Detox Is Serious

A couple of my favorite classic John Wayne movies involve the Duke coming into town to help alcoholic sheriffs regain control. “Rio Bravo” and “El Dorado” come to mind.

Dean Martin and Robert Mitchum played the drunken sheriffs, and in both cases they had to go through withdrawal. After prolonged periods of heavy drinking, they are suddenly denied the booze and John Wayne of course is there to make sure they don’t slip back.

In El Dorado, James Caan’s character makes a horrible concoction to help Mitchum get sober. The mixture includes gun powder. They hold Mitchum’s nose and force it down. Call it western movie detoxification. Maybe you know somebody that has gone through detox, or maybe you’re anticipating it for yourself or a loved one. It might help to know a little about what a person experiences during detoxification.

First a note of explanation about what is going on before and during detoxification. Brain chemistry is the key battle ground, because brain chemistry balances states of excitement and calm. There are other physical things going on, but we’ll limit this to brain chemistry. People drink to relax, and that relaxation is caused by the effect of alcohol on the neurotransmitter GABA (gamma-aminobutyric acid).

GABA acts with the neuroreceptor GABA-A. This is the control mechanism for slowing down brain function, giving us that relaxed feeling when we drink. The GABA works on the GABA-A and blocks the brain from getting excited, but as much as we may enjoy the feeling, over time it causes problems because we build up a tolerance to alcohol. In short, people drink more to get the same effect. The message isn’t being received, the GABA-A receptor is dulled, so more alcohol is needed.

On the opposite side to maintain balance is another neurotransmitter, glutamate. This acts in conjunction with its neuroreceptor N-methyl-D-aspartate (NMDA) and this controls excitement. The brain gets used to the alcohol, so the “calming effect” becomes the norm. Take away the alcohol and there is nothing to control excitement. If the alcohol has prevented the calming side of the brain to work properly, there is nothing to regulate the excitement part of the brain. People become irritated, or anxious. The Robert Mitchum character demonstrated this by his belligerent behavior.

In terms of detox, the troubles begin when the brain tries to balance calm and excitement. The more a person goes through detox, the more difficult the transition back to balance becomes. Alcoholics may go through severe withdrawal symptoms like delirium or having seizures. Some people might have a hangover, or maybe get the “shakes,” but these are mild compared to what is possible.

Fortunately, James Caan’s concoction isn’t necessary now. Medicine can help a person through and ease the discomfort. But the problem with detoxification is that the more times a person goes through it, the more difficult it may become. The idea is that long time alcohol abuse alters brain chemistry to the point where people develop obsessive thoughts and cravings for alcohol. Doctors may have to prescribe other medications to control those thoughts.

For the person who is abusing alcohol or has become dependent, withdrawal is avoided by drinking. A little “hair of the dog” in the morning helps attack the hangover. But you can see that for the alcoholic, the solution to the withdrawal just perpetuates the problem.

For spouses, loved ones and friends, they can try to help that person avoid the severe detoxification by getting them into treatment early. Alcohol withdrawal can be a serious, even life-threatening, so the detoxification process is best handled by medical professionals.

It’s important for people to be assessed and for treatment programs to be tailor made to meet their needs. In the movies, the “drunk” always gets better and returns to his former glory. It’s not that easy in real life.

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