A: Congratulations on your determination to overcome your addictions. We all know about the addictive potential and side effects of drinking too much alcohol, but few people realize the negative effects of dependence on caffeine. Over-stimulation from caffeine, especially coffee, provokes anxiety, interferes with restful sleep, and significantly irritates the urinary, gastrointestinal, and other systems of the body. So again, I applaud your efforts.
I would recommend withdrawing from caffeine first. Compared to alcohol – and tobacco – caffeine is a much easier habit to break. But to succeed, you should plan ahead. Give yourself three days to do it. Arrange to keep yourself distracted and comfortable and anticipate that you probably won’t have much energy for the duration. You’re also liable to develop a distinctive throbbing headache. You can take aspirin for it, but avoid Excedrin and other pain relievers that contain caffeine.
Giving up alcohol can be much more difficult depending on how much you drink. "Too much" usually means more than two drinks per day for men and more than one drink per day for women (twelve fluid ounces of regular beer or five ounces of wine or 1.5 ounces of 80-proof distilled spirits) or any habitual use that disrupts your life and routines. Withdrawal symptoms usually begin within 12 hours after you stop drinking and peak 48 to 72 hours later.
Since some of the symptoms - both physical and psychological - can be quite severe, I wouldn’t recommend going cold turkey on your own. At best, you’re likely to be nervous, shaky, anxious and may have trouble thinking clearly. Physical symptoms may include headache, nausea, vomiting, insomnia, rapid heart rate and tremor. At worst, withdrawal can lead to delirium tremens (a combination of confusion and visual hallucination), convulsions, and blackouts, all of which require emergency medical treatment. Severe alcohol withdrawal can be fatal.
If you think your withdrawal is unlikely to lead to severe symptoms, you might use the herb valerian as well as breathing exercises to cope with anxiety. Both acupuncture and hypnosis may help you deal with cravings down the line. And take one B-100 B-complex a day to make up for the B-vitamin deficiency alcoholism can cause. I also recommend the herb milk thistle for liver protection and regeneration. Buy a standardized product and follow the dosage directions on the label. (Everyone who drinks alcohol regularly should be on milk thistle, whether or not they plan to withdraw.)
Before you begin the withdrawal process, discuss your plans with your physician. He or she may recommend a drug rehab facility to get you through it. You also could look for one via SAMHSA, the federally sponsored Substance Abuse and Mental Health Facility Locator (http://findtreatment.samhsa.gov/). I also encourage you to join Alcoholics Anonymous or some other support group. Congratulations and good luck!
Andrew Weil, M.D.
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