Kindling Effect and Drug & Alcohol Detox

The kindling effect is a little-known phenomenon that can have severe consequences during drug and alcohol detox. Whilst it is a relatively new term that is used in the drug and alcohol treatment industry, it is not new in its existence.

Alcohol and drug addiction are well known for their progressive nature. However, what usually isn’t talked about is that withdrawal and relapse often become worse each time they happen. 

This worsening of addiction and withdrawal symptoms is not always down to increased substance use, although this plays a factor.  Increased severity of withdrawal symptoms and increased tolerance can also be attributed to what is known as the kindling effect.

In this article, we aim to answer any questions you may have relating to the kindling effect during detoxification. Additionally, we also look at how kindling symptoms happen and why. We hope that by providing you with this information, you will be able to make safe choices regarding drug and alcohol detox.

What Is The Kindling Effect In Addiction?

When someone repeatedly attempts drug or alcohol withdrawal, the process often becomes more difficult over time. This process is referred to as the kindling effect and can explain why the severity of withdrawal episodes can increase after successive attempts.

There is Clinical and experimental data that supports the presence of the kindling effect during drug and alcohol withdrawal. This effect is most prevalent in CNS depressant abuse such as alcohol, benzodiazepines and sedative-hypnotics. 

Much like a fire that latches on to kindling and spreads quickly, the brain increases in sensitivity with repeated drug and alcohol use and withdrawal. This leads to an exacerbation of symptoms and a potentially lethal ‘fire’ in the brain’s chemistry response.

This neurochemical overactivity in the brain of those with alcoholism is what is thought to be responsible for serious withdrawal symptoms such as alcoholic seizures. These chemical responses become more pronounced following multiple withdrawal experiences. The heightened brain response that characterises the kindling effect explains why successive detox episodes generally lead to a worsening of withdrawal symptoms.

How Alcohol Addiction Can Lead To Kindling

Alcohol addiction and abuse often involve drinking habits where heavy and excessive alcohol use is followed by abrupt cessation. This pattern takes its toll, increasing the sensitivity of your brain.

Alcohol has the effect of making the brain and Central Nervous System less active, slowing down normal activity. Opioids, benzodiazepines, barbiturates and sedative-hypnotics have a very similar effect.

When your alcohol exposure is excessive and frequent, your brain overcompensates by becoming more reactive to its presence. This process is known as tolerance and is what enables you to function at some level whilst intoxicated. 

If you have developed tolerance to alcohol or another substance, you will have had to increase the amount or frequency of your use. The original amount or dosage that originally hit the spot will no longer be as effective.  Developing tolerance is an early warning sign that changes in the brain have already taken place; it can lead to dependence and addiction.

Signs of drug and alcohol tolerance:

• Increasing the frequency of your drug and alcohol use
• Having to take a higher dosage of drugs, medications or alcohol to achieve the desired effect
• Swapping to a stronger strength of drugs or medications or swapping to an increased alcohol percentage (i.e. from beer to spirits)
• Experiencing a worsening of drug and alcohol use during relapse
• Withdrawal symptoms if you do not have enough drugs or alcohol in your system

The more your brain is exposed to alcohol, the more tolerant it becomes. With each increase, additional chemical and structural changes take place. Some of these changes in the brain are long-lasting and remain during periods of abstinence.

Now, suppose you want to stop alcohol? 

Many people who abuse alcohol will go through periods of really wanting to quit. The easiest way to stop is to cease drinking and deal with the hangover that follows. The problem with this is if your brain has developed tolerance and dependence, the symptoms you experience will be due to alcohol withdrawal and not a hangover. 

When alcohol is removed from someone who has become physically dependent, the compensatory changes in the brain that enable you to function alongside alcohol remain active for several more days. The brain can’t just revert after stopping alcohol. It takes time to calibrate to a healthy state. The more this is repeated, the more sensitive the brain becomes in its response to the presence of alcohol and when alcohol use is ceased.

Increased Brain Sensitivity Causes The Kindling Effect

The more episodes of alcohol withdrawal you experience, the more sensitive your brain becomes to detoxification. 

This hyperexcitability of your brain is what causes alcohol withdrawal symptoms. Symptoms of kindling can be very dangerous, especially in cases of acute withdrawal (cold turkey).

Going cold turkey from an alcohol or drug dependence causes your brain to scramble for equilibrium. It can take days and weeks before your brain returns to normal activity. 

The most effective way to dampen your brain’s response when abruptly stopping drugs or alcohol is to slow it down with the use of approved pharmaceutical medications. In many instances of drug and alcohol detox, this usually involves some form of short-term use of a benzodiazepine.

How The Kindling Effect Impacts Drug and Alcohol Detox

In terms of safe detoxification from alcohol and drugs, the kindling effect presents a very serious problem. You may think that because you have safely detoxed many times before that, radical methods of stopping alcohol involving cold turkey won’t pose a problem. The reality can be very different.

Even if you have never previously had a seizure or delirium tremens during alcohol detox, the kindling effect increases the likelihood of it happening. Moreover, it’s not only alcohol that can cause the kindling effect to develop. Abusing any Central Nervous System depressant, such as opioids or benzodiazepines, can cause the kindling effect to occur. 

Examples of Prescription Drugs  That Can Cause The Kindling Effect include:

• Diazepam
• Clonazepam
• Codeine
• Triazolam
• Zopiclone
• Morphine
• Methadone
• Zolpidem
• Tramadol
• Pentobarbital sodium (Nembutal)‌

Non-benzodiazepines, Sedative Hypnotics, Opioids, Benzodiazepines and Barbiturates are all CNS depressant medications. These medications have a moderate potential for abuse and are controlled prescription drugs. CNS depressant medications are often prescribed for the treatment of conditions such as sleep disorders and anxiety. They are also commonly abused by those with a substance use disorder (SUD) and, in slang terms, are known as ‘Downers’ on the street.

Central Nervous System depressants work by increasing the amount of gamma-aminobutyric acid (GABA) in the brain. This chemical slows down the brain and calms overactivity. 

When GABA in your brain is increased, you will feel more drowsy and relaxed, which is often the desired effect of such drugs. However, when exposure is repeated often, your brain starts to fight against these effects. This overactivity of the brain can lead to tolerance and dependence, which can occur if they are continuously taken for more than a few weeks. 

Clinical recommendations for prescribing state that CNS depressant medications should only be prescribed for short-term treatment in most cases. This is to keep patients safe from addiction and from becoming dependent. 

Who is At Risk of The Kindling Effect?

Those who suffer from addiction (a substance use disorder at the most severe end of the spectrum) are most likely to experience the kindling effect.  This happens because their brain has been exposed to multiple episodes of relapse and detox.

One of the defining characteristics of addiction is repeated relapse. Even when a person really wants to stop substance use forever, long-lasting changes in the brain make this extremely difficult to accomplish.

People who frequently binge on alcohol and drugs also go through many periods of heavy use followed by a period of abstinence. Similar to those who suffer from drug or alcohol dependence, binge drinkers can also develop changes to their brain neurotransmitter systems. These changes happen as a result of increased sensitisation during periods of exposure and withdrawal. 

It is important to note that kindling withdrawal can also happen during drug and alcohol use, not just within a premeditated detox or withdrawal. When a person’s intoxication level falls below what their brain has adjusted to, symptoms of kindling show up as withdrawal symptoms. 

Can it be reversed?

The kindling effect cannot be reversed but symptoms can be treated with approved detox medications. Support groups, therapy and appropriate medical monitoring are often vital components of treatment. 

The best way to treat the effects of kindling is through increased awareness of withdrawal, detox drugs and bespoke tapering regimes. All treatments should be adapted to a person’s individual withdrawal severity.

Stopping The Cycle of Relapse & Withdrawal

If you are someone who suffers from a substance use disorder, accessing the correct treatment can help you recover and prevent future episodes of relapse and withdrawal.

Therapy, rehabilitation programmes and relapse prevention are all evidence-based methods that are recommended in the treatment of drug and alcohol addiction.

Monitoring withdrawal symptoms and preventing them from spiralling is a very important aspect of treatment. Not only will this keep you safe, but also increase your chances of success, as well as prevent further over-sensitivity in the brain.

Some Of The Effects of Kindling During Withdrawal:

• Severe anxiety
• Depression
• Agitation
• Confusion
• Catatonia
• Cognitive difficulties (brain fog)
• Restlessness
• Panic attacks
• Tremors
• Insomnia
• Vomiting and diarrhoea
• Palpitations
• Psychosis
• Protracted withdrawal symptoms
• Restless legs
• Muscle spasms
• Seizures
• Suicidal thoughts and attempts

The effects of kindling can vary slightly depending on the substance the person is withdrawing from. Symptoms of kindling that are considered serious and are a potential threat to life include seizures, delirium tremens, confusion, chest pain, mania, psychosis and suicidal ideation.

Determining If You Suffer From The Effects Of Kindling

Kindling withdrawal symptoms manifest both physically and mentally. A good indicator of whether you will suffer from Kindling withdrawal symptoms is to consider your past withdrawal episodes and the progression of your drug or alcohol use. 

If things have generally gotten worse over time and you have suffered repeated binges or relapses, it is wise to safeguard yourself against the effects of kindling.

To help safeguard yourself, before attempting a withdrawal from drugs or alcohol at home, it is always best to speak with a healthcare professional who is educated on the kindling effect.

Preventing Kindling Withdrawal Symptoms

Whilst the kindling effect cannot be reversed once already established, symptoms can be successfully treated and prevented from becoming worse. 

Drug and alcohol addiction is well known for causing kindling through increased brain sensitivity. In simple terms, addiction only ever gets worse. This is what makes it so life-threatening.

The obvious solution is not to relapse and stop abusing substances. However, this is rarely easy. 

Addiction affects numerous areas in the brain and causes long-lasting changes. Many people who experience multiple relapses have difficulties recalling just how bad their addiction was and the reasons they sought recovery. They struggle to cope with their emotions and with day-to-day life. Additionally, they become convinced that they will be able to control their drug and alcohol use in future. These symptoms of addiction make maintaining sobriety extremely challenging.

In the first instance, a full medical detox is clinically recommended to help you stop drugs and alcohol safely. This should ideally be conducted within a CQC-registered detox facility or a hospital. 

Home detoxes are considered more risky as they don’t offer 24/7 access to medical monitoring and therapeutic support. For those at risk of the kindling effect, home detox is not considered a safe option.

Once you have successfully detoxed, a period of intensive rehabilitation is recommended. This helps to safeguard against further relapse and treats the underlying causes that drive your addiction. Rehabilitation is pivotal and could prevent a potentially fatal relapse.

Professional Drug And Alcohol Detox Prevents The Kindling Effect

We understand that asking for professional help can be difficult and scary. However, it can be life-saving.

Our CQC-registered drug and alcohol detox clinics and rehab centres are staffed by treatment professionals who have personal experience with addiction. Their understanding and compassion can be truly comforting and provide you with a much-needed source of hope and inspiration.

We have comprehensively assessed all of our treatment facilities to ensure they meet the highest standards of care. We have numerous locations all over the UK, Northern Ireland and overseas to suit multiple treatment needs and budgets. 

Call and speak with one of our trained addiction experts for an initial detox assessment and free advice on whether a medical detox could help you and prevent the effects of kindling manifesting. We are waiting to take your call and listen to your story.

Sources:

• Kindling and Alcohol Withdrawal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761822/
• Tolerance to alcohol: https://pubs.niaaa.nih.gov/publications/aa28.htm#:~:text=Tolerance%20means%20that%20after%20continued,the%20same%20effect%20(1).
• What To Know About CNS Depressants: https://www.webmd.com/brain/what-to-know-about-cns-depressants
• GABA (gamma-aminobutyric acid): https://en.wikipedia.org/wiki/%CE%93-Aminobutyric_acid
• Benzodiazepine Withdrawal Catatonia: A Diagnostic Intervention: https://www.psychiatrist.com/pcc/addiction/benzodiazepine-withdrawal-catatonia-diagnostic-intervention/#:~:text=The%20exact%20mechanisms%20underlying%20the,hallucinations%2C%20seizures%2C%20and%20delirium.