The Next Round: What happens after you change your drinking?

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How to safely taper off alcohol

How to safely taper off alcohol

If you need a structured and self-guided approach to safely taper off alcohol and stop drinking, this article will take you step-by-step towards being alcohol-free. It has been written particularly for people who think they may be dependent on alcohol.

Unmanaged withdrawal from alcohol can be dangerous if you are dependent on alcohol. As a result, much of the advice you read on the internet presents a very cautious view of the risks. Unfortunately, this leads many people who aren’t dependent on alcohol to worry unnecessarily about withdrawal symptoms.

This article is especially relevant to you if:

  • You drink more than half a bottle of spirits, one and a half bottles of wine or six pints of beer every day (equivalent to 150ml or 5 fl oz of pure alcohol)
  • You sometimes have a drink soon after you wake up to relieve shakes or sweats
  • You have had withdrawal symptoms when cutting down or stopping drinking, such as sweating, shaking, feeling sick or anxious.

If you don’t fall into any of these categories, there is less of a risk that you will experience severe withdrawal symptoms. But however much you currently drink, this article will guide your decisions about the support you need, including if tapering off alcohol is right for you.

The information in this article has been developed with guidance from a consultant clinical psychologist specialising in addiction recovery. And it draws on the best available evidence and practice in managing alcohol withdrawal symptoms. However, nothing in this article is a substitute for individual medical assessment and treatment.

This article is necessarily long, but it’s arranged into four key sections:

Understanding alcohol dependence and withdrawal

When people talk about alcohol dependence, they can be referring to two different things:

  • Physical dependence refers to the way your body adapts to alcohol and the emergence of withdrawal symptoms when you stop drinking
  • Psychological dependence is about all the other ways in which alcohol can become a seemingly non-negotiable part of life

It’s essential to make this distinction. Tapering off alcohol only deals with the immediate effect of physical dependence by managing the risk of withdrawal symptoms. Safely stopping drinking is an important task, but it is only the first step of a much longer journey of change to deal with psychological dependence. Unless you tackle the reasons your drinking got out of hand, it’ll be harder to stay stopped in the long term.

How alcohol dependence develops

As you drink regularly, over time, you begin to feel alcohol’s effects less. This change happens as you develop a tolerance for alcohol. Tolerance isn’t the same as dependence on alcohol, but it indicates that your body is beginning to compensate for alcohol’s presence.

If you continue drinking consistently over an extended period, your central nervous system will work harder to balance alcohol’s effects. Alcohol depresses the functioning of your central nervous system, causing a lack of coordination, slurred speech, drowsiness, poor judgement, slowed breathing, slowed heart rate, confusion, lethargy or even loss of consciousness.

But despite everything that alcohol throws at it, your body is remarkably resilient. Your central nervous system adapts and tries to keep your body functioning normally, ramping up its activity over time to balance alcohol’s depressant effects. So as you drink more and your central nervous system adjusts to cope, you become physically dependent on alcohol.

If you are dependent on alcohol and abruptly stop drinking, your nervous system cannot adapt to alcohol’s sudden absence. Without it, your central nervous system keeps functioning at an increased level.

This overactivity of your central nervous system causes the symptoms of alcohol withdrawal.

Common alcohol withdrawal symptoms

Alcohol withdrawal is different for everyone. Your physical health, medical history, body composition, age and drinking history will all affect what happens. But there are some commonly observed symptoms of alcohol withdrawal that you might experience if you abruptly stop drinking.

Alcohol withdrawal symptoms first appear around eight hours after your last drink and become most severe after two or three days. Milder physical symptoms include sweating, shakes, headaches, nausea and vomiting. Some people experience unpleasant emotions like anxiety, irritability, agitation and panic. Others have difficulty eating and sleeping.

Many people start to feel better after four to five days, but some will experience more serious symptoms:

  • Hallucinations might include hearing or feeling things that aren’t there or that you know are not real.
  • Poor coordination may manifest as being unsteady on your feet, losing your balance or struggling to speak clearly.
  • Confusion might be a feeling of being disoriented, uncertain of where you are, what time it is, or who you are with. A rapid onset of confusion, combined with hallucinations, poor coordination and other physical symptoms, might be diagnosed as delirium tremens (DTs).
  • Seizures may start with the twitching of a limb but are likely to progress to full-body convulsions and muscle contractions. Seizures can lead to loss of consciousness, so you will not feel anything while the seizure is at its height. After, you might feel confused and exhausted. If you fall, you may have physical pain and a severe headache.

These severe symptoms only occur in a minority of cases. But you must not let these symptoms go untreated. Fatalities caused by alcohol withdrawal are rare, but only because people receive medical support.

Reasons not to consider tapering off alcohol

Some people are more likely than others to need medical support to stop drinking safely. Before you change your drinking, you must talk to a doctor. Tapering off alcohol is not advisable if:

  • You have a previous history of complicated withdrawal, for example, if you’ve previously experienced delirium tremens (DTs) or fits
  • You experience confusion or hallucinations
  • You are currently using benzodiazepines, such as Xanax, Librium, Valium or Klonopin
  • You have epilepsy or a history of fits
  • You are malnourished and at risk of Wernicke’s encephalopathy
  • You have severe diarrhoea or vomiting
  • You have active suicidal thoughts or are at risk of harming yourself
  • You have any acute or poorly controlled physical or mental illness, such as hypertension, coronary heart disease, diabetes, or significant liver or renal impairment
  • You are currently using other drugs, especially opiates.

There are also some environmental factors which make it harder to taper off alcohol successfully. For example, if you have had multiple previous unsuccessful attempts at community detox, it may be that your home environment isn’t supportive of staying alcohol-free.

And you should consider how to handle caring responsibilities, such as looking after children.

Assessing alcohol dependence

In treatment settings, medical professionals commonly use the Severity of Alcohol Dependence Questionnaire (SADQ) [pdf download] to guide decision-making on treatment options for managing alcohol withdrawal. Your doctor might also use it if you discuss your drinking with them.

SADQ scores dependence on alcohol across five different areas:

  • Physical withdrawal symptoms
  • Affective or emotional withdrawal symptoms
  • Whether you drink to relieve withdrawal symptoms
  • How much you drink
  • How quickly withdrawal symptoms emerge.

A total score of 31 or more indicates that someone is severely dependent on alcohol, 16 to 30 indicates moderate dependence, and 8 to 15 indicates mild dependence. Someone with a score of 7 or less will likely not be dependent on alcohol.

While a SADQ score cannot provide a cast iron guarantee that you will experience alcohol withdrawal symptoms or not, it can be useful when taken together with other information about your general health and wellbeing.

Sources of support to safely taper off alcohol

Tapering off alcohol can be psychologically and physically challenging, and reaching out for support could be essential. Asking for the help you need is not a sign of failure.

Talking to your doctor

An honest relationship with your doctor matters because drinking can significantly impact your physical and mental health. You will not be the first person your doctor has spoken to about alcohol. So they can be a source of practical advice and information. They may also be able to prescribe medication to help you manage withdrawal symptoms at home.

Conversations you have with a medical practitioner are confidential unless you put yourself or others at risk. So, realistically, telling your doctor about your drinking can have real-world consequences. But any worries about increased insurance premiums, difficult conversations at work or the loss of a driving licence are nothing compared to the ongoing impact of drinking dangerously.

Your doctor can also be a valuable gateway to local treatment services and can be a partner in your treatment and care. But as an absolute minimum, you must be able to contact a doctor in an emergency caused by alcohol withdrawal symptoms.

Detox and rehab

It may be that your doctor recommends detox or rehab, or you might consider this for yourself. It’s important to understand the difference between these types of services.

The fundamental aim of detox is to medically manage the impact of alcohol withdrawal. A detox programme will monitor your symptoms and may include medication and other treatments. Detox programmes are generally short, typically between 7 and 10 days. Because detox is a medical intervention, you should always check the qualifications, experience and registration status of anyone who provides this service.

Rehab is designed to help you stay alcohol-free. A good rehab programme will build your skills and resilience, giving you the confidence to return to the world. However, there are no globally recognised standards for rehab, so it’s essential to understand what you are signing up for, who is running it and what their philosophy is. Ask too about their long-term outcomes. Spending more money is not a guarantee of increased success.

Your personal support network

Supportive people can help you monitor and control your alcohol consumption. If someone close to you is willing to help you, actively involve them in your planning and preparation to stop drinking.

However, your drinking habits might have strained your relationships. Your attempts to stop may be complicated if the people around you continue to drink in ways that cause you problems.

There are several options to consider if you feel like you need more personal support:

  • Find community support groups. Look for lived experience recovery organisations. And consider other groups that provide general support, such as mental health, connection and wellbeing. You want a support network that encourages your general wellbeing.
  • Connect with a SMART Recovery group. These groups use an approach backed by behaviour change science and offer online and real-world meetings.
  • Connect with a counsellor or therapist. A professional can be a useful addition to your personal support network. Note that most counsellors and therapists don’t have specific training in alcohol or addiction issues, and you’ll want to be assured that they can add value to your journey of change.

Creating a plan to safely taper off alcohol

Facing up to the extent of your alcohol consumption can be emotionally demanding. But if you’ve previously hidden bottles, filled your recycling bin in the dead of night, or deliberately avoided thinking about how much you’re drinking, you’re not alone.

The first step in determining how much you drink is tracking your alcohol consumption. Many people do this using apps, but you keep track by taking photos of your drinks or keeping notes.

If you haven’t been tracking your drinks, now is the time to start. Try not to forget any drinks, but don’t worry overly if you do. Repeat the exercise over several days to build up a record of how much you are drinking. Once you’ve got a consistent run of three or four days, you can use this information to calculate exactly how much alcohol you have been consuming.

Tapering off alcohol from a stable baseline

Alcohol withdrawal symptoms are not just caused by the complete absence of alcohol but by any big changes in the amount you drink. For example, you might be in a pattern of heavier drinking at the weekends than during the week. If you drastically cut back on a Monday and Tuesday, you may feel unwell on a Wednesday or Thursday as your symptoms intensify. So you may drink more on Friday to reduce your symptoms. As a result, you can end up in a cycle of regular alcohol withdrawal and increased cravings for alcohol each week.

So before you begin planning to reduce your drinking, try and stabilise your drinking as much as possible. You could steadily reduce your weekend binge drinking to match your weekday drinking before you make further changes.

Predicable drinking makes it easier to notice if alcohol withdrawal symptoms are emerging. The earlier you notice that you feel unwell, the quicker you can take corrective action.

Calculating exactly how much you drink

Some apps will calculate precisely how much pure alcohol you’ve been drinking. But you may need to do some basic arithmetic.

Here are the basics to help you understand the numbers you may encounter.

  • Each type of drink has an ABV, which stands for alcohol by volume. ABV is the proportion of your glass that is pure alcohol, expressed as a percentage. For example, beers might be around 5% ABV, meaning each drink has 5% alcohol and 95% water and other ingredients. Spirits are typically about 40% ABV, meaning an unmixed spirit is 40% pure alcohol and 60% other ingredients.
  • In the US, you may see spirits labelled with percentage proof. Divide this proof number by two to get the equivalent ABV. 80 proof is 40% ABV. 100 proof is 50% ABV.
  • You also need to know the volume of each drink. You can find this information on labels if you are drinking beer or wine. If you add non-alcoholic mixers to your spirits, you don’t have to count them. It’s only the spirit containing alcohol that matters.

To calculate the amount of pure alcohol in any drink, simply multiply the volume by the ABV and divide by 100.

This calculation works whether your drink volumes are measured in millilitres (ml) or fluid ounces (fl oz), but don’t mix them up. Use one or the other.

If you consume beverages with different ABVs, you’ll need a separate calculation for each type of drink. You can add these together to get a total for each day.

Designing your plan to taper off alcohol

Because of the risks involved in untreated alcohol withdrawal, there is minimal scientific research on safely tapering off alcohol. However, based on the experiences of countless people who have stopped drinking and the best available advice, you can use the following working assumptions for safe reduction:

  • On day one, reduce your consumption by 10ml or 1⁄3 fl oz of pure alcohol. This amount equals 1 UK unit or about half a US standard drink.
  • The next day, if you feel stable, reduce by a further 10ml or 1⁄3 fl oz.
  • Repeat these stepped reductions daily until you are drinking less than 100ml or 3 1⁄3 fl oz of pure alcohol each day. This amount is around 10 UK units or 5 ½ US standard drinks.
  • Once you have reached this level of drinking, you might try to stop drinking altogether. Or you may continue to reduce. But below 100ml or 3 1⁄3 fl oz of pure alcohol daily, you are unlikely to experience severe withdrawal symptoms.

These assumptions are cautious. But you must avoid reducing your daily consumption by more than 10%. Cutting back by 10% a day is aggressive, and you may need several days at each level to avoid withdrawal symptoms. Remember that your wellbeing is a priority, not stopping quickly.

Whether you take a cautious or more aggressive approach, you will continue drinking for some time. It might take two to three weeks or more to reach zero alcohol.

Deciding what to drink

When you taper off alcohol, you are not drinking for pleasure, and your favourite drinks can trigger unwanted drinking.

Because of its associations with pleasure, wine is rarely suitable for tapering. Some people suggest beer, although the amount of fizzy liquid can make this challenging. You could leave beer open to go flat. Another option is a neutral spirit like vodka, diluted with fruit juice or cordial.

Whatever you choose to drink, consider it medicine. Its only benefit is delivering the daily amount of alcohol you need to ward off withdrawal symptoms.

Documenting your plan to taper off alcohol

Make sure you write down your plan. Consider your plan a working document that you will look at each day, so you can adjust it as you go along.

Your plan should include:

  • Contact details for people in your support network
  • Contact details for your doctor or emergency medical services
  • Your starting amount of pure alcohol (in ml or fl oz)
  • Your target start date
  • How much you are reducing and how often (remembering that 10% a day is the absolute maximum)
  • What you will drink
  • How you will look after yourself.

You will notice that your plan does not have a target end date. Tapering off alcohol is unpredictable, and you may need to pause if you experience withdrawal symptoms. Letting go of the idea of a stop date takes the pressure off you so that you can prioritise your health and wellbeing.

Putting your tapering plan into action

Here are practical steps to get ready for your first day of reducing your drinking:

  • Your plan will tell you exactly how much alcohol you are permitted on day one.
  • You may need a drink first thing in the morning to reduce symptoms. And you may want a larger drink before bedtime. But beyond this, decide how often to drink to spread your consumption evenly.
  • Prepare the night before. Consider whether you want to divide your permitted amount into smaller containers to help you pace your consumption during the day.
  • Write down your daily drinking schedule so you can tick off the drinks individually. And set an alarm for your drinks if that helps you keep track.
  • Decide what you will do between drinks. Sitting and waiting for the next dose increases the chance of drinking too soon and your plan going off track.

Troubleshooting your approach

Drinking a large volume of liquid can irritate your stomach, and you may feel nauseous from withdrawal symptoms. If you vomit within 30 minutes of drinking, repeat your last drink.

Try to keep your drinking as regular as possible. As you reduce, start by removing drinks from the middle of the day. And don’t be tempted to save your drinks for later in the day. By that point, cravings may get the better of you, and it can be difficult to control your consumption.

Pacing your drinking throughout the day is important. Big gaps in your drinking schedule open the door to unwanted symptoms. That can also mean increased symptoms first thing in the morning, as you stop drinking overnight.

Realistically, you may still experience some withdrawal symptoms as you taper off alcohol. You might feel milder physical symptoms, such as sweating, shakes, headaches and nausea. You may feel anxious, irritable or agitated. And your normal patterns of eating and sleeping may be disturbed.

Each day, ask yourself whether you feel safe to continue. If your symptoms worsen at any point, it is always safer to maintain a steady level of drinking and seek medical help than to push on with further reductions. And it’s always OK to pause your planned reductions while you regain a feeling of stability.

Drinking to relieve symptoms

If your withdrawal symptoms are becoming too hard to handle, drinking to relieve them is a sensible precaution. However, relief drinking might mean you deviate from your plan, temporarily consuming more alcohol than your plan allows.

As you taper off alcohol, you will also notice other triggers for drinking. Be honest about whether you are drinking to relieve withdrawal symptoms or if your additional consumption is because of an external event. Simply responding to every difficult situation with alcohol will leave you with the same drinking patterns. You’ll need better ways to cope with triggers for drinking.

So if you feel the urge to drink more than your plan permits, give yourself a 20-minute breathing space. You could have a glass of water, stretch your body, or find some gentle distraction. Cravings for alcohol pass if you give yourself some time.

Self-assessing your withdrawal symptoms

The Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-AR) [pdf download] is commonly used in treatment services to assess the severity of withdrawal symptoms and determine whether medication is necessary.

The CIWA-AR questionnaire asks about:

  • Nausea and vomiting
  • Tremors
  • Paroxysmal sweating (paroxysmal is a medical term meaning sudden or unexpected)
  • Anxiety
  • Agitation
  • Tactile disturbances and hallucinations
  • Auditory disturbances and hallucinations
  • Visual disturbances and hallucinations
  • Headaches or fullness in the head (this does not include feelings of dizziness or lightheadedness)
  • Disorientation

Each question is scored from zero to seven, except the last, scored out of four.

Depending on the clinical setting, a total of eight or more would indicate that medication may be necessary to control symptoms. Scores of 20 or more mean you have an increased risk of delirium tremens and need urgent medical care.

Looking after yourself as you taper off alcohol

As you taper off alcohol, pay attention to your physical and emotional needs:

  • Ensure you stay hydrated. Dehydration will make alcohol withdrawal symptoms worse, so make sure you drink plenty of water. Oral rehydration sachets can help too.
  • Many physically dependent people have vitamin deficiencies, especially B vitamins. Your doctor or pharmacist can provide vitamin B compound tablets and thiamine (B1).
  • Try and eat as regularly as you can. You may feel nauseous, so choose simple foods that are easy to digest.
  • Make your immediate environment as safe and secure as possible. Try to avoid tapering off alcohol in an unstable home environment, especially if you share your home with people who drink chaotically.
  • Find ways to relax and soothe yourself. Gentle exercise, stretching, self-massage and warm baths can all comfort your body. Experiment with ways to feel good about yourself.
  • It’s OK to distract yourself when you’re coping with alcohol cravings. Find distraction activities that are mentally engaging but not emotionally demanding. You might watch your favourite comedy box set, crack out a jigsaw or try today’s crossword.
  • Games on your phone can be engaging, and they can also help reduce symptoms of trauma if you are triggered. There’s some research evidence that Tetris is particularly good at this.
  • Remember to stay connected with other people. You don’t necessarily have to talk about your experiences of tapering. Just chatting can meet your need for social interaction.

Keeping motivated to taper off alcohol

Safely tapering off alcohol can take some time. Even with the most ambitious reduction plan, it could be a couple of weeks before you bring your drinking entirely to a halt. Keeping motivated during this period can be a challenge.

Three things can happen as you taper off alcohol:

  • You might lose sight of the end goal. Remember that you began this process of reducing because you intend to stop drinking. However good it feels to be drinking less, you can feel even better. Do whatever you can to keep the goal of being alcohol-free in mind. Write it down somewhere you’ll see it, tell a supportive friend, or ask someone if you can be accountable to them for your progress.
  • You might lose hope that you’ll finish. Even if you don’t experience setbacks, tapering off alcohol takes a considerable commitment. If progress slows or you experience a setback, it can be tempting to give up altogether. In this case, set yourself an intermediate goal. Can you reach and stick at the next but one level of drinking? Reward yourself for your progress, however minimal it might seem at first. You can build on small successes.
  • You might find your drinking creeping back up again. Not everyone can taper off alcohol without help. Be honest if you are struggling to reduce and stop your drinking. If you are unable to stick to your plan, even after repeated attempts, talk to your doctor about accessing additional help.

Maintaining motivation isn’t about grinning and bearing it or an exercise of willpower. You give yourself the best chance of long-term success by learning to look after your physical, mental and emotional wellbeing and asking for the help you need. Caring for yourself builds your resilience to face the challenges of change.

Staying stopped after you taper off alcohol

It can take huge effort and commitment to reduce your alcohol consumption to nothing. So when you reach the end of tapering, you will likely feel relieved and proud. And you deserve congratulations on your achievement.

As you approach the end of the process, it’s time to think about what happens next. Simply walking back into your life unprepared is a recipe for drinking that will get quickly gets out of hand.

In many ways, your life before now has been designed to make drinking as easy as possible. Consciously and unconsciously, you’ve organised your world to maximise drinking opportunities. So every day, you’ll encounter triggers for drinking.

In our in-depth course, How to Stop Drinking, we introduce four simple questions which you can use to notice those triggers for drinking and make plans to deal with them. Each morning, consider the following:

  • Where are you going today? Will you be in places that make drinking seem easier? What are your options to avoid those places or keep yourself safe if they are unavoidable?
  • When might you think about drinking? Are certain moments in the day always been tricky for you? What alternative plans can you make to distract yourself at these moments?
  • Who will you encounter today? Are you seeing people you used to drink with? Or will some people trigger you? How can you meet people who will support you to stay alcohol-free?
  • What will you drink instead? Every situation in which you used to drink alcohol is a chance to try something alcohol-free. What delicious and refreshing drinks can you choose to help you stay on track?

Get into the habit of using these questions to plan each day. No situation you face is beyond your control. You always have the power to choose.

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