Do your withdrawal symptoms get worse everytime you stop drinking? Or does it feel like this time in detox was worse than the first? If so, you may be suffering from something called the kindling effect.
The kindling effect is often seen in chronic relapsers and is defined as an increase in sensitivity to withdrawal symptoms. In other words, each time a person attempts to quit alcohol, their withdrawal symptoms get more and more severe.
First-time detoxers may experience minor issues like fever or nausea. However, chronic relapsers may experience more serious issues like seizures or delirium tremens (DT). That’s because the body becomes more sensitive to changes in neurotransmitters, and any break in that cycle can spell disaster for long-time alcohol abusers.
The word kindling was coined by 1960s researcher Graham V. Goddard, who likened this effect to a campfire. Just like how a single match can start a large fire, the same can be said for how animals and humans respond to repeated stimulation.
Goddard first observed this phenomenon by accident while he was studying the how the amygdala works in lab rats. After repeated shocks to this region of the brain with an electrical signal, the rats soon developed seizures. But what’s interesting is that once these seizures developed, it only took a minor shock to send them into full-blown convulsions. The higher voltages used in the beginning were no longer necessary to elicit the same response.
In other words, the threshold needed to induce seizures was decreasing after each attempt. The rats’ brains were showing signs of plasticity and started changing in response to stimulation. This principal soon helped scientists understand the mechanism behind epilepsy and, later, substance use.
The following article will dissect the dangers of alcohol-induced kindling, some treatment approaches to this phenomenon, as well as some other drugs in which kindling has been observed.
What Are the Consequences of Multiple Withdrawal Attempts from Alcohol?
The severity of your alcohol withdrawal symptoms depends on 3 major factors:
- How much you drink
- How often you drink
- And how many times you’ve withdrawn from alcohol before
It’s this 3rd factor that is the most controversial but also the most promising in terms of us understanding more about the disease of alcoholism. Although most of the research examines the effects of multiple withdrawals on seizures, scientists are starting to learn how it also impacts other alcohol withdrawal symptoms, such as cravings, risk of relapse, and cognitive function.
In one study at a New York hospital, almost 75% of all patients detoxing from alcohol had previously admitted to the same hospital for withdrawal. Because of that, doctors specializing in addiction are now asking about your alcohol withdrawal history – some even suggesting that it’s more important to know than drinking pattern or duration.
As such, alcohol withdrawal history is starting to become an accurate predictor of how you’ll withdrawal from the substance next time.
But the correlations don’t just stop there. Other studies show that a history of alcohol withdrawal attempts is directly correlated to (1) cravings, (2) future withdrawal intensity and liver health, and (3) cognitive impairment.
First, drinkers who’ve detoxed at least twice score statistically higher on the Obsessive Compulsive Drinking Scale (OCDS), an indicator of compulsive drinking behavior that is related to cravings. People who score high on this questionnaire are different from your average happy hour drinker. High scorers tend to experience constant drinking-related thoughts, are unable to resist their urge to drink, and because of that, they are more prone to relapse.
This suggests that the more you unsuccessfully detox from alcohol, the greater your cravings will be whenever you put the bottle down. That’s why detoxing from this substance is so dangerous. And that could explain why heavy drinkers with a long history of alcohol abuse have a tougher time getting sober than people just starting out.
Second, scientists observed that withdrawal intensity was higher in those who underwent multiple withdrawal attempts. Measured by the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA), return patients experienced more nausea, tremors, auditory and tactile disturbances as well as more severe anxiety, headaches, and agitation.
And although doctors are most concerned with preventing seizures and delirium tremens (DT), others suggest that your visual and motor cortex of the brain is the most affected by repeated withdrawal attempts.
Regardless, don’t forget to tell your doctor if you have experienced seizures before in detox! That’s because patients with a history of seizures tend to have more progressive liver disease than alcoholics without a history of seizures, which can only complicate your detox regimen. So, be sure to be thorough when your doctor asks about your medical history so they can prevent more severe reactions from occurring.
Third, patients undergoing multiple detox attempt from alcohol tend to have poorer cognitive function than first-time treatment-goers. Cognitive and emotional issues seen in chronic alcoholics include:
- Learning deficits
- Emotional sensitivity and/or confusion
- Misinterpretation of social cues (via facial recognition)
- Overestimation of feelings of sadness or fear
- Increased task error
- Feelings of depression, anxiety, or mood swings
But this is more interesting than you think…
These neurological impairments seen in alcoholics who repeatedly detox are similar to those seen in binge drinkers, which suggests a relationship between the two. Whereas binge drinking is more socially acceptable than chronic alcoholism, its mechanism is more akin to that of a chronic relapser than a sober person.
This is because binge drinkers tend to drink large amounts of alcohol with large periods of abstinence in between; therefore, their body goes through repeated mini-withdrawals each time they stop. So, their body engages in a reaction that’s pretty similar to a patient undergoing repeated withdrawal attempts, causing them to perform poorly in executive cognitive tasks.
Because of that, young social drinkers who indulge in this behavior may accelerate brain disfunction induced by alcohol abuse. Get it? Scientists are saying that the more you binge drink, the worse your next-day hangover could be. So, yes, even occasional drinkers could be susceptible to the kindling effect.
Is there a Treatment for Alcohol Withdrawal Kindling?
There’s no cure for the kindling effect since it’s not technically a disease – it’s an acceleration of withdrawal symptoms. And unfortunately, the proper way to treat or manage the effects of alcohol withdrawal kindling are still being debated.
Some clinicians want to treat these enhanced withdrawal symptoms aggressively and prescribe a longer-term and larger dose of benzodiazepines. However, drugs like diazepam and lorazepam are controversial since they can be abused and lead to their own form of dependence. Therefore, they don’t necessarily address the underlying issues behind alcohol use disorder (AUD) and prevent relapse.
However, medical professionals are wary to do away with addictive drugs like benzodiazepines since patients with a history of withdrawal episodes are more likely to experience severe withdrawal symptoms like seizures. And benzodiazepines have been the gold standard in mitigating alcohol withdrawal symptoms.
Despite benzos being to go-to, other researchers are suggesting we look into the role of GABA, a neurotransmitter in the brain, in order to help chronic alcohol relapsers. For instance, anti-convulsant drugs like gabapentin have shown promise in treating alcohol withdrawal symptoms in chronic users due to there interaction with the brain’s GABA receptors.
As well, some are even suggesting that patients should be administered steroid shots as that may help reduce sensitivity to ethanol. But that area is still new and needs a lot more evidence before we start shooting alcoholics full of steroids.
Moreover, some researchers like J. Ulrichsen and his team are urging doctors to look into phenobarbital treatment for the first couple of detox attempts as doing so prevented rats from developing seizures in later withdrawal episodes. By treating early withdrawal attempts differently from later ones, scientists may alter a new way for us limit the dangers of alcohol withdrawal.
So, will benzodiazepines be the gold standard forever? Probably not. Although they do mitigate withdrawal symptoms, they aren’t without side-effects.
For example, continued administration of sedative hypnotics has actually enhanced withdrawal seizures in a large subset of chronic alcoholics. This unfortunate dichotomy – and heavy reliance of sedative hypnotics like benzodiazepines and barbiturates to treat patients withdrawing from alcohol – all but calls for more research into alcohol-related kindling.
The Kindling Effect isn’t just Limited to Alcohol Abuse
The kindling effect isn’t limited to just alcohol, unfortunately. Repeated use of drugs like cocaine and opiates can also cause increased sensitization and more severe withdrawal symptoms.
And don’t think this is new science either…
Doctors Robert Post and Richard Kopanda first observed this cocaine-induced behavior in monkeys back in 1975. After which, they wrote a letter to the National Institute of Mental Health (NIMH) urging for more research in the area.
They were surprised that repeated exposure to cocaine intensified hallucinatory-like behavior, mild catalepsy, and convulsions. Whereas prevailing science suggests that your tolerance to a drug increases the more you use it, these tolerances don’t necessarily prevent you from being immune to the negative effects of the drug.
In fact, these experiments suggested that a reverse tolerance can be caused by chronic administration of cocaine. That means that cocaine use can actually increase hyperactivity, paranoia, and psychomotor seizures. And the more you do, the more likely you’ll experience one of those dangerous side effects.
This same effect is also seen in those who abuse opiates. Although not as prevalent, some research points to the fact that repeated use of opiates can elicit seizures in certain individuals. But fortunately, drugs like naloxone are able to mitigate these seizures in addicted individuals, providing some form of temporary treatment.
Don’t just Detox from Alcohol… Reach Out to a Professional and Address the Root of the Problem.
Simply detoxing from alcohol is not enough. In fact, people who just go through an alcohol detox program and don’t follow-up with an after-care plan (e.g. inpatient, outpatient, or individual therapy) are more likely to relapse and more likely to experience expensive medical complications.
As illustrated above, repeatedly detoxing from alcohol may increase the severity of your next alcohol withdrawal. By doing so, you will increase the chances of experiencing seizures or delirium tremens (DT) – two extremely dangerous side-effects of alcoholism.
Luckily, addiction treatment professionals exist to help people get out of this dangerous cycle. So, if you are struggling with drug and alcohol addiction, we encourage you to reach out for help!
If you’re in need of an inpatient drug rehab in Texas, give our team a call at (817) 993-9733. Or, feel free to email us at email@example.com. We’ve treated thousands of individuals suffering from alcohol use disorder (AUD) as well as other diseases and are happy to get you on the road to recovery.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.