This article is not a substitute for a medical assessment. If you think that you or someone you know is experiencing alcohol withdrawal please seek help immediately.

ALCOHOL WITHDRAWAL?

The lockdown announced by the Prime Minister on the 23rd March changed all our lives. In one moment how we live, work, interact and communicate transformed.

We now live in a way none of us could have imagined at the start of March. For most of us, we are adapting to the ‘new normal’. In recovery we are attending our zoom meetings, building virtual communities, and, together over video chats, we address our fears, anxiety, share moments of celebration or sadness and support each other, until the time is right that we can meet again. But for others, the lockdown experience has meant persistent fear, anxiety and an unfathomed dimension of loneliness and isolation – the bedfellows that feed addiction.

Is it therefore so surprising that alcohol sales in the UK are up by at least a third since lockdown started? George Bernard Shaw described alcohol as “the anaesthesia by which we endure the operation of life.” For a small – but significant quantity of the population, the quote could be repurposed, so that alcohol becomes “the anaesthesia by which we endure the lockdown.” A recent article in The Guardian citing research from Alcohol Change UK reported that some 8.6 million Britons have increased their alcohol consumption during lockdown.

For the majority, this won’t be an issue, but a percentage of the 8.6 million people will build up a tolerance, become dependent, and potentially spiral into addiction.  In fact it would not be surprising to see a 10%-20% rise on the currently estimated 586,780 dependent drinkers in the UK - a possible extra 50,000-100,000 might meet the criteria for dependence within a few months, to the point of needing support through community, peer groups or addiction treatment. That’s a lot of people – too many for existing resources. Add these numbers to drugs, gambling, gaming, sex, love, and we have a secondary epidemic.

So, while most of the population are happily watching Normal People or Tiger King of an evening, a small but significant percentage are drinking themselves into blackout.

And it’s reaching a troubling head of steam.

There is no doubt that the human tragedy of lives lost during the pandemic eclipses all else. Of the other consequences, the majority of the first wave were the visible ones - the financial hardship for individuals and businesses, the physical and practical consequences of isolation and social distancing. But almost 2 months in we are beginning to see a second wave of disastrous consequences – social, emotional, wellbeing and welfare related, in their various forms, shapes and sizes. And what we are seeing of this wave, to mix oceanic metaphors, is just the tip of the iceberg.

Action on Addiction treats all forms of addiction. We have been here for people in its life stopping grip for over 35 years. And we are working round the clock to make sure we are still here, open to provide treatment now and after lockdown for people who need it, whether they can afford it or not. We are developing advice on how to spot the signs of addiction. Today we address alcohol.

So, when does an extra glass or two of wine to numb the effects of watching the news turn into problem drinking? How can you tell? How far into the afternoon does the 6.00pm beer, or prosecco need to move for it to be a sign that something’s not quite right? And even if it’s out of boredom rather than desire for anaesthesia, when does the tolerance developed by drinking become more like dependence? Where is the line? 

The focus in this article is to describe signs of tolerance, dependence and withdrawal, to help you notice if you may be experiencing them. Alternatively, if you’d prefer to speak to someone for a simple assessment please get in touch.

Acute Alcohol Withdrawal can be fatal. If you believe that you or someone you are with is experiencing acute alcohol withdrawal, call 111 or 999 immediately.

What is alcohol withdrawal?

Put simply, the human brain on a regular intake of alcohol learns to chemically rebalance itself in order to counteract the depressant and sedative effects and adapts accordingly as quantities of alcohol increases. To use the current favoured expression, a “new normal” in brain chemistry is achieved, dependent on the regular, (usually increasing) consumption of alcohol. If the quantity of alcohol reduces drastically or is suddenly stopped, this “new normal” is thrown into disarray, with the brain being totally overstimulated by the chemicals it is producing. It needs the alcohol to level things out again – and if it doesn’t get it, that’s when withdrawal starts.

Shaking and trembling signify the first and most common stage of alcohol withdrawals.

Depending on the degree of severity this stage of alcohol withdrawal is normally accompanied by symptoms such as excessive sweating, rapid heartbeat / pulse, high blood pressure, anxiety, sickness and vomiting, sleeplessness.  If you have ever woken up after a bender in the small hours of the morning, drenched sweat and unable to get back to sleep in an agitated state of mind, this may be a sign of alcohol withdrawal.

Hallucinations can also happen on their own, without an accompanying seizure or sensation. They can be mild – like thinking you’ve just seen something, catching a flashing glimpse out the corner of your eye, seeing insects, animals, or truly terrifying visions. They can be accompanied by sounds that seem real. They can create strange feelings and delusions and cause unusual or even violent behaviour.

Alcoholic Seizures are also extremely dangerous. They can be the result of acute withdrawal after drinking heavily for an extended period or alcohol poisoning after binge drinking. A withdrawal seizure is generally like a grand-mal or tonic-clonic epileptic seizure and typically includes convulsions, uncontrollable muscular contractions, unconsciousness, incontinence. You do not have to be a diagnosed epileptic to have a seizure, they can happen to anyone. A seizure caused by poisoning is very similar but could also include vomiting and difficulty breathing. In either case if a seizure is suspected you should call the emergency services immediately.

Delirium Tremens, better knowns as DT’s, are the most dangerous and drastic form of withdrawal and occur when the brain simply cannot deal with the sudden absence of alcohol, and vital functions and organs such as heart and lungs, blood pressure, breathing and temperature are severely compromised. Someone with Delirium Tremens will typically experience a state of confusion, hallucinations, shaking/tremors, or they may sleep for an unusually long time. DT’s can lead to fitting, stroke, heart attack, and death. If DT’s are suspected you should call the emergency services immediately.

Here is a list of other question that you may want to consider if you’re concerned that you may be developing a dependency on alcohol:

Are you finding that you start drinking / using earlier in the day?

Do you need to drink more to get the same effect (ease of anxiety, calm, contented?)

Are you struggling to sleep through the night? Or sleeping more?

Do you wake in the night covered in sweat after drinking? Or sweat unexplainedly at other times? (Unexplained sweating can be the symptoms of other health issues as well, such as menopause, asthma, heart disease.)

Are your hands shaking in the morning? Or before your first drink?

Do you find yourself craving a drink / substance to alleviate increased anxiety?

Are you having strange and unexplained visual or auditory hallucinations?

Do you ever feel like there are insects crawling on your skin? Or do you see them?

Are you getting increasingly irritable?

Were you already worried about your drinking before the lockdown and now find yourself drinking more?

Have you tried to cut down and found it harder than you expected?

Are you experiencing shame or remorse for your behaviour while drinking?

Are you feeling a sense of hopelessness and that there is no way through this situation without alcohol?

Are you fearful of stopping or asking for help?

Have you spoken to anyone about your experiences or concerns?

PROGRESSIVE WITHDRAWAL TIMETABLE

Withdrawals are not always experienced in order. A heavy drinker could enter any of these stages without experiencing the previous ones.

Trembling / Shaking can start up to about 10 hours after the last drink and may last 1-2 days. Most normally experienced the morning after.

Hallucinations can start between 12 hours and 1 day after the last drink and may last up to 2 days.

Seizures would normally start about 24 hours after the last drink, but can happen as close as 6 hours, and as far as 2-3 days after.

Delirium Tremens can start between 2 days and a week after the last drink.

If you are experiencing the mildest of these symptoms or feelings, it doesn’t necessarily mean that you have a problem. Only you can decide how to interpret them. You’ll probably know deep down if something is wrong,  even if you don’t want to admit it.

If you have become physically dependent on alcohol it does not necessarily mean that you are alcoholic. Sometimes the physical symptoms of dependency can simply be treated with a detoxification programme.  Addiction however requires a specialist treatment and therapeutic programme to support your recovery.

Clouds House Treatment Consultant Michael Rawlinson says “Everybody is different. If you’re concerned why not have a conversation. Connect with us. We might be able to help you see things more clearly."

Lockdown is highly likely to exacerbate a nascent addiction problem or a fully blown one.  We are seeing and hearing evidence of this. We will soon be publishing the result of a survey on addiction during lockdown. Please check back soon for the results.

If you think you have a problem?

Please contact us, and if not us, someone else.

Alcoholics Anonymous is always a great place to start. Visit their website or call 0800 9177 650.

Clouds House remains open throughout the lockdown and beyond, if you think you or someone you know needs treatment we can help and advise you on the next steps.