Alcohol Withdrawal Symptoms: A Complete Guide for Recovery

Alcohol withdrawal symptoms are a set of symptoms that occur when a person with a history of alcohol misuse suddenly stops drinking after drinking heavily and/or drinking regularly for a long time.

The more and the longer you drink, the more likely you are to experience withdrawal symptoms. Most people experience mild withdrawal symptoms such as headache, insomnia, gastrointestinal discomfort (nausea, vomiting), and anxiety. However, some people with heavy or chronic alcohol use experience more serious symptoms during alcohol withdrawal.

Severe alcohol withdrawal symptoms can lead to life-threatening complications, such as delirium tremens, that require urgent medical intervention.

What Happens In The Body When You Stop Drinking Alcohol?

Physical symptoms of alcohol withdrawal may include:

Fatigue
Headaches
Jitteriness or shakiness
Tremors in the hands or other parts of the body
Insomnia
Nightmares
Pale skin
Cool, clammy skin
Excessive sweating
Enlarged pupils
Abnormal eye movements
Upset stomach
Nausea
Vomiting
Loss of appetite
Fast heart rate or palpitations
High blood pressure
Hyperthermia (increased body temperature)
Dehydration

What Does Your Brain Do When You Stop Drinking Alcohol?

Psychological symptoms of alcohol withdrawal can include:

Irritability
Nervousness
Anxiety
Depression
Mood swings
Slowed thinking
Memory problems

Learn about the long-term effects of alcohol on the brain.

What Is The Most Serious Withdrawal Symptom Associated With Alcoholism?

Alcohol withdrawal delirium, previously called delirium tremens, is a severe form of alcohol withdrawal. It occurs in less than 5% of people recovering from alcohol abuse but is potentially life-threatening, and individuals should be seen by a doctor immediately. Delirium tremens can occur within 3-8 days of the last drink of alcohol and cause the following serious symptoms:

Delirium (sudden, severe confusion)
Irritability
Agitation
Hallucinations (seeing, hearing, or feeling things that aren’t actually there)
Fever
Alcohol withdrawal seizures

Find out: Is Alcoholism a Mental Illness or Chronic Disease?

Causes Of Alcohol Withdrawal

Mechanisms of Alcohol Withdrawal

Alcohol is a central nervous system (CNS) depressant. It stimulates the production of gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter (chemical messenger) in the brain that slows down brain activity. During alcohol intoxication, GABA is produced in excess, which results in the common symptoms of alcohol use, such as drowsiness and reduced mental alertness.

Long-term unhealthy* alcohol use changes the balance of inhibitory neurotransmitters (GABA) and excitatory neurotransmitters (glutamate) in the central nervous system. The brain responds to alcohol misuse by over-producing glutamate to balance the excess GABA provided by alcohol.

When a person with alcohol addiction who has been drinking for a long time stops or reduces alcohol intake, there is a sudden decrease in the amount of GABA in the brain, resulting in excess glutamate. Alcohol withdrawal symptoms reflect the effects of excessive glutamate. In short, you experience alcohol withdrawal due to changes in the levels of brain chemicals.

*Note: Unhealthy or excessive use of alcohol is defined by the Center for Disease Control (CDC) as:

Binge drinking: 4 or more drinks for women per week. Five or more drinks for men per week.
Heavy drinking: 8 or more drinks for women per week. 15 or more drinks for men per week
Under Age drinking: You should not drink if you are <21 years of age.
Drinking while pregnant: You should not drink while pregnant or trying to conceive.

However, these are general guidelines, and alcohol withdrawal can develop regardless of these specific guidelines, depending on several risk factors listed below. The CDC advises to limit alcohol use as much as possible.

Biological And Environmental Factors

Based on clinical and diagnostic research, certain biological and environmental factors have been found to increase the risk of experiencing a more severe or complicated withdrawal from alcohol. This includes prolonged alcohol withdrawal symptoms or complications such as delirium tremens and alcohol withdrawal seizures.

Risk factors for experiencing withdrawal symptoms that are severe or dangerous include:

Severe alcohol dependence (prolonged duration of alcohol abuse and/or heavy alcohol intake).
Prior alcohol detoxification (attempts at quitting alcohol) with the development of severe alcohol withdrawal symptoms.
Previous history of delirium tremens or alcohol withdrawal seizures.
More severe symptoms when starting alcohol withdrawal treatment.
Abnormal liver function.
Intense cravings for alcohol.
Co-occurring mental disorders or physical illnesses.
Concomitant use of other drugs with alcohol.
Older age.

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Severity of Alcohol Dependence

Moderate to severe alcohol use disorder is associated with an increased risk of more severe withdrawal symptoms, including developing delirium tremens (DT), the most severe form of alcohol withdrawal. DT can be life-threatening, causing serious medical complications like delirium, hallucinations, and seizures, which require immediate medical care.

How Long Do Symptoms Last When You Quit Drinking?

The length and severity of alcohol withdrawal syndrome can vary widely from person to person, depending on various factors such as the severity of the alcohol use disorder. A general timeline of alcohol withdrawal stages is as follows:

Early Symptoms (6-12 Hours)

Mild symptoms such as headache, insomnia, and mild anxiety are common in the first 6-12 hours after the last drink of alcohol.

Peak Symptoms (24-72 Hours)

For most people with moderate or mild alcohol withdrawal, symptoms peak (are at their worst) 24-72 hours after the last alcohol intake. After this timeframe, with appropriate alcohol withdrawal treatment, the symptoms usually begin to resolve.

Severe Symptoms (48-72 Hours)

People with severe or complicated alcohol withdrawal are at the highest risk of experiencing seizures 24-48 hours after their last drink. Delirium tremens, which can include shaking, confusion, hallucinations, fever, and high blood pressure, typically develops 48-72 hours after last alcohol consumption.

Post-Acute Withdrawal Syndrome (PAWS)

Most people with alcohol use disorders experience a mild to moderate withdrawal syndrome with short-term resolution of the symptoms in 1-2 weeks. However, some people experience prolonged withdrawal symptoms after they significantly reduce alcohol intake. This is called post-acute withdrawal syndrome (PAWS). It can result in fatigue, insomnia, and mood changes lasting for several weeks to months after the last alcohol consumed.

Treatments For Alcohol Detox

The goals of treatment for alcohol use disorder are to:

Reduce the severity of withdrawal symptoms.
Prevent health complications from severe alcohol withdrawal.
Reduce cravings to help you stop drinking alcohol.

Outpatient Alcohol Detox

People with mild to moderate alcohol withdrawal symptoms can usually be treated in an outpatient setting with daily visits with a healthcare provider. However, such individuals may need to have a friend or family member stay with them to monitor their health and get medical care for potentially life-threatening symptoms.

An important factor to take into consideration during outpatient alcohol withdrawal treatment is a living environment that supports sobriety. Complete abstinence from alcohol (total, lifelong avoidance of alcohol) is recommended for people who have gone through alcohol withdrawal.

Inpatient Alcohol Detox

People with moderate to severe alcohol withdrawal symptoms may require inpatient care, either in a hospital or a specialized medical detox facility for alcohol use disorders. This is to ensure close monitoring and timely management of complications such as hallucinations, seizures, and delirium tremens.

Note: Some people may benefit from inpatient treatment for alcohol withdrawal syndrome regardless of the severity of their symptoms, such as those who drink heavily (recent high levels of alcohol consumption), those with a history of severe withdrawal symptoms, withdrawal seizures, or delirium tremens in the past, people who have undergone multiple previous detoxifications, those with co-occurring psychiatric illnesses or acute medical conditions, pregnant women, and individuals without a reliable support network.

Medication For Alcohol Withdrawal

Some of the drugs prescribed to ease withdrawal symptoms in people with alcohol abuse and alcoholism include:

Benzodiazepines such as chlordiazepoxide (Librium), lorazepam (Ativan), and diazepam (Valium) for insomnia and anxiety
Haloperidol (Haldol) to manage agitation and hallucinations
Gabapentin (Neurontin) to manage withdrawal, cravings, anxiety, and insomnia
Beta-blockers in people with a history of heart disease
Anti-seizure drugs such as phenytoin (Dilantin) in people with seizure disorders.
IV (intravenous/into the vein) fluids
Symptom-driven treatment, for example, anti-nausea medication or pain medication
B vitamins such as thiamine and/or multivitamins

Learn more: Benzodiazepines Vs. SSRIs: What’s A Better Treatment Option?

Counseling And Long-Term Management

Once medically supervised detoxification has been completed, and acute alcohol withdrawal has resolved, the long-term treatment for alcohol use disorder consists of psychotherapy (talk therapy) to manage cravings and build resilience for staying sober. In addition, there are several medications that can help a person stay sober after they stop drinking, for example:

Acamprosate (Campral)
Disulfiram (Antabuse)
Naltrexone (Revia)
Topiramate (Topamax)

Support Groups

More information for people recovering from alcohol use disorders is available from the following resources:

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Substance Abuse and Mental Health Services Administration (SAMHSA)
SMART Recovery (SMART)
Alcoholics Anonymous (AA)
Al-Anon Family Groups (Al-Anon)

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Clinical Features Of Alcohol Withdrawal

How is Alcohol Withdrawal Diagnosed?

Healthcare providers diagnose alcohol withdrawal syndrome based on medical history and physical examination. Important information that should be provided to healthcare professionals includes:

Quantity of alcohol intake
Duration of alcohol abuse
Time since last alcohol consumption
Previous history of alcohol withdrawals
Other medical or psychiatric conditions
Use of other substances

Medical conditions that can result in severe or complicated withdrawal from alcohol include heart disease (arrhythmias, congestive heart failure, coronary artery disease), infections, gastrointestinal bleeding, pancreatitis, liver disease, and nervous system disorders.

Clinical Evaluation And Monitoring

Laboratory tests that may be done to evaluate the effects of alcohol withdrawal include blood tests (blood alcohol level, complete blood count, electrolyte levels, kidney and liver function tests) and a urine drug screen. A physical exam will also be performed upon arrival.

Long-Term Outlook And Recovery

Most people have mild symptoms and make a full recovery from alcohol withdrawal. But heavy drinking can lead to severe withdrawal, which can result in serious health complications, even death. The risk of severe or complicated withdrawal increases with the severity of the alcohol use disorder. In addition, alcohol-related health complications may require long-term follow-up and medical care.

When To Seek Help For Alcohol Withdrawal

You should call 911 or go to the nearest emergency room if you develop a high fever, severe confusion, seizures, visual or auditory hallucinations, or an irregular heartbeat during alcohol withdrawal. These can be signs and symptoms of alcohol withdrawal delirium, the most severe form of alcohol withdrawal. It is a medical emergency and can be life-threatening.

If you have mild alcohol withdrawal and are managing the symptoms at home, call your doctor if you note any changes in your health status.