How to Taper off Alcohol

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How to Taper Off Alcohol[1]

Going to a detox program and receiving medical supervision is recommended, because alcohol withdrawal can cause heart attacks and seizures.  However, regardless of the risks, many people will not go to a detox center or seek medical intervention.  It is less dangerous for someone experiencing withdrawal symptoms to know how to taper, than for the individual to quit “cold turkey”.

DISCLAIMER: The information about how to taper off alcohol is for informational purposes only and is not a substitute for medical advice.  It is safest to withdraw under medical supervision.

Some people can just quit drinking alcohol without having significant withdrawal symptoms.  Other people, however, may suffer significant withdrawal symptoms when they suddenly stop drinking.  Alcohol withdrawal is potentially fatal, so if experiencing significant alcohol withdrawal symptoms when stopping drinking, it is important to gradually detoxify from alcohol rather than quitting all at once.  One can gradually detoxify by either by using alcohol itself or by using medications.

Who is likely to have significant alcohol withdrawal symptoms?

  • People who have stayed intoxicated several days in a row
  • People who have gotten intoxicated every night for a month or more
  • People who have drunk small amounts throughout the day for a month or more
  • People with a history of alcohol withdrawal symptoms

What Are Withdrawal Symptoms?

Withdrawal symptoms can be classified into three categories: mild, moderate, and severe.

  • Mild or minor alcohol withdrawal usually occurs within 24 hours of the last drink and is characterized by tremulousness (shakes), insomnia, anxiety, panic, twitching, sweating, raised blood pressure and pulse, and stomach upset.
  • Moderate or intermediate alcohol withdrawal usually occurs 24 to 36 hours after the cessation of alcohol intake.  Its manifestations include intense anxiety, tremors, insomnia, seizures, hallucinations, high blood pressure, and racing pulse.
  • Severe or major alcohol withdrawal known as delirium tremens (DTs) usually occurs more than 48 hours after a cessation or decrease in alcohol consumption.  It is characterized by disorientation, agitation, hallucinations, tremulousness, racing heart, rapid breathing, fever, irregular heartbeat, blood pressure spikes, and intense sweating.  When untreated, about one person in five will die of DTs.  Some people refer to shakes as DTs, but this is inaccurate.

Even mild or moderate withdrawal can be dangerous for people with high blood pressure or weak hearts, because withdrawal raises blood pressure increasing the risk of heart attack or stroke.  People with high blood pressure should seek medical consultation and need to taper.

A taper is needed if the following symptoms occur upon stopping:

  • Hands are visibly shaky
  • Excessive sweating
  • Rapid or irregular pulse (a pulse of over 100 beats per minute is a danger sign)

How to taper?

People taper off by using alcohol or by getting prescription medications from their medical providers.

Beer is the best form of alcohol to use for or tapering.  Attempts to taper off using wine or hard liquor are difficult because these have higher alcohol content than beer.  Try to limit drinking to no more than necessary.  Drink just enough to keep the sweats and shakes under control.  Gradually reduce the consumption of beer as the taper continues.  If the withdrawal is not too extreme, the taper should only take a day or two.  Some tapers may take longer – three days or even a week.  If symptoms of withdrawal persist, it is a sign that the taper is not done.

It is also very important when tapering, to prevent dehydration and to replenish lost vitamins.  Medical detox may rehydrate with an IV and may also give vitamin shots.  If doing a self-detox, be sure to drink lots of fluids and to take vitamins.  Gatorade® is a good choice because it has balanced electrolytes.

Setting up a taper schedule:

It is very important to set up a taper schedule, which corresponds to the amount consumed and the amount of withdrawal one might have as a result.  The first step in setting up a taper schedule is to estimate the daily baseline consumption of alcohol.

It is very important to estimate the baseline alcohol consumption in terms of standard drinks in order to set up a taper schedule.  For reference: a standard (750-milliliter [ml]) bottle of wine at 12% alcohol contains 5 standard drinks.  A 750-ml bottle of 80-proof alcohol contains 17 standard drinks.  A liter of 80-proof alcohol is 23 standard drinks.

If drinking 20 or more standard drinks a day, then it is recommended that on the first day of the taper, drink one beer per hour starting in the morning for a total of 16 beers.  On the second day, drink one beer every hour and a half for a total of ten beers.  Then continue to taper down by reducing the amounts by two beers per day until down to zero.

If the baseline alcohol consumption is less than 20 drinks per day, reduce consumption by two standard drinks per day.  For example, if drinking an average of 12 drinks per day then the taper schedule can be 10 beers the first day, 8 the second, 6 the third, 4 the fourth, 2 the fifth, and 0 the sixth day.  Likewise, if the average consumption is 6 standard drinks per day, one can set a taper schedule of 4, 2, 0.

Some people choose to taper more quickly by cutting the amounts in half.  For example, 20, 10, 5, 2, 0.  But if you start having withdrawal symptoms, the taper is too fast and should slow down.  Monitoring pulse and blood pressure is a very good idea while tapering.

Only people who are tapering down from very large quantities of alcohol such as a liter of vodka per day will need to start drinking in the morning in order to taper.  If tapering from smaller quantities and feeling no withdrawal symptoms until afternoon or evening, then wait until the time the symptoms appear to begin to taper.  Remember, drinking is not for pleasure; the alcohol is medicine, so only drink what is needed.

Taper using medications:  Medical providers use benzodiazepine such as Valium or Librium.  In some states medical personnel are required by law to admit anyone suffering from alcohol withdrawal to an inpatient detox facility.  In other states, the person may be allowed to attend an outpatient detox program or be given a prescription for benzodiazepines for self-detox.

 


[1] Anderson, K. (2010) How to Change Your Drinking (Hamsnetwork.org).