Advice on managing alcohol withdrawal from a Castlegar withdrawl nurse

Submitted by Ashley Parsons, Axis House Withdrawal Management

Human consumption of alcohol has been a phenomenon forever. Well, at least 9,000 years. Likely discovered by accident it evolved to become ingrained in culture, ritual, religion and medicine. People used it, and still do, to feel euphoric, to lubricate social encounters, to escape or manage pain or mental health issues.

It is unsurprising that alcohol can cause significant harms to individuals, families, communities. It is well documented. The line between "appropriate" use of alcohol and problematic use is less so.

A physician, psychologist or psychiatrist can make a medical diagnosis of alcohol use disorder, based on 11 very specific criteria. Often intuitively individuals and families know when alcohol use becomes problematic: longer-term use, increasing quantity, roles being unfulfilled, the substance might seem to be in control and in some cases withdrawal occurs when the person attempts to stop.

The brain of a person with alcohol use disorder (or any substance use disorder) has been hijacked by inherent pleasure seeking responses, rewiring their circuitry to become increasingly dependant on the use of that substance. Not everyone will have the same response to a substance, some people are more susceptible to developing problematic substance use due to trauma, adverse childhood experiences or genetics, among other factors. The point here is that the brain changes.

Because the brain has changed, when the substance is removed withdrawal can occur. This is different from a hangover. It is the effect of rebalancing that occurs when a brain that has adapted to chronic alcohol use is starved of that substance.

In the simplest terms, the brain has to recompensate for the changes that have occurred over time. Here is the interesting thing about alcohol withdrawal: it is life threatening. Our most accessible, legal, socially acceptable substance is the most dangerous to withdraw from. More dangerous to withdraw from than crystal meth, than crack, than even fentanyl.

Surprised? Many people are.

People withdrawing from alcohol are not only uncomfortable with sweating, tremors, nausea and vomiting, they are also at risk seizures or delirium tremens. Delirium tremens (DTs) is a rare but dangerous manifestation of alcohol withdrawal in which the person may suffer confusion, changes in level of consciousness, hallucinations, agitation and aggression. They can be a danger to themselves or others.

Both the discomforts and the risk of having life-threatening complications can be managed medically. Some people opt to withdraw at home with support while others opt for inpatient care at the withdrawal management site in Castlegar, Axis House. Either way, it needs to be recognized that this is not a bad hangover, it is a withdrawal syndrome that requires medical intervention.

It is important to acknowledge that even after withdrawal a person will still struggle with substance use. Withdrawal management is far from a cure; only the first baby step in the journey of recovery. And changing brain circuitry is extremely hard work.

Even after the initial three-to-five days of inpatient care, physical symptoms can persist to a lesser degree for up to six months. Even then the factors that contributed to development of the issue in the first place need to be addressed.

Addiction is a chronic illness that requires work to manage every single day. People often have relapses back into that "hijacked" maladaptive pattern. And every time the person endures withdrawal the risk of complications and the severity of their symptoms increases.

Beyond all of the dangers of intoxication, the social harms, the consequences for families, it can be startling to realize that there is potential for harm in cessation of alcohol use. This courageous leap toward making change requires support. If you or a loved one is ready to address problematic alcohol use, acknowledge the harms that can occur during withdrawal. Involve your healthcare team and stay safe.