Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.
Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.
Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.
The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)
The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).
Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.
Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.
1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115
2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87
I can’t even count how many times I’ve talked about the difference between alcohol or drug users and alcoholics or addicts (see here, here, and here for some examples and keep reading). The quick summary: Many people use drugs and many abuse them at times, a small percentage meet criteria for addiction at some point in their life and an even smaller percentage is the type of addict we’ve been taught to think of – chronically relapsing and seemingly incapable of quitting no matter how crappy their life gets.
One of the main reasons we study drug and alcohol abuse is because of the hugehealth impact of this stuff – we spend billions and billions of dollars every year on health-care that is directly or indirectly related to the abuse of nicotine, alcohol, and pretty much every other drug on earth (marijuana can certainly help some conditions but heavy use of marijuana can bring its own consequences). One of the major players in these health problems is the effect of alcohol and drug use on stress in the body. Stress increases death rates in several ways including: Heart attacks, strokes, cancer, and more.
Well, a recent study in Amsterdam looked at alcohol (yes, you read that right, the Dutch care about more than weed) consumption, alcohol addiction (alcoholism) diagnosis, and effects on the body’s stress system, also known as the HPA (Hypothalamic-Pituitary-Adrenal) Axis. If nothing else, the study helped confirm that an alcoholism diagnosis is not necessarily the same as an indication of heavy drinking and that excessive drinking is no bueno, regardless of whether it meets addiction criteria or not.
Alcohol drinking, alcoholism, and stress regulation
I’m not going to go into this in detail (look here and here for more) but just as our brains and bodies have systems for decision making, they also have complex stress management systems. The latter rely heavily on hormones, including Cortisol, to keep our bodies in the right states whether those be fight, flight, or reading a book before sleep (see figure on left for over-simplified cortisol levels throughout the day in a normal person). We’re supposed to have the most cortisol right upon waking with constant reductions throughout the day until we fall asleep, and back again. Individuals with mental health disorders like anxiety and depression have substantially different cortisol level patterns throughout the day and are less effective at regulating cortisol (in case you needed another reason why our biology affects our states of being and behavior).
The dutch study tested cortisol levels at 7 different times throughout the day after giving their subjects a 4 hour battery of tests. They also assessed their cardiac functioning by assessing different measures related to heart beat regulation that allows for adapting across challenging situations by affecting the sympathetic nervous system (excitatory processes) and parasympathetic nervous system (inhibitory processes).
They looked at these measures as a way of assessing the relative functioning of the HPA Axes’ of different groups. Specifically, they looked at:
Moderate drinkers (less than 3 drinks per day)
Heavy drinkers (more than 3 drinks per day)
Remitted alcoholics (met criteria for alcoholism previously but not in past 12 months)
One of the most interesting findings, as far as I’m concerned, was that among remitted alcoholics the average amount of drinking was around 1.3 drinks per day with a lot of variability, a little higher than that of moderate drinkers (0.8 drinks per day) but lower than that of heavy drinkers (4.0 drinks per day). I see this as a little more proof that people who met criteria for alcoholism at one point don’t necessarily abstain forever and don’t necessarily continue to have drinking problems (per Moderation Management, spontaneous remission, or some other means of stopping their alcoholic drinking).*
You can blame improper diagnostic criteria, a continuum of addiction severity, or anything else as far as I’m concerned but as I pointed out in my first paragraph, we’ve talked about this topic repeatedly and I see no end coming soon. The bottom line is that meeting criteria for alcoholism at one point in life tells me something, but far from everything, about a person’s drinking habits or drinking problems later in life.
But back to stress. As you might have already guessed, since it is heavy drinking that causes serious dysregulation of the body’s stress response, what the researchers found was that meeting criteria for alcoholism now, or in the past, didn’t have any major effect over their participants’ HPA functioning. Instead, all that mattered was how heavy their drinking was now. Heavy drinkers had higher waking cortisol levels, higher night-time cortisol, and increased sympathetic (excitatory) control. In short – heavy drinkers were less able to regulate their stress and excitation response, likely leading to increased stress on their bodies.
As a side note, this study also found that if anything, moderate drinking conferred health benefits when it came to stress over not-drinking at all – far from the first study to note this but another set of reinforcing evidence that drinking alcohol is not in itself bad for you while over-drinking is.
So – Drinking a lot of alcohol causes disruptions to your body’s stress regulation system that will likely increase the likelihood of heart problems, depression, anxiety, and more. Those disruptions are there whether you meet criteria for alcoholism or not.
Obviously, there are many alcoholics who drink a lot of alcohol, but there are also people who meet (now or in the past) criteria for alcoholism who are binge drinkers and therefore don’t drink daily and have lower “drink numbers.” As we mentioned before, addiction is not about quantity, in fact, the criteria for addiction barely mentions quantity – when it states that addicts consume “more than intended” or that tolerance creates a state where an person needs greater quantity to reach the same effect of the drug. Drinking or using a lot of drugs or alcohol does not an addict make.
*Note: Given the variability in the remitted-alcoholics groups their is little doubt that some of them had stopped drinking while others drank to excess. Additionally, it should be pointed out that alcohol abuse was not assessed in this sample, so it could still be a problem for at least some of those now-drinking past-alcoholics.
We all know that drinking alcohol changes the way people think and can make them act strangely right? We also know that alcohol is involved in more than 50% of violent crimes and about 75% of partner violence. The question is, why the connection?
A recent paper I published suggests that drugs and alcohol can not themselves be thought to cause violence. Still, the relationship exists, so what gives?
The thought altering effects of consuming alcohol, and most drugs, can be said to affect something called executive functioning (EF). What exactly makes up this type of functioning is a source of some debate, but let’s just say that it refers to attention, strategic planning, reasoning, thought flexibility, and the ability to process information in working memory (an important type of memory used in learning).
You can probably already tell that this type of brain function is extremely important and that different people possess different levels of it. I can also tell you that alcohol consumption has been shown to reduce overall executive functioning. If you drink alcohol, or have ever seen someone drink, this probably doesn’t come as a huge surprise.
The thing is that alcohol consumption messes up everyone’s EF, though obviously, the more you drink, the more affected you become. Still, given the fact that more than 50% of Americans report at least one binge drinking episode a year and less than 7% are involved in violent crime, something else must be at play, right?
Aggressive personality and irritability
As I mentioned earlier, I published a paper showing that aggressive personality, which I measured using 5 different tests, contributes far more to violent behavior than drug use alone. Still, a recent study found that irritability alone could account for some aggressive behavior. Still, the more interesting finding had to do with alcohol-related EF problems and irritability together. The experiment was pretty interesting, so let’s go over it for a bit.
Researchers at the University of Kentucky took more than 300 students and gave them a whole bunch of tests assessing their EF and their overall level of irritability. Afterward, half of the students were given alcohol to drink (about 3-4 drinks per person) and the other half was given a similar number of drinks that contained no alcohol but were sprayed before being handed to smell the same. The students were then asked to play a game that pitted them against another person. The secret was that there was no game and no other person, the winner and loser in each round was pre-determined. Every time the student “won” they got to give the other player a shock, but every time they lost, they themselves got shocked. As the game went on, the shocks the participants got increased in intensity. The researchers wanted to see how the students would react and how large the shocks they would give back would be.
The results showed that the more mistakes people made in their initial EF testing (and therefore the less overall EF capability they showed) the more aggressive they were. This makes sense, as people who are less able to plan, think ahead, and control their behavior would be more likely to engage in things that would hurt them, or misjudge events and think react inappropriately. Irritability was also shown to affect aggression, but this time only for men and intoxicated women.
The effect of alcohol abuse on aggression and violence
When the whole thing was put together the researchers found that for drunk men only, reduced EF and increased irritability worked together to generate even more aggression that was shown for all the other participants. For the simplest example think back to anyone you know who is pretty quick to react anyway and is a little too easily pissed-off. Chances are they become a pretty mean drunk who likes to get in fights.
Obviously this makes sense if you know someone like that, but in terms of helping us make decisions about who should be considered dangerous and who shouldn’t, especially when consuming alcohol, this research helps further explain why we see such a strong connection between alcohol abuse and violence or aggression.
The way I see it there’s a relatively small number of people (mostly men) who is normally pretty aggressive, irritable, and lacking in judgment and self-control, who often get violent when they drink alcohol. For them, many alcohol drinking episodes end badly, and since they’re the most visible of the aggressive drinkers, their behavior produces an association between alcohol consumption per se and violence. For the rest of us, alcohol consumption rarely leads to violence, but violence rarely occurs without drinking alcohol either, so we hardly ever enter the equation at all. That’s why the pattern holds.
Godlaski, A. J., Giancola, P. R. (2009). Executive function, Irritability, and Alcohol-Related Aggression. Psychology of Addictive Behavior, 23, 391-404.
Jaffe, A. et al., (2009). Drug Use, Personality and Partner Violence: A Model of Separate, Additive, Contributions in an Active Drug User Sample. The Open Addiction Journal, 2.
What influences college students’ decisions about whether to drink and how much?
Do friends peer pressure them?
Do they do it because they are bored?
Do they drink to relieve depression or anxiety?
Researchers recently tried to answer these questions by surveying college students…
65% of the participants reported having at least one drink in the past three months. It was astonishing that the typical number of drinks in a week was 10.5 and on a weekend was 7.3 average drinks. These numbers included drinkers and nondrinkers and was the average (meaning around half the people had more drinks as those had less). This indicates that college drinking is far more extreme than drinking happening outside of the college setting.
3 main influential factors for someone’s decisions in college drinking and to what extent:
You can tell a lot about a person by watching their friends, so watch who you surround yourself with. Those who think favorably of drinking tend to think they can drink more before reaching intoxication and also tend to hang out with others who do the same. However, these people are the ones that need the most intervention yet are the most difficult to change.
Those who socialize with a wide variety of people typically are lighter drinkers and tend to respond better to treatment immediately as well as have fewer problems further down the line. The heavier drinkers benefit more from motivational interventions focusing on their attitudes toward drinking.
Regardless of stereotypes, ethnicity, weight and gender did have an effect on any of these findings. It was peoples’ closest friends that were the most significant factor in influencing all aspects of college drinking.
Examining the Unique Influence of Interpersonal and Intrapersonal Drinking Perceptions on Alcohol Consumption among College Students. Journal of Studies on Alcohol and Drugs. Volume 70, 2, March 2009
By the time I was done with my addiction to crystal meth, I had racked up 4 arrests, 9 felonies, a $750,000 bail, a year in jail, and an eight year suspended sentence to go along with my 5 year probation period. Though I think education is important to keep getting the message out about addiction and drug abuse, there is no doubt that addiction stories do a great job of getting the message across, so here goes.
My crystal meth addiction story
The kid my parents knew was going nowhere, and fast. That’s why I was surprised when they came to my rescue after 3 years of barely speaking to them. My lawyer recommended that I check into a rehab facility immediately; treating my drug abuse problem was our only line of legal defense.
I had long known that I had an addiction problem when I first checked myself into rehab. Still, my reason for going in was my legal trouble. Within 3 months, I was using crystal meth again, but the difference was that this time, I felt bad about it. I had changed in those first three months. The daily discussions in the addiction treatment facility, my growing relationship with my parents, and a few sober months (more sobriety than I had in years) were doing their job. I relapsed as soon as I went back to work in my studio, which was a big trigger for me, but using wasn’t any fun this time.
I ended up being kicked out of that facility for providing a meth-positive urine test. My parents were irate. I felt ashamed though I began using daily immediately. My real lesson came when I dragged myself from my friend’s couch to an AA meeting one night. I walked by a homeless man who was clearly high when the realization hit me:
I was one step away from becoming like this man.
You see, when I was in the throes of my crystal meth addiction, I had money because I was selling drugs. I had a great car, a motorcycle, an apartment and my own recording studio. After my arrest though, all of that had been taken away. I just made matters worse by getting myself thrown out of what was serving as my home, leaving myself to sleep on a friend’s couch for the foreseeable future.
Something had to change.
I woke up the next morning, smoked some meth, and drove straight to an outpatient drug program offered by my health insurance. I missed the check-in time for that day, but I was told to come back the next morning, which I did. I talked to a counselor, explained my situation, and was given a list of sober-living homes to check out.
As I did this, I kept going to the program’s outpatient meetings, high on crystal meth, but ready to make a change. I was going to do anything I could so as not to end up homeless, or a lifetime prisoner. I had no idea how to stop doing the one thing that had been constant in my life since the age of 15, but I was determined to find out.
When I showed up at the sober-living facility that was to be the place where I got sober, I was so high I couldn’t face the intake staff. I wore sunglasses indoors at 6 PM. My bags were searched, I was shown to my room, and the rest of my life began.
I wasn’t happy to be sober, but I was happier doing what these people told me than I was fighting the cops, the legal system, and the drugs. I had quite a few missteps, but I took my punishments without a word, knowing they were nothing compared to the suffering I’d experience if I left that place.
Overall, I have one message to those struggling with getting clean:
If you want to get past the hump of knowing you have a problem but not knowing what to do about it, the choice has to be made clear. This can’t be a game of subtle changes. No one wants to stop using if the alternative doesn’t seem a whole lot better. For most of us, that means hitting a bottom so low that I can’t be ignored. You get to make the choice of what the bottom will be for you.
You don’t have to almost die, but you might; losing a job could be enough, but if you miss that sign, the next could be the streets; losing your spouse will sometimes do it, but if not, losing your shared custody will hurt even more.
At each one of these steps, you get to make a choice – Do I want things to get worse or not?
Ask yourself that question while looking at the price you’ve paid up to now. If you’re willing to go even lower for that next hit, I say go for it. If you think you want to stop but can’t seem to really grasp just how far you’ve gone, get a friend you trust, a non-using friend, and have them tell you how they see the path your life has taken.
It’s going to take a fight to get out, but if I beat my addiction, you can beat yours.
By now, I’ve received my Ph.D. from UCLA, one of the top universities in the world. I study addiction research, and publish this addiction blog along with a Psychology Today column and a number of academic journals. I also have my mind set on changing the way our society deals with drug abuse and addiction. Given everything I’ve accomplished by now, the choice should have seemed clear before my arrest – but it wasn’t. I hope that by sharing addiction stories, including mine, we can start that process.
Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.
One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.
Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:
Money truly doesn’t buy happiness – Rich teens and drug use.
While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.
Thankfully, the researchers cited in the article gave some simple advice to parents:
Give children clear responsibilities to help around the house.
Take part in community service (to unite the family and reduce narcissism).
Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
Monitor internet use.
Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.
I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.