The Next Round: What happens after you change your drinking?
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The Next Round: What happens after you change your drinking?
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:
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:
When people talk about alcohol dependence, they can be referring to two different things:
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.
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.
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:
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.
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:
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.
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:
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.
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.
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.
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.
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:
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.
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.
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.
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.
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:
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.
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.
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:
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.
Here are practical steps to get ready for your first day of reducing your drinking:
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.
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.
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:
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.
As you taper off alcohol, pay attention to your physical and emotional needs:
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:
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.
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:
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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