Alcohol Withdrawal and the Kindling Effect
- Kim May
- 7 days ago
- 4 min read
In media, it is opioid withdrawal that gets all the attention. Countless movies and TV shows have depicted someone addicted to heroin and the harrowing experience of coming off it. Yes, opioid withdrawal sucks, but it is not likely to kill you.
Withdrawing from alcohol might.
That is a little alcohol factoid that it is conspicuously absent from our society’s portrayals of alcohol. For people with alcohol use disorder who are consistent and heavy drinkers, withdrawal from alcohol can range from unpleasant to life threatening.
What is alcohol withdrawal?
Alcohol withdrawal syndrome comprises a range of symptoms that may occur after a person ceases or reduces their alcohol intake after a period of heavy, sustained use.
Alcohol is a central nervous system depressant; thus, it has a sedating effect on the brain. When the brain is continuously exposed to the depressant effects, it adjusts its own chemistry to compensate. When the alcohol is removed, there is nothing to “slow down” the brain and the brain become overstimulated.
What are the symptoms of alcohol withdrawal?
Symptoms range from mild to life-threatening and tend to emerge 6-24 hours after the last drink. Not everyone will experience all symptoms.
Headache
Anxiety/irritability
Difficulty sleeping
Excessive sweating
Digestive issues
Heart palpitations
Increased blood pressure/heart rate
High body temperature
Tremors (“the shakes”)
Alcohol hallucinosis
Seizures
Delirium Tremens
Which symptoms of alcohol withdrawal are the most dangerous?
The level of danger with various symptoms can vary based on a person’s medical history and underlying conditions. However, some symptoms consistently are considered dangerous.
Alcohol withdrawal seizures may occur 6-48 hours after the last drink. When people experience seizures, they commonly have several within a few hours.
Delirium tremens have a longer onset, typically a few days, but sometimes up to a week after the last drink. Related symptoms include changes to breathing, circulation, and temperature regulation. It can cause your heart to race or can cause your blood pressure to increase dramatically. It may also cause severe dehydration. Delirium tremens can also temporarily reduce the amount of blood flow to your brain.
According to Harvard Health, symptoms may include confusion, disorientation, stupor, or loss of consciousness, nervous or angry behavior, irrational beliefs, soaking sweats, sleep disturbances, and hallucinations. While relatively uncommon, delirium tremens are dangerous enough to be a consideration of all people who drink heavily and are considering stopping.
How is alcohol withdrawal treated?
Ideally, alcohol withdrawal is treated under the care of a physician. Alcohol withdrawal treatment helps to reduce withdrawal symptoms and prevent complications like seizures and/or delirium tremens. In some cases, doctors can assist with an ambulatory detox (outpatient), but in general, going inpatient for a few days is best, especially for people who are considered higher risk for severe alcohol withdrawal.
During a detox, medications are provided that reduce the potential for risk and complications. Additionally, blood work is usually taken to check for key nutritional deficiencies, manage hydration, and assess common health issues related to alcohol use disorder such as liver function.
If you are unsure what level of care would be best for you, consult with your doctor.
What are the risk factors for severe alcohol withdrawal?
Heavy daily alcohol use: According to the U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) heavy drinking is defined as:
Adult males-5 or more drinks per day or fifteen or more per week
Adult females: four or more drinks per day or eight or more drinks per week.
65 years or older
History of seizure or delirium tremens
Underlying health conditions
Dehydration
Electrolyte imbalances
Brain lesions
Abnormal liver function
What is the kindling effect in alcohol withdrawal?
Kindling is the worsening of withdrawal symptoms over time when a person repeatedly stops a psychoactive substance. It is most associated with benzodiazepines and alcohol. According to the Benzodiazepine Information Coalition, kindling is defined as: “the tendency of some regions of the brain to react to repeated low-level bioelectrical stimulation by progressively boosting synaptic discharges, thereby lowering seizure thresholds.”
The exact mechanisms at play in the kindling effect are still unclear. One of the suspected causes is due to the excess release of the neurotransmitter, glutamate. Glutamate increases activity to the brain’s neurons. Over time, the excess glutamate may damage these neurons, thus worsening the symptoms of withdrawal.
How to avoid the kindling effect in alcohol withdrawal
Unfortunately, the only way to avoid the kindling effect is to avoid relapses. Ideally, any treatment for alcohol withdrawal includes a good plan to minimize the likelihood of a relapse occurring. “Good” plan is subjective—for a plan to be good, it must be the right fit for the individual.
Options may include therapy for substance use, group recovery programs (i.e., SMART Recovery), in patient rehab, intensive outpatient programs, or peer support. For some, medications such as Naltrexone or Antabuse are options (based on consultation with their physician of course).
Support if you need it.
Managing alcohol use disorder can be isolating and overwhelming. Support is available if you need it. Whether you want to stop drinking, minimize your use, or simply have a non-judgmental space to explore your relationship with alcohol, Substance Use Therapy is here.
Important note: this post is for general information and not a substitute for a consultation with your prescriber.
Sources:
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By using a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation.
Comments