Is it possible to detox from alcohol at home? What happens if you quit drinking without going to rehab?
Are you thinking about quitting alcohol? Have you already decided that you are not going to check into a rehab? Many people make that decision, and most of them have good reasons.
Yes, you can stop drinking at home, and people do it every day. Unfortunately, the part that most articles on the subject leave out is that alcohol withdrawal, unlike withdrawal from most other drugs, can kill you.
So, the answer is yes and no. You can quit at home, and you must not quit alone.
Why do so many people decide against rehab in the first place? And, if not rehab, then what?
Why do so many people decide against rehab?
Do you have a job that cannot be left for thirty days? Children? A business with your name on the door? Just because you are drinking too much does not mean that you are not functioning in your life.
The cost of residential rehab is high, and even with insurance you may decide not to spend tens of thousands of dollars to sit in group circles for a month.
There is also the question of what you would be paying for. Unfortunately, the rehab industry in the United States is built on the 12 steps, and 12-step-based programs tend to favor abstinence without medical treatment, even where proven medical treatments exist.
Follow the money, and you find programs competing for bodies to fill their beds, with much of what they take in going right back out as marketing. One clue to the nature of the business is that these medical facilities refer to their admissions as “clients,” not patients.
Some people find that the 12 steps are what works for them, and that is their choice to make. I no longer recommend meetings as part of medical care, and a meeting is never a substitute for medical supervision of alcohol withdrawal. Yet, you do not have to be a pawn in the rehab game to quit drinking safely. What you cannot do without is a doctor.
Alcohol withdrawal can be deadly. Why is it so dangerous?
Withdrawal from most drugs is miserable, and it is not usually dangerous to the body. Alcohol is one of the exceptions. Within hours to days of the last drink, a heavy daily drinker can develop seizures, or the DTs, also known as delirium tremens.
Delirium tremens is a state of confusion with a racing heartbeat, high blood pressure, fever, drenching sweats, shaking, and hallucinations. It is a medical emergency, and without treatment it can be fatal.
Why does the body do this? Think of a pot on the stove with a heavy lid, and think of alcohol as the lid. Over years of daily drinking, the brain turns up the flame underneath to keep things moving under the weight of it.
Take the lid off all at once and the pot boils over. That boiling over is the tremor, the sweating, the racing heart, and, at the extreme, the seizure. While this is not a perfect analogy, it explains the one instruction that matters: the lid has to come off slowly, with someone watching the pot.
What are the stages of alcohol withdrawal, and when do the symptoms begin?
Withdrawal begins as the alcohol level in the blood falls, not when it reaches zero. For a heavy daily drinker, the first symptoms can start within six to twelve hours of the last drink. Shaky hands, anxiety, sweating, clammy skin, nausea, a pounding heart, and a sleepless night are the early signs.
Hallucinations, usually visual, can appear between twelve and twenty-four hours in. Withdrawal seizures most often occur within the first two days. Delirium tremens, when it comes, typically starts two to three days after the last drink, sometimes later.
Not everyone goes through every stage. While someone who drinks moderately on weekends may feel nothing worse than a bad hangover, a person who has had withdrawal seizures or the DTs before is at high risk of having them again.
This escalation over hours and days is exactly why quitting cold turkey is dangerous. The early stage feels survivable, and the dangerous stage arrives after you have decided that you are through the worst of it.
Call 911 or go to the emergency room if you, or the person you are with:
- has a seizure, or has had a withdrawal seizure before and is now shaking hard and drenched in sweat.
- is confused, does not know where they are, or is seeing or hearing things that are not there.
- has a fever, a racing or irregular heartbeat, or chest pain.
- cannot keep fluids down, or is too weak or unsteady to stand.
If drinking, or trying to stop, has left you feeling that there is no way out, call or text 988, the Suicide and Crisis Lifeline, at any hour.
How long does alcohol take to leave your system?
The liver clears roughly one standard drink an hour, and no amount of coffee, cold showers, or exercise speeds it up. A standard drink is a twelve-ounce regular beer, a five-ounce glass of table wine, or a shot of eighty-proof liquor, about an ounce and a half. Body size, sex, food, pace, and genetics change how high the level climbs and how long it takes to come down, so a bottle of wine at night can still be in the blood at breakfast.
For a heavy daily drinker, this arithmetic matters for one reason. Withdrawal starts as the level falls, which is why the shakes arrive in the morning, sometimes while there is still alcohol in the blood.
Why do the shakes and clammy skin keep people drinking?
A daily drinker who wakes up shaking and sweating, with cold and clammy hands, has learned something the body does not forget. A drink makes it stop, the hands are steady within twenty minutes, and the day can begin.
Fear of that feeling, not lack of willpower, is what keeps many people drinking. Every attempt to stop brings the shakes back, and the shakes bring the drink back. Is that weakness? Is it a character flaw? Is it a failure of will?
It is none of those. It is physical dependence, and physical dependence is not addiction. Dependence is the body’s adjustment to the drug, the turned-up flame under the pot, and it is a medical condition with a medical treatment.
Of course, with alcohol the two usually travel together, and the craving and the compulsion are the other half. Fortunately, there is treatment for that half as well.
In my practice, the morning shakes are often the first thing a patient mentions, before the DUI, the marriage, or the liver tests. They have usually tried cold turkey more than once, and the shakes won every time. Cold turkey is not the only exit.
What is Wernicke-Korsakoff syndrome, and why does every alcohol taper start with thiamine?
Heavy drinking depletes thiamine, or vitamin B1. Alcohol interferes with its absorption from food, and a person who drinks heavily often does not eat well in the first place.
Run short of it, and the result can be Wernicke encephalopathy: confusion, trouble with eye movements, and a staggering, unsteady walk. Left untreated, it can progress to Korsakoff syndrome, an often permanent loss of the ability to form new memories. Together, they are Wernicke-Korsakoff syndrome, or, in the old slang, “wet brain.”
This is why thiamine comes first, and why a doctor gives it before glucose or a big meal, which can use up the last of the reserve. Folate, or folic acid, and the rest of the B vitamins are usually replaced at the same time, and magnesium, often low in heavy drinkers, is checked and replaced as needed.
Vitamins from the pharmacy shelf are not a substitute for a doctor here. The doses and the order matter, and a person who is already confused cannot manage them alone.
So, does this treatment have to happen in an inpatient detox facility?
Detox centers are not hospitals. A patient in critical condition, in the DTs or having seizures, belongs in the intensive care unit of a real hospital. And, a person with heart disease, liver disease, past seizures, or several other health problems may do best going to an emergency department first for an evaluation.
While withdrawal can be managed at home for most people by a doctor who is experienced in it, whether home is safe for you is the doctor’s call. That call is made from your drinking history and your health, and it comes before the first missed drink, not after.
The standard medical treatment for alcohol withdrawal is a benzodiazepine, such as Librium (chlordiazepoxide), Valium (diazepam), or Ativan (lorazepam). It is given for a few days and tapered down as the withdrawal settles. It quiets the over-excited nervous system while the alcohol leaves, and it prevents seizures. Thiamine, folate, fluids, and daily contact with the doctor complete the plan.
One warning belongs here. If you already take a benzodiazepine for anxiety or sleep, tell the doctor, because a benzodiazepine must never be stopped suddenly either. Abrupt discontinuation can trigger seizures and can be life-threatening, and alcohol withdrawal layered on top of benzodiazepine withdrawal is far more dangerous than either alone.
So, at home with a doctor is not a compromise. It is the same medicine, in your own bed, with your own family, and without a marketing department.
What is the alcohol deprivation effect, and why does cold turkey so often fail months later?
The alcohol deprivation effect was first described in laboratory animals. Take alcohol away from animals that have learned to drink it, give it back weeks later, and they drink more than they did before the break.
In people, the picture is less tidy. Many people who quit cold turkey do well for months, and then the cravings come back stronger than ever, even with support from family, meetings, and counseling.
What I have noticed in my own patients is a pattern, and I offer it as an observation, not a proven fact. Patients who quit abruptly often hit a craving rebound somewhere in the months that follow, and one sip at that point can open the floodgates. Patients who taper their drinking down gradually with naltrexone tend not to describe that rebound at all.
I do not know the whole reason. One theory is that abstinence never unlearns the brain’s drive to drink, it only starves it, and a starved drive comes back hungry.
Cravings do not have to lead to drinking, and people learn to get through them. Yet, it would be better not to have them at all. Is there a way to quit that takes the drive apart instead of starving it?
Is it possible to quit drinking by having a glass of wine with dinner?
As strange as it sounds, some people quit drinking by drinking. The method was developed in Finland, and it is known as the Sinclair Method, or TSM.
The doctor prescribes naltrexone, a medication that blocks the brain’s opioid receptors, the receptors that endorphins act on. Alcohol releases endorphins, and endorphins are the reward that taught the brain to want the next drink. With naltrexone in place, the drink still happens, and the reward does not.
The patient takes a tablet one hour before drinking, every time, and drinks as they normally would. Nothing dramatic happens that evening. Over weeks and months, though, the brain unlearns the drive, a process known as pharmacological extinction.
Many patients find themselves drinking less often and less at a time, and a good number stop altogether without ever deciding to. Imagine quitting alcohol by having a glass of wine with dinner.
There is no cold turkey and no withdrawal cliff, because the drinking comes down gradually, the way a good taper of any drug comes down. This is the principle behind every taper, and alcohol is not an exception to it.
TSM does not require you to be abstinent to begin, and it suits gray area drinkers as well as people with alcohol use disorder. Naltrexone blocks opioid pain medicines, so it is not for a person who needs them, and the doctor will usually check your liver along the way. While TSM can still seem unorthodox in the United States, it is not a bad idea to ask your doctor about it.
What about acamprosate and disulfiram?
Campral, or acamprosate, is the other commonly prescribed option. It is taken after you have already stopped drinking. It is thought to steady the brain chemistry that alcohol disturbed, though nobody fully understands how it works. It is generally well tolerated, and its most common side effect is diarrhea.
So, why naltrexone first? In my opinion, the logic of the Sinclair Method decides it. While acamprosate asks you to stop first and then holds the line, naltrexone lets the drinking wind down without a cliff.
There are patients for whom acamprosate is the better fit, and sometimes the two are prescribed together. I have compared them in more detail in acamprosate vs naltrexone.
Antabuse, or disulfiram, is punishment by design. Take it and then drink, and before long you are flushed, nauseated, and vomiting, with a pounding heart and a throbbing head. A severe reaction can be dangerous, and it must never be given to a person who is drunk, or to anyone who does not know they are taking it.
Supervised disulfiram, where someone watches the daily dose go down, does work for some people who want a hard stop. Yet, it is rarely my first choice, because a treatment that works by making you sick is a treatment that most people quietly stop taking.
How should you prepare to quit or cut back at home?
Get the alcohol out of the house. A cabinet full of bottles is a trigger, and even on the Sinclair Method, where you will still be drinking for a while, it is a good idea not to keep a large supply around. Clear your schedule, because the first days of stopping, or of cutting down sharply, are not days to be at work or in charge of small children.
Line up your support before you need it. Who will be in the house? Who can drive you to an emergency room at two in the morning? A person going through withdrawal should not be alone, and the person with them should know the 911 list above.
Drink water or an electrolyte drink through the withdrawal period, because vomiting, sweating, and not eating drain fluids and salts fast. Dehydration makes every symptom worse, and it can turn a manageable withdrawal into an emergency. Eat, even when food is the last thing you want, and take the vitamins and magnesium your doctor prescribes, in the doses the doctor gives.
You will find amino acid supplements sold for withdrawal and cravings, L-tyrosine, L-tryptophan, taurine, acetyl-L-carnitine, and others. The evidence for them is thin. If you want to try one, that is a conversation with the doctor who is watching your withdrawal, not a decision made in the supplement aisle.
Why does a drink to help you sleep make the insomnia worse?
While alcohol helps you fall asleep, it wrecks the second half of the night. It suppresses dream sleep, and as it wears off the brain rebounds into light, broken sleep with more awakenings. Snoring gets louder, and sleep apnea gets worse in the people who have it. So, the nightcap that seems to fix insomnia is causing it, and in early withdrawal the insomnia is often the hardest part.
A sleeping pill is not the answer either. Most prescription sleeping pills are benzodiazepines or the related z-drugs, which act on the same brain system as alcohol, and a person leaving one physical dependence should not be handed another. Fortunately, sleep does come back, over weeks rather than days, as the flame under the pot turns down. Until then, keep a fixed wake time, and tell your doctor if you are not sleeping at all.
How do you help someone who drinks without pushing them away?
If a person you love is drinking too much and will not slow down, you may want to do whatever it takes to make them stop. Be careful. Force pushes people away, and a person who has been pushed away is harder to help and in more danger.
Tough love, meaning ultimatums and the door, is not treatment. What helps is harm reduction, meaning you protect their safety until they are ready to get out of harm’s way. Keep them eating and drinking water, know the signs of withdrawal, know when to call 911, and keep the conversation open about what a doctor could offer, without a lecture attached.
While a professional interventionist can sometimes help, the help is a calm, informed conversation about medical options from someone outside the family, not an ambush. Sober coaches and 12-step sponsors help some people to stay quit, and finding a sponsor is not always easy, particularly for women in meetings that are mostly men.
None of these people can prescribe naltrexone or manage a withdrawal, and none of them can tell you whether your loved one’s withdrawal is safe at home. That is a doctor’s job, and the first appointment can be nothing more than a conversation about options. In my experience, people who feel respected come back.
What is the first step?
Before you stop drinking, or start cutting down, see a doctor. If your doctor has no experience with alcohol withdrawal or with naltrexone, ask for a referral to one who does.
Then make the plan together: whether home is safe for you, which medication fits, who will be with you, and what the first week looks like. The plan should be patient directed, because you are the one who has to live it.
The best time to quit drinking was the day you first noticed it was a problem. The next best time is today, with a doctor, and not cold turkey.
Dr. Leeds treats alcohol use disorder with the Sinclair Method by telemedicine.
Dr. Leeds prescribes naltrexone and guides patients through the Sinclair Method by telemedicine throughout Florida, with in-office visits available in Fort Lauderdale. Treatment does not require abstinence to begin, there are no mandatory group meetings, and the pace is set with each patient as a partner.
If you are drinking more than you want to, or you are afraid of what will happen when you stop, contact Dr. Leeds through the contact form to ask about the Sinclair Method.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
