Alcohol Withdrawal Symptoms

Medically Reviewed By Kayla Loibl | Last Edited : November 04,
2020 | 4 Sources

Signs of Alcohol Withdrawal
Treatment for Alcohol Withdrawals

Learn the possible complications of alcohol withdrawals, as severe alcohol withdrawal can be fatal

Alcohol withdrawal refers to the changes an alcoholic’s body goes through when he or she person suddenly stops drinking after heavy and prolonged alcohol use.

The process of cleaning the body from the alcohol substance to overcome its addiction is called alcoholism detox. Detox is the first (necessary) step in overcoming alcohol dependence.

Not everyone who stops drinking experiences withdrawal symptoms, but most people who have been drinking a high quantity for an extended period of time will experience some form of withdrawal symptoms if they stop drinking suddenly.

Understanding the alcohol withdrawal symptoms that may follow the short term and long term stopping of drinking is critical for avoiding unnecessary complications and dangers. For more on the treatment of alcohol withdrawals read Diazepam and alcohol withdrawals.

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What Causes the Signs of Alcohol Withdrawal?

When a drinker consumes large quantities of alcohol over weeks, months or years – their body attempts to safeguard its internal stability and processes.

The body, particularly the brain, adapts to the presence of alcohol by compensating for alcohol’s effect on the central nervous system (CNS).

Alcohol, specifically Ethanol, has an overall suppressing effect on CNS activity. Most of the clinical effects can be explained by the interaction of alcohol with various neurotransmitters and neuroreceptors in the brain.

Another thing to understand is that while your body is adjusting to the continuous effects of Ethanol, it increases naturally occurring chemicals to respond to this. When a person stops drinking all at once, their body is still producing extra chemicals out of habit despite not having ethanol in the body. This overstimulates the brain which leaves it over active which can lead to difficulty concentrating.

Physical dependence to alcohol occurs with the long term use of alcohol. Due to the down regulation of brain receptors, more alcohol is needed to reach have the same effect. This is also known as tolerance. This process is also responsible for the physical alcohol withdrawal symptoms that are often alleviated with an eye-opener, or a drink when a person wakes up in the morning.

The Severity Of Alcohol Withdrawal...

The severity of alcohol withdrawal symptoms vary, depending on various factors including age, genetics, and, most importantly, degree of alcohol intake, length of time the individual has been misusing alcohol and number of previous alcohol detoxes.

The period of time in which the symptoms occur and peak range from 5 - 10 hours after the last drink (drinkers in the early stages of alcoholism) up to 48 - 72 hours (for alcoholics in the advanced stages) and may persist for weeks and even months.

Mild to Moderate Psychological Symptoms

Anxiety or nervousness
Depression
Difficulty thinking clearly
Fatigue
Irritability or easy excitability
Jumpiness or shakiness
Nightmares
Rapid emotional changes
Anxious

Mild to Moderate Physical Symptoms

Clammy skin
Enlarged (dilated) pupils
Headache
Insomnia - Sleeping difficulty
Loss of appetite
Nausea and vomiting
Pallor - An abnormal loss of color from normal skin
Rapid heart rate
Sweating
Tremor of the hands or other body parts

The Severe Alcohol Withdrawal Symptoms

Agitation - An unpleasant state of extreme arousal (stirred up or excited), increased tension, and irritability. May also be easily confused
Delirium Tremens - Withdrawal has a wide range of symptoms starting from mild tremors to a severe condition called delirium tremens. This condition results in in seizures and could even progress to death if not identified and treated promptly. It is a state of severe confusion, visual hallucinations, physical shaking, high blood pressure.
Fever
Alcohol Withdrawal Seizures - The physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain. Alcohol seizures can lead to serious complications such as death.

If you think you might be suffering from signs of alcohol withdrawal then it is essential you call for medical assistance as soon as possible. Alcohol withdrawal seizures can be life-threatening.

Alcohol Withdrawal Symptoms

Prolonged Alcohol Withdrawal

Prolonged alcohol withdrawal syndrome occurs in many alcoholics where alcohol withdrawal symptoms continue beyond the acute withdrawal stage (the first 72 hours) but usually at a sub-acute level of intensity and gradually decreasing with severity over time.

Some withdrawal symptoms can linger for at least a year after discontinuation of alcohol. Symptoms can include:

Craving for alcohol.
Inability to feel pleasure from normally pleasurable things (also known asanhedonia).
Clouding of sensorium.
Disorientation
Nausea and vomiting or headache.
Insomnia

In addition to the amount of alcohol consumed and the duration of the alcohol intake just before cessation of drinking - a history of withdrawal episodes appears to be a critical factor in the intensity of withdrawal symptoms.

The Kindling Graph

Many alcoholics experience numerous withdrawal episodes during the course of their illness. This is a common characteristic of a chronic and progressive disease. Kindling is the phenomenon where repeated alcohol detoxifications lead to an increased severity of the alcohol withdrawal symptoms.

For example, binge drinkers may initially experience no alcohol withdrawal symptoms but with each period of resumption of drinking followed by abstinence, their withdrawal symptoms intensify in severity and may eventually result in full blown delirium tremens with convulsive alcohol withdrawal seizures.

This effect can also be observed in those who fall into the advanced alcoholic category.

Given the high rate of regressions among alcoholics, each withdrawal episode may perhaps best be viewed not as an isolated event but as part of a potentially long-term process that can lead to dangerous exacerbation of withdrawal symptoms with each subsequent episode.

The harsh reality is that alcohol relapses are a common experience. Addiction research has shown that 50%-90% of alcoholics relapse.

Treatment for Alcohol Withdrawals

Alcohol withdrawal is a serious medical condition that could rapidly become life threatening, if not treated properly or in time.

Call your health care provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. Do not minimize symptoms you are experiencing. Doing so, would interfere with your health care provider’s ability to identify an appropriate course of action.

Call for an appointment with your health care provider if symptoms persist after treatment. Go to the emergency room or call the local emergency number (such as 911) if seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.

It is essential that you only attempt to withdraw from alcohol under medical supervision. This which will help you relax ensuring that you do not have alcohol withdrawal anxiety and, more importantly, you don't suffer from alcohol withdrawal seizures which can be fatal.

Detoxification means weaning a patient from a psychoactive substance in an effective and safe manner by progressively removing the dependence producing substance.

There are three treatment options when considering detoxification:

1. Outpatient Detox- Most patients suffering from alcohol withdrawal could be treated effectively and safely as outpatients. This would be appropriate for individual who fall into the low and moderate risk level for withdrawal symptoms. These individuals would be seen by their provider with frequent check-ups. Your provider may provide medications that would ease the symptoms of withdrawal.

2. Medically Monitored Detox- This option would be appropriate for individuals who fall into the moderate to severe risk level of withdrawal. This option would include being in a medical facility for a brief period of time, around 24 hours, while being consistently monitored by medical doctors as well as nurses. Again, medications would likely be provided to ease the symptoms of withdrawal.

3. Medically Managed Inpatient Detox- This option would be appropriate for individuals who fall into the sever risk level of withdrawal. Individuals who are at risk of severe withdrawal, or those who suffer from concurrent serious psychiatric or physical disorders, or who do not have adequate support, should ideally be managed in an inpatient setting. This option would include staying in an inpatient setting, possibly a rehabilitation center, for several days. Common medications that may be used for individuals at this level of risk include:

Anticonvulsants
Antinausea medications
Blood Pressure medications
Sedatives to help reduce anxiety
Benzodiazepines

Options After Detox

After a person completes detox, the automatic question is what now?

There are several options available, which can accommodate those who are willing to stop drinking and those who are not. It is important to be honest with oneself about their motivation for recovery. There are two forms of motivation; internal and external.

Internal motivation could be a person wanting to be healthier, to improve relationships, improve job functioning.
External motivation would be outside factors such as pending legal concerns, being told they could lose their job if they continue and if a spouse threatens to leave if something doesn’t change.

For those who are not ready to stop drinking, they may consider a harm reduction approach. Further information about this can be located throughout this guide.

From a clinical stand point, if a person experiences alcohol withdrawal, one could assume that they have seen negative impacts of their drinking on their physical health and other areas of their life. If this is true, it may be time to begin considering a sober lifestyle.

A common recommendation for individuals after completing detox programs is a rehabilitation program. The hope for these programs is that a person will come out with a better understanding of addiction, addictive behaviors, their triggers and have a better idea of how to cope. For individuals with co-occurring mental health concerns, psychotherapy may be a healthy option as this likely had an impact on their drinking behaviors.

Recovery, similarly to addiction, looks different for every alcoholic. Options for approaches to recovery and further information on treatment options can be located throughout this website.

Do you want to stop drinking without having to attend 12 step meetings? I highly recommend Rahul Nag's E-book, in which he outlines the steps you need to take to moderate your drinking or give up entirely. A great alternative to the way of AA and the expense of a treatment center. Take a risk-free look at his method and return to social drinking.

If you found this page helpful, then the following may be of interest to you:

Diazepam and alcohol withdrawals
Alcohol abuse effects. The Impact of alcohol on health.
Naltrexone treatment of alcoholism. How can this anti-craving drug help those in early recovery.
Vivitrol. Discussion on the injectable form of naltrexone.
Alcohol treatment programs. Alternatives to AA.
Alcoholics Anonymous
Alcoholism definition. What is alcoholism exactly?
Alcoholism medication
The stages of alcoholism
Binge drinking facts
The ten warning signs of alcoholism

Lead Writer/Reviewer : Kayla Loibl

Licensed Medical Health Professional

Hello!

I am a Mental Health Counselor who is licensed in both New York (LMHC) and North Carolina (LCMHC). I have been working in the Mental Health field since 2015. I have worked in a residential setting, an outpatient program and an inpatient addictions program. I began working in Long Island, NY and then in Guelph, Ontario after moving to Canada. Read More

Sources:

Harvard Health Publishing. Alcohol Withdrawal. April 2019. https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z

Medline Plus. Alcohol Withdrawal. https://medlineplus.gov/ency/article/000764.htm

NCBI. Clinical management of alcohol withdrawal: A systematic review. Jul-Dec 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

American Family Physician. Alcohol Withdrawal Syndrome. March 15, 2004. https://www.aafp.org/afp/2004/0315/p1443.html

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