The Science Behind the Shakes

By

Sober Recovery Expert Author

Detox is a word that means different things to different people. I’m fortunate to have been sober long enough to have fond yet uncomfortable memories of the price I paid for allowing my alcoholism to get so completely out of control. There are so many official sources to weed through concerning detox. Here’s a quick breakdown of what I find most confusing about alcohol withdrawal: PAWS, or “post-acute withdrawal syndrome” is different from PAWSS (predictors of alcohol withdrawal severity scale). Alcohol withdrawal syndrome (AWS) is different from “complicated AWS” (c-AWS). The c-AWS includes withdrawal paired with withdrawal specific symptoms such as seizures, hallucinations, and delirium tremens. Research is limited on factors that could realistically indicate AWS, and predictors for the severity of withdrawal symptoms.

The official PAWSS is the “first validated tool for the prediction of severe AWS in the medically ill” and is a useful tool in identifying precursors for c-AWS. This is a relatively new development in the grand scheme of things, but I’m excited that there are official diagnostic tools that now exist to help people. As someone who has been physically dependent on alcohol, here are four things I wish I knew before I did the whole withdrawal and detox thing one last, grand time.

A not-so-sterile explanation of what detox felt like, what it's called, and what I'm glad not a whole lot of folks had to see firsthand.

1. Withdrawal shares symptoms with a lot of conditions, but when you’re finished, the severity is virtually impossible to forget.

Fatigue, anxiety, and depression, oh my! Add to the list common occurrences such as loss of appetite, dizziness, sweating and nausea and we have the most basic symptoms of withdrawal. Looks like maybe a cold, allergies, or the basis for pretty much every other illness I’ve had in my life. I get sad when I don’t feel good, except withdrawal is another beast entirely. These common symptoms of AWS actually looked a lot like the worst hangover of my life and a flu that went on far too long. It was symptomatically the furthest from “kinda” nauseated. Compound my nausea in similar degrees of severity with every other symptom on that U.S. Library of Medicine list.

2. I’m not having a heart attack. I just really, physically need a drink.

Heart palpitations, increased heart rate, and just general cardiac weirdness come from long term and heavy drinking, as well as quitting the aforementioned behavior. Technically, prolonged drinking weakens the muscle and causes a bunch of no-go’s for the National Heart Association’s ideas on cardiac health.

One word: hypertension. High blood pressure, then plummeting blood pressure from detox is one of the many things that made me think “this is the end, I’m pretty sure I’m dying, so it’s kind of a good thing I destroyed my life and didn’t have plans today”. Bless my stressed out, 22 year old heart, I had no idea how much better it would get.

3. Seizures would be the single trippiest thing to ever happen to me.

It’s always scary to wake up and not know what happened as an alcoholic (“I did what?!”). It’s another beast entirely to seize out during complicated alcohol withdrawal multiple times and have no idea what my name was. I think the longest seizure I ever had was just 2.5 minutes but believe me, I have lots of questions on those long-term effects. Thankfully, twelve step meetings were there — and other humans (who knew their names) were in them when this part of the process was extra overwhelming.

According to the National Institute of Health, alcohol can slow the pace of communication between neurotransmitters in the brain. Neurotransmitters are chemicals that travel back and forth around the brain. They’re pretty important. They control basic functions like breathing and more complex functions such as mood. Yeah, they’re as important as they sound. It’s also worth mentioning that alcohol has an effect on electrical connectivity and the brain tissue itself.

In the Hillborn study published by the National Center for Biotechnology Information, the seizure threshold drops when you quit drinking. A seizure can happen anywhere from 6-48 hours after quitting. The tricky part was, even if I just drank until I passed out/came to, I would then come to and shortly thereafter have a seizure because my brain thought I was quitting. I wish I had known the seizures would soon be over if I would just actually quit. Yes, “soon” as used above is entirely subjective.

4. Delirium tremens could have their own horror movie made about them.

The seizures, which were the worst part in my opinion and experience, weren’t just occurrences where I’d drop and have a seizure, then be fine and go about my day. Seizures were only a portion of a complex, epic illness that I like to consider redemption for my alcohol abuse to my body called “delirium tremens”. I prefer to never do this part in particular, ever again. I’ll pass today on feeling completely insane, emotionally volatile, and unpredictable, in addition to feverish and like all my bones had been scraped out and refilled with toxic waste. The resources listed below are more polished glimpses into what having a nervous breakdown right before meeting your maker must feel like.

Technically, the U.S. National Library of Medicine defines it as “a severe form of alcohol withdrawal [which] involves sudden and severe mental or nervous system changes.”
I think how the experts describe it sounds like a tropical retreat with first world problems compared to the reality. I kept my old journals, where I wrote about the experience as it was happening and their horrors have single handedly helped push me further into the safety of sobriety once or twice.

Now I’m certainly no substitute for trained, professional medical personnel. However, judgment from the professionally qualified was the last thing I wanted when I was so severely ill. The people in the recovery fellowship gave me all the old wives’ tale remedies and support I needed and it’s about time I give that understanding and empathy back. So there it is, the four scariest things I experienced. I’m also sharing a few links below to resources with comprehensive information from actual qualified professionals way smarter and more educated than myself. If you’re in it now or know someone who is, these wise, un-attributable words were often said to me — “this too shall pass”.

Painfully, like a kidney stone, but it will pass. Detox stories and sharing medical aftermath anecdotes with other people like me has been better than any D.A.R.E. class scare tactic because real people are what truly gave me hope, even just through their honesty and transparency. We are never alone in our suffering, unless we choose to be. Help is everywhere.


References:

“Alcohol Withdrawal” National Institute of Health, U.S. National Library of Medicine. 14 January, 2017. https://medlineplus.gov/ency/article/000764.htm. Accessed 28 June, 2017.

“Beyond Hangovers: Understanding alcohol’s impact on your health”. National Institute on Alcohol Abuse and Alcoholism, U.S. Department on Health and Human Services. https://pubs.niaaa.nih.gov/publications/hangovers/beyondhangovers.htm. Accessed 28 June, 2017.

“Delirium tremens”. National Institute of Health, U.S. National Library of Medicine. 14 January, 2017. https://medlineplus.gov/ency/article/000766.htm. Accessed 20 June, 2017.

Hillbom M, Pieninkeroinen I, Leone M. “Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management”. National Centers for Biotechnology Information, National Institute of Health. CNS Drugs. 2003;17(14):1013-30.
https://www.ncbi.nlm.nih.gov/pubmed/14594442 Accessed 1 July, 2017.

Maldonado JR, Sher Y, Ashouri JF, Hills-Evans K, Swendsen H, Lolak S, Miller AC.The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome”. Elsevier, Science Direct. 2014 Feb. http://www.sciencedirect.com/science/article/pii/S074183291400024X?via%3Dihub. Accessed 3 July, 2017.

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