The Innovation, Nicotine and Tobacco, Research, Education Programming, Implementation and Digital Health Lab (INTREPID Lab) at the Centre for Addiction and Mental Health (CAMH), has released a new toolkit describing the health impacts of e-cigarettes across four key areas: cancer, cardiovascular health, dependence, and respiratory health. The resources included in this toolkit include recommendations and resources to guide decision-making for both healthcare practitioners and people who either use, or are thinking of using e-cigarettes.
The prevalence of e-cigarette use is increasing in Canada; in 2022, six per cent of Canadians, (representing 1.8 million people), used e-cigarettes in the last 30 days (Statistics Canada, 2023). Among youth, vaping has nearly doubled since the late 2000s, with stress reduction (30.5 per cent), curiosity (27.0 per cent), and enjoyment (22.9 per cent) as reported reasons for use (as per Statistics Canada, 2023). While an increase in e-cigarette use increases the number of people exposed to nicotine, e-cigarettes may simultaneously provide a lower-risk alternative for those who use commercial combustible tobacco products. The resources developed by the INTREPID Lab offer important, evidence-based insights on both the potential harms and benefits of e-cigarette use.
“There’s a perception that e-cigarette use, or vaping, is harmless or non-addictive to youth who have never smoked,” said Dr. Peter Selby, Senior Scientist, Senior Medical Consultant, and Principal Investigator, INTREPID Lab at CAMH. “Though e-cigarettes are considered less harmful than combustible cigarettes for those addicted to conventional cigarettes, they are not risk-free. These resources were created to help healthcare practitioners better understand the health effects of e-cigarette use as a harm reduction intervention, and help patients make informed decisions, while preventing youth from getting addicted to nicotine in the first place.”
The Vaping and Electronic Cigarette Toxicity Overview and Recommendations (Project VECTOR) toolkit was developed in collaboration with a panel of international subject matter experts and people with lived and living experience of using e-cigarettes. Key findings from Project VECTOR include:
- Though e-cigarettes are less harmful than combustible tobacco cigarettes, they are not entirely risk free. E-cigarette use has the potential to cause harms to health.
- E-cigarette use may lead to dependence. E-cigarette use is associated with increases in dependence, and long-term use of these products should be avoided.
- People who do not smoke should not use e-cigarettes to avoid exposure to cancer-causing chemicals, cardiovascular toxicants, respiratory dysfunction and symptoms, and dependence.
- E-cigarettes may be used as a harm reduction tool for those who smoke. Tobacco users who have been unable or unwilling to quit smoking using current best evidence-based approaches, should switch completely to e-cigarettes to reduce exposure to cardiovascular toxicants and improve measures of cardiovascular function (where relapse to tobacco is not a concern). Long-term use should be avoided.
Project VECTOR was completed in partnership with the Ontario Tobacco and Research Unit (OTRU), and made possible through Health Canada’s Substance Use and Addictions Program (SUAP). Please note that the views expressed in these resources do not necessarily represent the views of Health Canada. To access the full toolkit, including Health Effects of E-Cigarette Use: Guidance and Recommendations for healthcare practitioners, Harm Reduction Tips, and FAQs on Vaping, please visit https://intrepidlab.ca/en/Pages/Project-VECTOR.aspx.
Originally posted by Centre for Addiction and Mental Health
What is an overdose?
Overdose occurs when someone takes one or more drugs in a quantity or combination that exceeds what their body can handle. Overdose can happen with many types of drugs, including those used recreationally, bought over-the-counter, or prescribed. This includes everything from alcohol, to Tylenol, to opioids. Some drugs, such as opioids, are central nervous system depressants, meaning that they slow normal functions like breathing and heart rate to the point that they stop altogether. Other drugs such as amphetamines, cocaine, and MDMA (ecstasy) have an opposite effect: they speed up the central nervous system and can increase the risk of heart attack, stroke, or seizure.
Overdoses can have serious consequences, including permanent brain injury or even death.
Who does it affect?
In Canada, overdose deaths are reported differently among provinces and territories, making it difficult to determine the number of Canadians who are hospitalized or die from an overdose.
Despite gaps in the data, we do know that we are currently experiencing an opioid overdose crisis. In 2017, approximately 17 Canadians a day were hospitalized due to opioid poisoning and 3,987 Canadians died from an opioid overdose, although these numbers are likely an underestimation.[1] In 2016, 2,978 Canadians died due to opioid overdoses. The steep increase in the number of deaths is linked to fentanyl and other synthetic opioids that are similar to fentanyl (e.g. carfentanyl) which are being cut into an increasing number of psychoactive drugs on the illegal drug market, without the knowledge of the people who use them. Cocaine, heroin, and MDMA are some examples of drugs that have been contaminated with fentanyl. Even small quantities of fentanyl are deadly: two grains of fentanyl, equivalent in size to two grains of salt, are enough to cause overdose and death.
Drug overdose cuts across all segments of the Canadian population; any person who takes a prescribed drug or who uses a psychoactive substance recreationally is at risk. However, some communities are at an increased risk, including:
- Anyone who uses drugs when alone: The B.C Coroners recently reported that up to 94% of deaths from illegal drugs in January 2018 happened indoors, with 64.8% of that number in people’s own homes.[2]
- Men: Canadian men are more likely than women to use psychoactive substances and develop problems with substance use. In 2016, 73% of all opioid-related deaths occurred among men.[3]
- Youth: Young people may experiment with different substances and engage in riskier substance-use behaviours. They are also more likely to binge drink, which poses a higher risk of toxicity.[4] Where opioids are concerned, youth ages 15 to 24 are one of the groups with the fastest-growing rates of hospitalization for overdoses.[5]
- Seniors: Over the last 10 years, older adults age 45 to 64 and seniors age 65+ had the highest rates of hospitalization due to opioid poisonings.[6] Older Canadians are more likely to be prescribed multiple medications, which increases their risk of overdose from drug interactions.
- Indigenous peoples: Due to the traumas associated with colonialism, residential schooling and systemic racism, some Indigenous communities in Canada report higher incidences of substance use. Despite comprising only about 3.4% of B.C.’s population, First Nations people represented 10% of all overdose deaths in 2016.[7]
- Canadians in correctional facilities: Canadians in or recently discharged from a correctional facility may be at increased risk of overdose. Drugs can and do find their way into Canadian prisons, which may not offer harm reduction programs or provide clean supplies for drug consumption. If someone is abstinent during a period of incarceration, their tolerance for drugs may be lowered. So, if, upon release, they return to consuming at the same rate as they did before incarceration, they are at higher risk of overdose.
- Other populations: Anyone who has a history of substance use problems, is prescribed a high dose of opioids, or takes multiple medications – particularly depressants – are at a higher risk of overdose.
What are the warning signs?
The warning signs for overdose depend on the type of drug consumed.
For opioids and other central nervous system depressants, some of the warning signs include:
- Unresponsiveness or unconsciousness
- Passing out or a “slumped over” posture
- Shallow or irregular breathing, or no breathing at all
- Slowed heart rate or absence of a pulse
- Choking or gurgling sounds
- Purple lips and fingernails
- Clammy skin
- Low body temperature
- Vomiting
- Seizures
- Loss of coordination
For amphetamines and other central nervous system stimulants, some of the warning signs include:
- Tremors and muscle twitches
- Hot, flushed, or sweaty skin
- Headaches
- Chest pain
- Difficulty breathing
- Hostile or violent disposition
- Uncontrolled movements or seizures
- Panic
- Paranoia and other symptoms of psychosis
- Confusion or disorientation
If you suspect someone is having an opioid overdose:
- Shake their shoulders or call their name
- Call 9-1-1 if unresponsive
- Perform chest compressions and rescue breathing
- Administer nasal spray naloxone or injectable naloxone
- If the person resumes breathing, place them in the recovery position
If you suspect someone is having an overdose caused by cocaine, amphetamines, (MDMA) ecstasy or another stimulant:[8]
- Call 9-1-1
- Move the person to a quiet, safe room away from bystanders, noise, excessive light, heat and other stimulation
- If confused or panicking, try to reassure them
- If overheating, try to cool them down by loosening outer clothing or putting a wet towel on the back of their neck or under their arms
- If you can’t get a response or the person is unconscious, put them in the recovery position
- Remove anything from the immediate environment that might cause injury in case muscle spasms or seizures occur
You can help prevent overdoses in your school or workplace. CMHA Ontario developed an opioid overdose prevention toolkit, which can be accessed here: http://ontario.cmha.ca/wp-content/uploads/2018/05/CMHA-Ontario-Reducing-Harms-Updated.pdf.
How can I reduce the risk of overdose?
If you use drugs, whether prescribed or not, or know someone else who uses drugs, carry a naloxone kit with you. Naloxone is a drug that reverses the effects of an opioid poisoning. Naloxone kits are available through pharmacies, health-care workers and some community-based organizations, often at no cost.
Overdose prevention sites (OPS) and supervised consumption sites (SCS) are some of the most effective interventions for reducing the risk of overdose. These sites, which are staffed by health-care professionals and trained peers, are effective because they can offer drug checking services (test strips to check what’s in your drugs) and can respond quickly with naloxone. In B.C.’s 20 overdose prevention sites, there were 66,604 visits between December 2016 and March 2017, and 481 overdoses were reversed, preventing 481 possible deaths.[9] OPSs and SCSs, which also provide sterile injection/consumption equipment and information and referrals to services, also promote access to health-care services and reduce the rates of HIV.[10] Despite the fears that some communities have about OPSs and SCSs in their neighbourhoods, these facilities do not lead to increased crime. In fact, they reduce unsafe consumption practices and syringe disposal and improve public order while also having a positive impact on the health and quality of life of people who use drugs.[11]
We also recommend not using drugs when alone. The risk of fatal poisoning is higher for people who consume illegal substances alone at home, given that they lack a peer or support network that can intervene with naloxone and by calling 9-1-1. Visiting OPSs and SCSs can save your life.
How can I help a loved one?
If you suspect someone close to you might have a substance use problem or may be at risk of an overdose, talk to them. Listen with openness and without judgment. It can be difficult to watch someone you care about experience problems with substances and frightening to think that they can experience an overdose. You may have fears about their safety, or maybe even your own.
If your loved one is actively using drugs or is at risk of an overdose, encourage them to follow harm reduction practices and use harm reduction services. Harm reduction can mean visiting overdose prevention sites, which are supervised by staff and peers who are trained in safer drug consumption practices and how to intervene during an overdose.
If they are using prescribed medications in high doses to manage pain, encourage your loved one to talk to their doctor or health-care professional about alternative therapies. Under some conditions, prescribed medications can be tapered to a lower dose or stopped completely, and pain can be managed with massage, physiotherapy, exercise, counseling, and other therapies.
Although people use drugs for many different reasons, problematic substance use can be a sign of underlying mental health problems and an addiction. Some people use drugs problematically to cope with untreated mental illness, childhood trauma, family difficulties, pain, and other stressors. If your loved one is open to seeking treatment, talk to them or encourage them to speak to their physician or another health-care professional about their treatment options. Remember that change can rarely be forced onto others, and that imposing treatment on someone when they are not ready is not necessarily helpful or in their best interest.
Treatment options for managing problematic substance use include counseling, group therapy, recovery groups (such as 12-step programs), residential treatment (detox), medication, or withdrawal management, among others. Contact your local Canadian Mental Health Association to find out more about available treatment options and encourage your loved one to choose an option that is right for them. Remember that everyone’s needs are different and sometimes a variety of treatments must be tried before the right one is found.
Many people are better able to recover when they have the support and encouragement of friends, family, and peers. Listening, encouraging good communication and healthy habits, being patient, and helping to instill a sense of hope for recovery are only a few ways that you can help support a loved one.
Originally posted by Canadian Mental Health Association
Frightening, painful or distressing experiences happen to everyone at some point. It’s when these experiences cause disruptions to our usual functioning that we refer to them as traumatic. Our responses to trauma vary; we might feel nervous, have a hard time sleeping well, or go over and over the details of a situation in our mind. Our responses also depend on whether the distressing experience happens again. For many, the symptoms of distress decrease over time and we can go back to our daily lives. Some experiences of trauma, however, stay with us and can seriously disrupt our usual functioning and well-being. Post-traumatic stress disorder (PTSD) is one example of this.
What is post-traumatic stress disorder?
Post-traumatic stress disorder (PTSD) is a mental illness. It stems from exposure to an experience involving death or the threat of death, injury, abuse or sexual violence. PTSD affects approximately eight percent of the population in Canada.[1]
Something is experienced as traumatic when it is very frightening, overwhelming, causes a lot of distress or disrupts our sense of self and security. Events that we may experience as traumatic include neglect and abuse during childhood, crimes, natural disasters, experiences of racism or gender-based violence, violence based on sexual orientation, accidents, war, conflict or genocide, colonialism, or other threats to life. Trauma, especially when it is experienced during childhood, can affect our ability to build trusting relationships with other people.[2] It can also build up when we are exposed to many stressors that create a trauma response because it can make us more vulnerable and less able to bounce back.[3] Trauma can be caused by an event or situation that you experienced or something that happens to others, including families and loved ones. Intergenerational trauma, for instance, means that the effects of trauma experienced by one generation are passed down, and are often accompanied by other traumas rooted in current social inequalities.[4] Many Indigenous communities deal with the intergenerational traumas caused by colonial and genocidal policies at the same time that they are experiencing systemic violence that is the result of those policies.
Trauma happens in our bodies where stressors can cause neurochemical changes in the brain and alter not only our behaviours but also our immune system. Ongoing experiences of stress can even make us vulnerable to illness. A person suffering from trauma may experience chronic pain, heart disease, high blood pressure, stroke, diabetes, immune system-related illnesses and neurodegenerative disorders.[5] PTSD causes symptoms such as re-experiencing the traumatic event. Many people have vivid nightmares, flashbacks, or thoughts of the event that seem to come from nowhere. They often avoid things that remind them of the event—for example, someone who was hurt in a car crash might avoid driving.
PTSD can make people feel very nervous or ‘on edge’ all the time. Many may be startled very easily, have a hard time concentrating, feel irritable, or have problems sleeping. They may often feel like something terrible is about to happen, even when they are safe. Some people feel very numb and detached. They may feel like things around them aren’t real, feel disconnected from their body, thoughts, or emotions. People also experience a change in their thoughts and mood related to the traumatic event. Some might experience symptoms of depression and/or anxiety, and they might use alcohol or drugs to cope with PTSD.[6]
Who does it affect?
While most people experience trauma at some point in their lives, not all traumatic experiences lead to PTSD. It’s not clear why trauma causes PTSD in some people but not others, but it’s likely due to many different reasons. This includes the length of time the trauma lasted, the number of other traumatic experiences in a person’s life, their reaction to the event, and the kind of support they received after the event.
Social inequalities make some people more vulnerable to experiences that can result in trauma. Racism, socioeconomic disadvantage and poverty, sexism and gender-based inequality, discrimination based on dis/ability or sexual orientation, or experiences of stigma or mistreatment related to one’s mental health can all result in trauma. Children and adults who are dependent on others for care are also vulnerable, and youth who are homeless, living in poverty, identifying as 2SLGTBQ, or who have a disability are also at a higher risk of being victimized repeatedly.[7]
Some jobs or occupations put people in dangerous situations. Military personnel, first responders (police, firefighters, and paramedics), doctors, and nurses experience higher rates of PTSD than people in other kinds of work. Trauma is not always a single event that happened in the past. Some trauma, particularly repeated trauma during wartime or ongoing abuse can impact a person’s life far beyond the symptoms of PTSD, making it difficult to form and nurture strong relationships and even bringing on other health problems. Some use other terms like ‘complex PTSD’ to describe this.
What can I do about it?
Many people feel a lot of guilt or shame about PTSD because we’re often told that we should just get over difficult experiences. Others may feel embarrassed talking with others. Some people even feel like it’s somehow their own fault. Trauma is painful. If you experience problems in your life related to trauma, it’s important to take your feelings seriously and talk to a healthcare professional.
Access to social supports
Experiences of trauma are often linked to the conditions we live in, and to any discrimination we experience, so it is important to address the root causes of social inequality. This is not your responsibility as an individual but rather is a collective one that must be addressed by governments and the health and social services sectors. When it comes to loved ones, we can help get them supports in the community, such as assistance for income, employment and housing, shelter services, crisis services, or access to cultural supports and support in different languages.
Counselling
A type of counselling called cognitive-behavioural therapy (or ‘CBT’) has been shown to be effective for PTSD. CBT teaches you how your thoughts, feelings, and behaviours work together and how to deal with problems and stress. You can learn and practice many CBT skills on your own. You can also learn skills like relaxation and techniques, such as meditation, to bring you back to the present moment. Exposure therapy, which can help you talk about your experience and reduce avoidance, may also help. It may be included in CBT or used on its own.
Medication
Medication, such as anti-anxiety medication or antidepressant medication, may help with anxiety itself, as well as related problems like depression or problems sleeping. Talk to your doctor if you’d like to learn more about medication options.
Support groups
Support groups can also help. They are a place to share your own experiences and learn from others, and help you connect with people who understand what you’re going through. You may also find support groups for loved ones of those affected by PTSD.
How can I help a loved one experiencing PTSD?
When someone is diagnosed with PTSD, loved ones can also experience difficulties. You may feel guilty or angry about the trauma itself—then, on top of those feelings, experience difficulties with helping your loved one cope with PTSD. You may feel like your loved one is a different person, worry that things will never be the same again, or wonder what will happen in the future. Here are some tips to help you cope:
- Start by learning more about PTSD. This can give you a better idea of your loved one’s experiences.
- People who experience PTSD may withdraw from family and friends. Even if your loved one doesn’t want to talk, you can still remind them that you are there to listen if they’re ready.
- Understand that behaviours related to PTSD—like avoiding certain situations or reacting angrily to a minor problem—are not about you. They are caused by the illness.
- While it’s usually not a good idea to support behaviours that create problems, it’s still important to support your loved one as they move toward wellness. This balance is not always easy, and you need to respect your own boundaries, too.
- Ask what you can do to help, but don’t push unwanted advice.
- Try to put your own feelings into words and encourage your loved one to do the same. It’s easier to solve problems or address conflicts when you know what’s really going on.
- Take care of your own wellness and seek support for yourself if you experience difficulties.
- If a loved one’s PTSD is affecting other family members, it may be helpful to seek family counselling.
With support, people can recover from PTSD and the effects of trauma. Recovery is helpful for everyone in a person’s circle, especially for young people who are still learning how to interact with the world. A loved one’s recovery is a chance for everyone to learn the skills that support wellness.
Originally posted by Canadian Mental Health Association
Mental health and resilience – the secrets of inner strength from DW Documentary.
The practice of self-compassion: What is it?
We may not always have control over the events and emotions that unfold in our day-to-day lives. Yet, what is within our control is how we view difficult situations and engage with our thoughts and feelings. Being able to do so in a self-compassionate manner enhances our well-being and our ability to cope with life’s challenges.
“If your compassion does not include yourself, it is incomplete”- Jack Kornfield
Defining Self-Compassion
Practicing self-compassion means approaching ourselves with the same kindness we extend to others such as our family and friends. In moments of difficulty, failure, or self-doubt, we recognize our pain instead of ignoring it and provide ourselves with comfort and care. It’s acknowledging that everyone experiences challenges, as this is simply part of being human.
The Three Key Elements of Self-Compassion
- Self-kindness vs. Self-judgment: Offering ourselves warmth and acceptance during difficult times or when making mistakes, rather than judging ourselves harshly.
- Common Humanity vs. Isolation: Recognizing that no one is perfect and that we aren’t alone in our struggles are key elements of our shared human experience.
- Mindfulness vs. Over-identification: Bringing awareness to painful thoughts and feelings and taking a step back to see them as they are, rather than getting overwhelmed by them.
How to Practice Self-Compassion
- Pay attention to your inner voice. Is it supportive or overly critical?
- Replace unhelpful thoughts, such as “I shouldn’t feel this way” or “I’ll never fit in” with more helpful ones, like “anyone would feel disappointed in these circumstances” or “I accept my whole self.”
- Try specific self-compassion exercises such as writing a letter to yourself or engaging in a loving-kindness meditation.
- Prioritize self-care with activities like going for a walk, journaling, calling a friend, or treating yourself to your favorite dinner.
- Cultivate a mindfulness practice.
Why Start?
We’re all deserving of compassion, kindness, and understanding. Cultivating self-compassion not only fosters more positive mental health but also supports the development of stronger connections with others. This powerful tool empowers us to lead more fulfilling lives. By approaching it in a manner that respects our individual needs and journeys, we contribute to bringing healing into the world. The journey starts with each one of us.
Originally shared by the Canadian Mental Health Association
Detox from alcohol can be a complicated process, but before you can recover from alcohol addiction, you need to get all the alcohol out of your system. The alcohol withdrawal timeline can vary, and how long it takes to get alcohol out of your system depends on how long you’ve been drinking and your overall health.
Some people are able to recover from mild alcohol use problems without experiencing severe withdrawal symptoms, while others have symptoms that could cause permanent disability or death.
An effective detox and alcohol addiction treatment program can help you get through this risky process safely. To be prepared for what comes next, learn more about the benefits of detoxing from alcohol and the typical withdrawal timeline after admission to an inpatient rehab program.
What is alcohol detox?
People who have an alcohol use disorder often find it difficult to stop drinking. Alcohol affects the brain by raising levels of dopamine, which interrupts the brain’s natural dopamine production. It depresses natural brain functioning, which can lead to overstimulation of those systems when the person stops drinking. Frequent and heavy drinking can damage the brain in ways that make it dependent on alcohol. Withdrawal symptoms can develop when the person stops drinking.
Alcohol detox is a managed process of stopping alcohol use and letting the brain clear itself of the negative effects of alcohol. Because withdrawal symptoms can sometimes be dangerous, detox from alcohol should only be attempted under medical supervision. Alcohol self-detox isn’t recommended since some withdrawal symptoms could turn deadly.
When it comes to long-term rehabilitation from addiction, detox is only the first step. After going through detox, you still need to participate in a comprehensive rehab program that addresses the underlying causes of alcohol addiction and teaches you techniques to avoid a relapse.
What withdrawal symptoms can you experience during alcohol detox?
Not everyone experiences the same withdrawal symptoms during detox from alcohol. Symptoms range from mild to severe, and the severity is often tied to the severity of the alcohol use. Some typical alcohol withdrawal symptoms include:
- Sweating
- Shakiness
- Nausea
- Vomiting
- Depression
- Foggy thinking
- Disorientation
- Difficulty sleeping
- Anxiety
- Hallucinations
- Severe agitation
For some people, the risks of alcohol withdrawal include long-term disability and death. This is particularly true for those who have been through multiple detoxification and addiction cycles. People with liver disease, older individuals, and those with a history of withdrawal seizures may also have a higher risk of dangerous withdrawal symptoms. In particularly dangerous cases, the person undergoing alcohol detox develops a condition called delirium tremens. This life-threatening condition involves confusion, restlessness, fever and seizures. Delirium tremens is potentially fatal.
Various factors can influence the type and severity of withdrawal symptoms during detox from alcohol. Factors that might increase your risk of severe symptoms include:
- A family history of alcoholism or drug addiction
- How long you have been addicted to alcohol
- The amount of alcohol you typically drink in one drinking session
- Medical history
- Childhood trauma
- Stress levels
- Co-occurring mental health issues
- Co-occurring substance abuse problems
Medically managed detox helps reduce the risks during this potentially dangerous time period. During a medically managed detox program, doctors and nurses monitor the person for a few days so they can intervene if symptoms become problematic. The individual in recovery may be prescribed medicine to ease symptoms.
Doctors and rehabilitation center staff use a scale called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to assess where the person is in the detoxification process. This helps them decide what interventions are appropriate at different stages of withdrawal.
What factors influence alcohol withdrawal?
Several factors influence the severity of alcohol withdrawal, making it a highly individual condition. These factors include the following:
- medical history
- stress levels
- how long the individual has been drinking
- family history of addiction
- how much alcohol was consumed each time
- presence of a co-occurring mental health disorder
- childhood trauma
Another factor that can influence alcohol withdrawal symptoms is using other drugs and alcohol simultaneously. It can also increase the potential side effects and dangers.
Generally speaking, the more dependent on alcohol an individual is, the more likely the individual is to encounter severe alcohol withdrawal symptoms.
Alcohol withdrawal can be fatal since the central nervous system and brain experience a revival after being restrained by alcohol for an extended period of time. Alcohol acts as a central nervous depressant and its sudden removal can be life-threatening.
It is never recommended that an individual stops drinking completely without professional supervision since symptoms can occur and magnify at a rapid rate. Even after the physical side effects of alcohol withdrawal have subdued, cravings and emotional symptoms can continue without the proper treatment and support.
How long is alcohol detox?
An alcohol detox program takes from three to ten days. During this time, you stay onsite at the rehab facility and receive 24-hour monitoring for withdrawal symptoms.
The alcohol withdrawal timeline typically occurs over 12 to 72 hours and progresses in stages. The first symptoms usually begin to show up about 12 hours after the last drink. Depending on the severity of the addiction, withdrawal symptoms can start even before all the alcohol has left your system.
The symptoms of alcohol withdrawal may last up to a week. Most people going through detox experience the worst symptoms around 24 to 72 hours after the last drink. If hallucinations occur during withdrawal and detox, these typically start 12 to 24 hours after the final drink and dissipate by 48 hours after the last drink. Delirium tremens begins around 48 to 72 hours after halting all drinking. If someone in detox doesn’t progress to severe symptoms by 24 to 48 hours after the last drink, they are unlikely to have a significant increase in symptoms after this point.
Once you’ve gone through alcohol detox, rehab from addiction can begin. A typical addiction rehabilitation program takes around 7 weeks, but the program can be tailored to your specific needs. Some people require more time in rehab before they are ready to live a sober life and deal with regular activities using the techniques they learned in therapy. If you are dealing with other substance abuse issues or mental health problems, you may need a longer rehab program to address these issues alongside the addiction.
After completing a rehab program, you may remain in an aftercare program for a year or more. These therapy sessions, peer group meetings and check-ins help you assess your progress and reduce the chances of a relapse into addiction.
What are the stages of alcohol withdrawal?
There are three stages of severity when it comes to alcohol withdrawal side effects ranging from mild to severe.
Stage 1: Mild
- Loss of appetite
- Nausea
- Depression
- Heart palpitations
- Anxiety
- Tremors
- Mood swings
- Abdominal pain
- Insomnia
- Foggy thinking
Stage 2: Moderate
- Increased mood disturbances
- Irregular heart rate
- Irritability
- Increase blood pressure
- Sweating
- Mental confusion
Stage 3: Severe/delirium tremens
- Fever
- Agitation
- Respiration and body temperature
- Seizures
- Hallucinations
- Severe confusion
How long before symptoms start showing up?
Between 12 and 24 hours, after individuals stop drinking, some people may experience tactile, auditory or visual hallucinations. These typically end within 48 hours.
Withdrawal seizures usually happen between 24 and 48 hours after an individual stops drinking. But in rare cases, seizures can occur as early as 2 hours after drinking stops and up to 10 days after cessation of alcohol. There is an increased risk of seizures for people who have gone through numerous detoxifications or have had previous seizures.
Delirium tremens typically start between 48 and 72 hours after an individual’s last drink. Individuals most at risk of delirium tremens have acute medical illness, a history of withdrawal seizures, abnormal liver function, or are of an older age.
Are there medications that can help during alcohol detox?
In some cases, medication is required to reduce withdrawal symptoms to manageable levels. Alcohol detox medications are administered by the doctor monitoring the withdrawal process.
There are a few different medicines used in detox, and what works for one person may not work for another. The type and amount of medication may be adjusted during detox as the client’s needs change.
Benzodiazepines
Benzodiazepines include short-acting and long-acting versions, both of which can be used in a detox program. These medicines treat anxiety, insomnia and muscle spasms that occur during withdrawal.
Naltrexone
This medication reduces alcohol cravings. Because it can cause an increase in withdrawal symptoms, naltrexone is not usually prescribed or administered until a few days into the detox process. Naltrexone is available in pill and injectable forms, and the doctor managing your detox and rehabilitation can determine which version is right for you.
Anticonvulsants
Individuals with a history of withdrawal-induced seizures may be given anticonvulsant drugs during detox. Common anticonvulsant drugs used to manage convulsions during withdrawal include carbamazepine, divalproex sodium, phenobarbital, levetiracetam, and clonazepam.
Anti-Nausea Medication
Because nausea is a common symptom during detox, anti-nausea medication is sometimes used during the withdrawal phase of addiction recovery. Some commonly prescribed anti-nausea medications during detox include ondansetron and metoclopramide.
Antipsychotics
These drugs reduce psychotic episodes, such as hallucinations, delusions, and paranoia. Individuals experiencing these symptoms as part of their withdrawal from alcohol may be prescribed antipsychotics such as olanzapine and risperidone. These drugs are also used to treat conditions such as schizophrenia and bipolar disorder, so individuals with these conditions who are going through detox may continue taking these medications during and after rehab.
Antidepressants
Individuals with clinically diagnosed depression who are going through detox may be prescribed antidepressants. These medicines also help reduce anxiety, another potential symptom of alcohol withdrawal. In some cases, those with a co-occurring mental health disorder may continue taking medication for depression or anxiety after rehab in order to manage those symptoms. Treating mental health issues is part of rehabilitation because these conditions can increase the risk of a relapse later if left untreated.
Disulfiram
Disulfiram is typically used during the later stages of rehabilitation, not during the detoxification process. This drug causes negative side effects when alcohol is consumed. The intended use of disulfiram is to make alcohol use so unpleasant that you don’t want to drink anymore. Someone who drinks alcohol while on disulfiram may experience nausea, headache, body weakness, face flushing and low blood pressure.
Acamprosate
Individuals who have been drinking heavily for years may be prescribed acamprosate. This drug helps reduce alcohol cravings and assists the brain in returning to normal functioning after experiencing the effects of long-term alcohol addiction.
What are the risks of attempting alcohol detox at home?
While it may be tempting to attempt alcohol detox at home, it’s important to understand the serious risks involved. Alcohol withdrawal can be a dangerous and potentially life-threatening process, especially for those with a long history of heavy drinking.
One of the biggest concerns with at-home detox is the potential for severe complications and health risks. Alcohol withdrawal can cause a range of physical and psychological symptoms, including seizures, delirium tremens (DTs), and even heart failure. These conditions can escalate quickly and require immediate medical attention. Without proper monitoring and intervention, the consequences could be fatal.
Another significant risk of attempting detox at home is the lack of medical supervision and support. Detoxing under the care of trained professionals ensures that individuals receive the necessary medications to manage withdrawal symptoms and prevent complications. Medical staff can also monitor vital signs and intervene if any health issues arise. At home, individuals are left to manage the process on their own, which can be overwhelming and dangerous.
Furthermore, attempting detox at home can increase the likelihood of relapse. Withdrawal symptoms can be intense and challenging to manage without professional support. The urge to drink to alleviate these symptoms can be incredibly strong, leading many individuals to return to alcohol use. In a supervised detox setting, individuals have access to round-the-clock support and are removed from triggers and temptations, increasing their chances of successful completion.
It’s crucial to remember that alcohol detox is just the first step in recovery. Without proper aftercare and ongoing treatment, the risk of relapse remains high. Professional treatment programs not only provide a safe and supportive environment for detox but also offer the therapy and tools necessary for long-term recovery.
What happens after alcohol detox?
After completing alcohol detox, it’s essential to recognize that this is just the beginning of the recovery journey. Detox is a crucial first step, as it allows the body to rid itself of the physical dependence on alcohol. However, to maintain sobriety and prevent relapse, individuals must engage in ongoing treatment and therapy.
Continued care focuses on developing coping strategies and relapse prevention skills. This involves learning how to manage stress, identify and avoid triggers, and build a strong support network. Therapy sessions, whether individual or group, provide a safe space to explore the underlying causes of addiction and develop healthier coping mechanisms. Cognitive-behavioral therapy (CBT) is a commonly used approach that helps individuals recognize and change negative thought patterns and behaviors.
It’s also crucial to address any underlying mental health issues or trauma that may have contributed to the development of alcohol addiction. Many people use alcohol as a way to self-medicate or cope with unresolved emotional pain. By working with a mental health professional, individuals can begin to heal from past traumas and learn to manage symptoms of depression, anxiety, or other mental health disorders in a healthy way.
Seek professional help.
Self-detox generally isn’t advised, and often isn’t effective. Willpower can only take you so far, and it may not be enough to counter the physical changes that alcohol has caused in your system.
For managed detox that helps you get through withdrawal symptoms as comfortably as possible and a rehab program that maximizes your chances of long-term success, you’re likely to need professional help.
Originally posted by Edgewood Health Network
The Social Connection Series: Imad’s Story from World Health Organization.
Teresa Bansen, Director, Quality and Patient Experience at Edgewood Health Network sheds some light on what’s troubling young people – and where they can find help.
Recent findings by the Mental Health Commission of Canada found that 1.2 million children in Canada are experiencing mental health issues. And less than 20% get the care they need.
A perfect storm of conditions is putting today’s youth at greater risk for addiction and mental health disorders. Social media, video games, peer pressure, and an intense political climate are all playing a part.
EHN Canada offers a virtual Healthy Minds Teen Comprehensive Program available to youth across the country. Teresa talked to us about what’s on young people’s minds and what makes our program uniquely positioned to help.
WHAT YOUNG PEOPLE ARE STRUGGLING WITH TODAY?
Teresa: While substance use and mental health concerns have been impacting youth for ages, there are some relatively newer concerns that young people are facing.
One concern, unsurprisingly, is the impact of the pandemic on children and youth. I don’t know that we fully understand or can anticipate how COVID has impacted youth. To speak to what I’ve seen with youth I’ve worked with, along with what other professionals in the field have noted, is that we’re seeing an increased tendency to isolate and that youths’ social batteries are running out more quickly.
We know that because of the pandemic’s closures and lockdowns, many children and adolescents missed out on very important socialization and developmental milestones. In some ways, children and youth are presenting a bit younger developmentally because they haven’t had as many opportunities to gain experiences with their peers, interests, and academics in the way that the generations before them have.
Other concerns many young people are struggling with are technology and social media, which has likely been reinforced and worsened by the pandemic and lockdowns. There’s also typically a pretty large discrepancy between the capacity and understanding adults have of social media and technology when compared to the knowledge of young people. Gaming has also been identified as a growing concern brought forward by parents and caregivers. Many parents I’ve worked with are expressing concern about their children and teens spending excessive amounts of time playing video games, as well as time on their screens.
YOUNG PEOPLE ARE VERY TECH-SAVVY, YET THEY’RE STILL VULNERABLE TO SOCIAL MEDIA DANGERS. WHY IS THAT?
Teresa: Youth tend to be very tech-savvy and can typically find their way through a variety of applications, even providing support and help to their parents or siblings. However, the brain does not stop developing until at least the age of 25, which puts youth in a particularly vulnerable position when consuming media and technology.
We also know that when parents are armed with knowledge and information about risks associated with behaviours or common vulnerabilities for youth, they can facilitate helpful discussions surrounding concerns. However, with social media and access to technology, there is a gap in knowledge and therefore parents are less likely to be able to facilitate meaningful conversations about risk and safety.
THERE MUST ALSO BE ELEMENTS OF SOCIAL MEDIA THAT TEENS DON’T TELL THEIR PARENTS ABOUT?
Teresa: Yes, absolutely. I am glad you raised this point. I think a large majority of teens have experienced or contributed to various levels of cyberbullying, or perhaps have felt out of control or troubled regarding situations or relationships online. For example, a peer has access to a photo or information that they sent, which then gets shared with others without their consent.
Another potential area for concern is that many adolescents are meeting friends online – friends that they may not ever meet in person. These could be mutual friends they’ve added through a platform such as Snapchat, or it could be people who live on a different continent altogether. And unfortunately, a lot of parents just aren’t aware of the number and nature of relationships their teenagers are making online.
While many parents do a good job of educating their teenagers on the basics about certain risks of the internet, there are still tremendous gaps and blind spots that parents aren’t even aware of.
SOCIAL MEDIA HAS HELPED CONNECT YOUNG PEOPLE WHO FEEL ALONE. AND IT HAS HELPED REFLECT DIFFERENT BODY TYPES, ETHNICITIES, AND GENDER EXPRESSIONS. HOW DO TEENS BALANCE THE GOOD AND BAD?
Teresa: I do believe that social media can have a really positive impact on people’s lives, as well as help to raise understanding and increase access to information and education on important topics. For example, social media can be a great vehicle for increasing representation of certain folx within the media, or for advocacy surrounding equity deserving groups like BIPOC or 2SLGBTQQIA+ communities. Having said that, it’s hard to know how much of this positive content is being consumed by adolescence.
It can be helpful for trusted adults to work with young people to avoid certain topics that might be triggering or unhelpful for them. For example, if a teen is in recovery from an eating disorder or has mental health concerns, it is worth having open, non-judgemental conversations about which pages or accounts they should consider removing from their social media feeds.
Approaching these conversations with curiosity and working with the youth to come up with their own solutions can also be helpful. This could also look like actively searching out and interacting with those more positive accounts and content. Unfortunately, there’s still a lot of really negative content out there that’s misrepresentative of many things, with a large portion of it pertaining to mental health concerns.
Additionally, it is especially hard for adolescents to discern what advice and content is healthy and legitimate versus what isn’t.
HOW MUCH IS A TENSE GLOBAL POLITICAL CLIMATE IMPACTING YOUTH MENTAL HEALTH RIGHT NOW?
Teresa: I’ve seen some examples where I have really admired and been impressed by the level of insight, nuance, and advocacy young people bring to important social justice movements. I personally have had moments where I feel very encouraged and hopeful due to younger generations being so vocal and well-informed on important topics.
However, as you can imagine, the flip side of having so much access to global information can feel very overwhelming and can absolutely have a negative impact on mental health. For example, for an adolescent exploring their own gender identity who isn’t sure how to work through this self-discovery, access to tense political climates regarding gender and sexuality has the potential to significantly impact their mental health. Similarly, it is important to recognize the impact of witnessing collective trauma, which can be quite detrimental for youth given their stage of development.
PEER PRESSURE HAS BEEN DISCUSSED AS A CAUSE OF TEEN MENTAL HEALTH ISSUES FOR DECADES. WE SEEM TO HAVE MADE LITTLE HEADWAY IN SOLVING THAT ISSUE.
Teresa: Oh, gosh, and there really isn’t a simple solution to peer pressure because relationships and connection are at the core of our being. Humans are social creatures who have a survival instinct and drive to feel included, valued, loved, connected, and as if we belong.
For many youths, staying connected to peers and being accepted can often override any hesitancy they may feel about engaging in certain behaviours, such as drug use. If being with friends is the only place a teen feels that they really belong, or have a chance of eventually belonging, it makes sense that the adolescent (or anyone, for that matter) may succumb to peer pressure. It’s hard-wired into us.
DO YOU THINK THAT WITHIN 2SLGBTQQIA+ TEENS, THERE ARE EVEN MORE WHO ARE LOOKING FOR COMMUNITY AND FINDING IT IN THE CLUB SCENE?
Teresa: This is a great question. While I can’t say yes or no definitively, I would have to imagine that that is what’s happening to many young people. Because as we talked about, if you’re already in a marginalized position and “othered” within the larger society, it’s hard to find your place of fitting in and connection.
CAN YOU TELL US ABOUT EHN ONLINE’S HEALTHY MINDS TEEN PROGRAM AND HOW IT CAN HELP? Teresa: In light of everything we’ve just been chatting about, there is a great need for youth and for families to navigate what’s happening for them. Specifically, the Healthy Minds Comprehensive Teen Program provides youth with the counselling, education, and support they need to thrive. It is a 6-month program that also includes educational and supportive sessions for caregivers to help foster a healthy and open environment for their teens – all virtually.
WHY IS TREATING CONCURRENT DISORDERS SO IMPORTANT?
Teresa: It’s been my experience working in the field of mental health that teens with concurrent disorders tend to fall through the cracks. For example, if a teen has both substance use and an eating disorder, they may get a referral to an eating disorder program. However, once they complete the assessment and it’s identified that they also use substances, substance use is a common exclusion criterion, which will likely lead to the assessment team asking the teen to work on their substance use first to access services. Often, a similar situation arises if the same youth attempts to get help for their substance use first.
When we look at human behaviour, what it boils down to is just different symptoms for similar pain and struggles that human beings experience. I think it is important that we offer this treatment so fewer teens will fall through the cracks.
YOU MENTIONED SUPPORT FOR BOTH TEENS AND THEIR FAMILIES?
Teresa: Yes, we really encourage parents and caregivers to attend the family support components of our program. Many parents don’t know what to do or how to support their teen, but there’s a clear desire from families to learn.
Specifically, the Healthy Minds Teen Program offers orientation and exit sessions, as well as 12 hours of Emotion-Focused Family Therapy for caregivers. The hope is to build some community and connection not just for the teens, but for parents and caregivers as well. I’ve heard from so many parents that having a child that is struggling can be an incredibly isolating experience, leaving caregivers feeling lost and helpless. And the research shows us that when family is involved, there are much better outcomes for treatment.
SHOULD TEENS IN THE PROGRAM WORRY THAT EVERYTHING THEY SAY IN TREATMENT WILL BE SHARED WITH THEIR PARENTS?
Teresa: No, definitely not. As licensed mental health professionals, we have to adhere to personal health privacy laws, which means that what youth share with us must remain confidential. There are always exceptions or limits to confidentiality with regard to imminent harm or safety, but our clinicians do a great job clarifying any questions youth may have.
SO, TEENS WITH VARIOUS STRUGGLES – EATING DISORDERS, TRAUMA, OCD, ADDICTION, DEPRESSION – WILL ALL EXPERIENCE GROUP THERAPY TOGETHER?
Teresa: Yes. There are a few different reasons and ideas behind that. These teens are struggling and are in pain. They need support. The behaviours they have are just the surface level symptoms. Having teens together with various struggles can be really helpful for them to not feel like they’re alone or that they’re weird or different.
HOW CAN PARENTS, TEACHERS, AND HEALTHCARE PROVIDERS KNOW WHEN A TEEN IS REALLY STRUGGLING?
Teresa: That’s a great question. There is a large range of indicators that parents, teachers or healthcare providers can notice or pick up on when a teen is struggling. Generally speaking, warning signs may include noticing fairly significant shifts in the youth’s mood, whether the teen is a lot more excitable than usual, or perhaps noticing the teen is feeling sad, disengaged, or is self-isolating. If grades start to drop in school, that’s typically an indication that they’re struggling in some way.
You may notice a young person commenting more on their body or on their appearance, which might include really degrading comments toward themselves. It may be helpful to watch out for significant weight loss or weight gain within a short amount of time, as well as changes to how much and what types of foods they’re eating.
We are also starting to see more parents pre-emptively connect teens with a therapist or support program. The teen may not be expressing significant distress, but it can still be very helpful to make that connection with a trusted person or therapist before things get really bad. Having an existing connection and learning skills in advance can help with preventative work.