How to Break Out of a Blackout: A Detox 411

By Dr. Scott Bienenfeld 04/28/11

If you find yourself trapped in the middle of a full-blown bender, stopping cold-turkey could endanger your life. So how do you revert from insane over-indulgence to a semblance of sobriety? Our expert five-step guide provides some useful advice.

Don't Try This at Home! Medical help is key to a safe and comfortable detox. Thinkstock

So you’re blotto on a bender—say it’s the middle of the night on Day 2, and you’ve just woken up, and you don’t have any booze at home, and as you’re looking for your keys and wallet to go out and pick up a six-pack to tide you over, you decide that you just can’t bear to lose another day of your life to oblivion, and that you might as well head to detox rather than the deli—how do you do it? Where do you go? What can you expect? Here's a tip sheet that breaks the entire process down for you.

1. Start with medical help. Your best bet is to call 911 if you are in really bad shape or hop a cab to your local emergency room. In cities like New York, Chicago and Los Angeles, however, hospital-sponsored walk-in clinics may be cheaper, faster, and easier to handle. Make sure you have your wallet with photo ID, health insurance card, and prescription medication you may be on. Be prepared to undergo a thorough medical examination (a full history, physical exam, and routine blood work as well as a toxicology screen to measure your blood alcohol content and any other drugs). You should provide an honest history of your drinking and drug use, explain which prescription meds you take, and discuss any other physical or mental health issues you have. Depending on the severity of your condition, an E.R. doctor will likely advise a stay lasting from several hours to several days.

2. Warning: Don’t try this at home. Yes, E.R.s are crowded, hectic, depressing—and often very expensive. And no, hospitals aren’t anyone’s idea of a good time. But detoxing at home is dangerous. By stopping cold turkey, you may be risking acute alcohol withdrawal—especially if your alcohol abuse is severe. While only about 5% of alcoholics suffer the most severe symptoms, even the mild variety can be painful and scary. Proper medical treatment improves your odds of a safe detox by ensuring that any medical issues that arise are dealt with professionally.

3. Allow three to five days for drying out. When your alcohol-soaked body and brain are “drying out,” you face certain health hazards. Almost everyone experiences certain initial symptoms—generally from six to 24 hours after downing your last drink—such as increased pulse and respiratory rates, sweating, shakiness, insomnia, and agitation. One common symptom is known as formicating—the sensation that insects are crawling on or under your skin. There’s also the risk of delirium tremens (D.T.s), an extreme and poorly understood form of withdrawal that results in shivering, palpitations, acute anxiety, and hallucinations. Some heavy drinkers endure seizures within the first 48 to 72 hours after their last drink. Seizures may last for several minutes or longer and typically involve loss of consciousness and convulsions. In some cases these seizures can lead to more severe medical problems and even death if the person is not being monitored.

4. Take meds to boost brain and body. Detoxing patients are usually given a sedative to reduce the symptoms of withdrawal and protect against seizures. Benzodiazepines such Ativan or Valium are most commonly used. Because many alcoholics are malnourished, nutritional support is also necessary, mainly with vitamin injections, including thiamine (B1), B12 and folate (B9).

5. Next stop: rehab. The entire withdrawal process generally lasts from three to five days. But while successful medical detox can help avoid severe medical problems, it doesn’t prevent the problems associated with longer-term low-level withdrawal, which can last up to six months. Treating alcohol detox is a psychological process as well as a medical one. For most people, continuing care in a residential facility that treats patients with substance abuse disorders should follow detox. In fact, the period immediately following detox is a window of time when a person may be more inclined to accept and follow the advice of professionals who recommend longer-term rehab. The hospital or clinic should provide you with several rehab recommendations. And of course, that’s when the recovery process truly starts.

Scott Bienenfeld, M.D., a psychiatrist and addiction specialist, has been in private practice in New York City since 2000. He is also the medical director for The New York Center for Living, in New York City, an outpatient substance-abuse treatment center for adolescents and young adults, as well as a consulting psychiatrist for Road Recovery, a program to keep teenagers sober through music and the arts.

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