able to complete a 4-6 week alcohol rehab programme and fully understand the challenges ahead of you
Look for confirmation and evidence that you have been experiencing problems with alcohol use, including referrals from doctors, psychiatrists and social workers. (4)

Comprehensive assessment

To ensure that all clients receive the most accurate and appropriate treatment that meets their individual needs senior rehab centre staff will be required to carry out a comprehensive assessment.

This will evaluate the precise nature of the patient’s condition shortly after they have been admitted, before the alcohol detox begins.

Despite being diagnosed with the same condition all patients will have a different profile and have different backgrounds and experiences which led to the development of their alcohol dependence.

The member of the rehab staff who will carry out the comprehensive assessment will use the recommendations set down by the American Society of Addiction Medicine (ASAM).

This has been developed a set of 6 criteria that needs to be considered when developing a care plan for clients diagnosed with alcohol use disorder.

The 6 areas are:

Their current level of alcohol consumption/intoxication – This may include a measurement of the blood alcohol levels and measuring the severity of their withdrawal symptoms and whether they have a mild, moderate or severe addiction.
The current state of patients’ physical health – Patients will undergo a medical examination to investigate the full state of their health and assess how much damage has been done to their bodies by alcohol. It is important to diagnose conditions like asthma or diabetes so that medical specialists in these areas can work with the treatment team to provide the necessary care
The current state of patients’ mental health – Many patients with alcohol addiction are likely to have another mental health condition as well, such as depression, anxiety or trauma. This affects the type of treatment they will receive, so having an up-to-date psychiatric profile of each patient helps to ensure that all their treatment needs are met
Motivation levels – It is important for the assessor to gauge how committed the patient appears to be towards their treatment, or whether there are any signs of apathy and ambivalence. Patients who may appear to not be so highly motivated may be advised to engage in regular sessions of motivational interviewing
Relapse risk – The assessor will need to investigate how likely each patient is to relapse, this may involve enquiring about their living circumstances, support network and how many times they have previously attempted to give up drinking. They also need to establish how committed they are to their recovery and how regularly they attend support group (AA) meetings
Relevant social factors – This area is concerned with the nature of the client’s living arrangements, employment status, and whether they have any family issues or legal problems that may derail their recovery efforts

There are many external and social factors that cause people emotional distress and these need to be identified and considered to help make the client’s life more manageable as they try to overcome their alcohol addiction. (6a)

Do I Need an Alcohol Detox Program?

If you have been diagnosed with an alcohol use disorder and have been judged to have a physical alcohol dependence then you will probably require an alcohol detox.

It is extremely unsafe to suddenly stop drinking alcohol without consulting with medical professionals who can assess your level of intoxication and the seriousness of your alcohol use.

If you do experience withdrawal symptoms within 1-2 days of consuming your last alcoholic drink then it is likely you may have alcohol dependence.

If you require some form of detox, you should contact your GP as soon as possible. No one should ever attempt an alcohol detox themselves.

The Importance of Alcohol Detox

Alcohol detox is an important part of treatment for alcohol use disorder and is usually the first part of the treatment process.

This is because it physically stabilises clients who have become physically dependent on alcohol and who suffer unpleasant and life-threatening withdrawal symptoms.

Alcohol is a very dangerous substance to give up due to the fact patients can have seizures if they attempt to give up alcohol suddenly or attempt withdrawal without consulting with medical professionals. (4)

The Nature of Alcohol Withdrawal Symptoms

The severity of the withdrawal symptoms patients experience will be determined by the level of alcohol in the blood and the severity of the alcohol use disorder.

Patients who meet 6 or more of the 11 criteria set down by DSM5 when assessed by a doctor or psychiatrist will be diagnosed with a severe alcohol disorder. (1,9)

The main symptoms associated with alcohol withdrawal include:

Problems with sleep patterns/insomnia
A hyperactive autonomic nervous system, which could result in heavy sweating or a resting heart rate of over 100 beats per minute
Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm)
Increased prevalence of hand tremors
Insomnia
Frequently feeling nauseous or vomiting
Episodic bursts of visual, tactile, or auditory hallucinations/ illusions
Psychomotor agitation, indicated by the patient frequently experiencing states of restlessness and anxiety
Anxiety
Seizures

The Timeline for Alcohol Withdrawal Symptoms

The staff at alcohol detox/ rehab centres fully understand the nature of the alcohol withdrawal timeline and know exactly what medical assistance to offer throughout the 7-10 day detox period that patients will be going through.

Any patients who have been drinking heavily for years will experience very severe withdrawal symptoms and may have developed alcohol-related conditions like Delirium Tremens. (14)

It is likely most people who have developed a moderate to severe alcohol use disorder will begin to initially experience withdrawal symptoms from 6/8 hours after their last alcoholic drink.

These include headaches, anxiety, feelings of nausea and even mild tremors.

These symptoms may gradually worsen over the next 4/5 hours and patients may begin to vomit.

From 12 hours onwards patients may experience both auditory and visual hallucinations and feel strange sensations on their skin, which may slowly intensify as the 24-hour mark draws nearer.

It is after the 24-hour mark that the risk of having a seizure significantly increases although long-term, heavy consumers of alcohol may well have seizures as early as 10 hours after their last drink.

This is why it is essential to gather as much detailed information about several historical aspects of a patient’s health and alcohol intake. (4,12)

After 48 hours, most of the symptoms will become extremely uncomfortable and patients are still vulnerable to having seizures.

As the clock ticks towards the 60-hour mark, heavy drinkers may begin to experience symptoms of delirium tremens.

Between 3-5 days after their last drink, anyone diagnosed with delirium tremens will find their symptoms will get worse although these usually disappear within two days.

After the 5-day period is over, the likelihood of having a seizure is dramatically reduced and many of the symptoms will weaken and slowly disappear over the next couple of days. (4,12)

What Happens During Detox?

Prior to commencing detox, treatment patients will undergo a thorough medical examination and will be assessed for their current level of intoxication.

It is always essential to review the client’s condition to confirm the severity of their alcohol use disorder and the intensity of their withdrawal symptoms.

Alcohol detox centres monitor the severity of patients’ alcohol withdrawal

To monitor a patient’s progress during the early phases of detox treatment, medical support staff will continuously assess the severity of the patient’s withdrawal symptoms at least every 4 hours while the patient is awake.

This is done using a scale such as the CIWA (Clinical Institute for Withdrawal Assessment).

Depending on the responses of the patient, they may be prescribed a suitable dose of a substitute drug (e.g. Librium) from the benzodiazepine group. (2)

The CIWR scale requires patients to report the severity of their withdrawal symptoms on a scale of 0-7 for the following:

Nausea
Tremor
Sweating
Anxiety
Agitation
Tactile / auditory / visual disturbances
Headaches

From their responses, the medical team can gauge the severity of their symptoms and administer the relevant pharmacological dose that will alleviate the withdrawal symptoms.

Any patient reporting a score of 8-10 or lower is unlikely to be given medication at this stage.

Each patient will have a unique pattern of withdrawal symptoms due to the individual differences in the patient’s biology and their pattern of alcohol use.

The timing and strength of the pharmacological intervention will differ between patients.

It is essential therefore that each patient has their own individual treatment programme which takes into account their personal circumstances. (2)

Detoxification Medications (Pharmacology)

To facilitate the detox treatment process, the medical staff at alcohol detox/rehab centres will use a substitute drug from the benzodiazepine class.

Benzodiazepine drugs share enough chemical properties with alcohol to ensure that the patient will not experience any withdrawal symptoms when their alcohol consumption ceases after entering rehab.

The substitute drug will not possess any physically addictive qualities nor will it elicit any feelings of pleasure and relaxation in the patient that may have maintained psychological dependence. (5,6)

Chlordiazepoxide (Librium)

A common benzodiazepine drug used in detox treatment is Librium, this is a very effective drug used for alcohol detox as it contains anti-convulsant contents.

These protect patients against the risk of having seizures in the first few days after stopping their alcohol intake.

Diazepam, also known as Valium has also been used for alcohol detox as, like Librium, it is a slow, long-acting benzodiazepine drug that keeps withdrawal symptoms at bay for at least 24 hours.

This means clients will slowly find the time in between experiencing withdrawal symptoms will gradually lengthen as their blood alcohol levels slowly drop. (4,6,8)

Another benefit of using benzodiazepine drugs is that despite being chemically similar enough to alcohol to keep withdrawal symptoms at bay it does not depress the respiratory system as much as alcohol.

This offers a significant safety margin between dose and overdose.

Non-Pharmacological detox

Not all clients who enter rehab with a substance use disorder will require a pharmacological detox.

Some clients may be diagnosed with a mild alcohol use disorder and their lower level of blood intoxication may mean they do not suffer extreme withdrawal symptoms when they stop drinking alcohol.

However, it is still important to provide a calm, supportive environment for these patients to ensure they remain stress-free during their withdrawal phase.

This is because there may be some uncomfortable symptoms that may need tending to.

Being in a residential setting means they can focus on their recovery, which is hugely beneficial to patients who usually live in a state of upheaval.

Residential rehab also ensures that people in recovery do not succumb to negative social influences that may trigger their relapse.

Rehab centre staff will be close at hand to monitor the patients carefully in case there are any medical complications or mental health emergencies that need addressing.

It is difficult to predict how any one patient will react to the withdrawal process, given the toxic and erratic effect that alcohol has on the central nervous system. (4)

What Happens After Detox Treatment?

Patients that enter rehab treatment for alcohol addiction will usually spend the first 7-10 days receiving detox treatment.

It is imperative that anyone who has completed detox should recognise the value of the psychological therapies and educational workshops they will work through after completing their detox.

Detoxification treatment is NOT a complete treatment for addiction, it is only one component of their overall rehab treatment plan. (3)

Alcohol addiction is a chronic condition with a huge potential for relapse.

Any patient that leaves rehab after receiving a detox and does not engage with the psychotherapeutic elements of their programme is more likely to relapse.

Patients diagnosed with an alcohol use disorder also become emotionally and psychologically reliant on alcohol as well.

They will need to work through the psychological attachment they have to alcohol in group and individual therapy sessions. (4)

Psychological Therapies

The main psychological therapies used in alcohol detox centres (rehab) are:

Cognitive Behavioural Therapy
Dialectical Behavioural Therapy
One-to-one alcohol counselling
Group therapy
AA meetings
12-step therapy (7,13)

References

(1) Black, D., Grant, J. (2013) DSM5 Guidebook: The Essential Companion to Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition. APP. London.

(2) Ewin- NHS (2022) Alcohol withdrawal assessment scoring guidelines available@ Alcohol Withdrawal Assessment Scoring Guidelines (CIWA – Ar) (ewin.nhs.uk)

(3) Ghodse, H. (2002) Drugs and Addictive Behaviour: A guide to treatment Cambridge University Press.

(4) Herie, M. & Skinner, W. (2014) The Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.

(5) Kahan, M. (2014) Physical Effects of Alcohol and Other Drugs. In Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada

(6) Mack, A.H., Harrington, A.L. & Frances, R.J. (2010) Clinical Manual for Treatment of Alcoholism and Addictions. APP. London.

(6a) Mee-Lee, D. (2013) The ASAM Criteria: Treatment Criteria for Addictive, Substance Related and Co-occurring Conditions

(7) Moss, A, Dyer, K (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York.

(8) National Health Service (2021) Alcohol Misuse available @ Alcohol misuse – NHS (www.nhs.uk)

(9) National Institute for Clinical Care Excellence (2022) Management of Acute Alcohol withdrawal available@Alcohol Care Bundle A4 guide (nice.org.uk)

(10) Peterson, T. (2002) Exploring Substance Misuse and Dependence Explanations, Theories and Models in Working with Substance Misusers: A Guide to Theory and Practice by Peterson, T. & McBride, A. (ed) London. Routledge.

(11) Pycroft, A. (2010) Understanding and Working with Substance Misusers. Sage. London.

(12) Raistrick, D. (2004) Alcohol Withdrawal and Detoxification in Heather, N., & Stockwell, T. (ed) The Essential Handbook of Treatment and Prevention of Alcohol Problems by (2004). John Wiley & Sons. Chichester.

(13) Rassool, G.H. (2011) Understanding Addictive Behaviours. Palgrave MacMillan. New York.

(14) Stern, TA; Gross, AF; Stern, TW; Nejad, SH; Maldonado, JR (2010). . Primary Care Companion to the Journal of Clinical Psychiatry. 12 (3). available@Current Approaches to the Recognition and Treatment of Alcohol Withdrawal and Delirium Tremens: “Old Wine in New Bottles” or “New Wine in Old Bottles” – PMC (nih.gov)