What is alcohol withdrawal?
Alcohol withdrawal is a term used to describe the symptoms that occur after an individual suddenly stops drinking after prolonged and heavy exposure to alcohol. The condition is also termed alcohol withdrawal syndrome.
People who experience alcohol withdrawal are often alcohol dependent. Alcohol dependence, or alcoholism, is characterized by a strong and often uncontrollable desire to drink. People with alcohol dependence will typically build up a tolerance to alcohol, meaning they need a subsequent increase in their alcohol intake to reach the state of being intoxicated.
The symptoms of alcohol withdrawal, which can be both physical and psychological, will normally begin to present themselves around three to eight hours after an individual stops drinking. The first-line treatment for alcohol dependency is complete abstinence, which usually involves a programme to provide the affected person with psychological support throughout the withdrawal process. This usually involves group support sessions, in order to ensure that people do not feel alone as they go through the experience.
For people who are struggling with the physical symptoms of detoxing or detoxification in particular, a course of medication designed to alleviate these might be prescribed. Alternatively, depending on the affected person’s health, they may be required to undergo the process of detoxification in a hospital or another type of inpatient facility.
Alcohol withdrawal symptoms
The symptoms of alcohol withdrawal can be divided into two types: physical and psychological.
- Hand tremors (shaking)
- Dry mouth
- Abdominal pain
- Increased sweating
- Fever / increased body temperature
- Excessive, purposeless physical activity
- Physical tiredness
- Hyperventilation; rapid breathing
- High blood pressure
- Tachycardia, i.e. fast heart rate, with a pulse greater than 100 beats per minute
- Seizures; rare, but more common in severe cases
Psychological symptoms of alcohol withdrawal include:
- Irritability and mood swings
- Sleep disturbances, including frequent awakening, restless sleep, insomnia and night terrors
- Transient tactile, visual or auditory hallucinations or illusions
- Poor focus
- Depression or a shorter lasting depressed mood
If an individual ceases to consume alcohol, most of these symptoms will decrease significantly after about 10-12 days, but some might be present for longer. A symptom assessment using the Ada app can help you to check your symptoms. Download the free app now or find out more here.
Alcohol withdrawal timeline
The stages of alcohol withdrawal can be roughly broken down into three stages:
- Stage 1 (8 hours after last drink): Anxiety, insomnia, abdominal pain and nausea are typically experienced during the first stage.
- Stage 2 (24-72 hours after last drink): High blood pressure, high body temperature, unusually increased heart rate, rapid breathing and confusion are typical of this stage.
- Stage 3 (72+ hours after last drink): Hallucinations, fever, agitation and, in severe cases, seizures.
This is a rough timeline – some individuals may experience a different timeline with differing symptoms.
Delirium tremens refers to a severe reaction to alcohol withdrawal. Symptoms will generally begin after around two to three days of ceasing drinking and may include:
- Severe trembling and agitation
- Heavy sweating
- Increased heart rate
- Visual and auditory hallucinations
- High blood pressure
- Convulsions in some cases
These symptoms may appear suddenly, but they typically develop two to three days after the affected person stops drinking and are typically at their worst on the fourth or fifth day. Dehydration can also make delirium tremens worse. It is a serious condition which can in some cases be fatal. If any of these symptoms occur, immediate medical attention should be sought.
There are several factors that make the development of delirium tremens more likely. These include:
- A history of heavy drinking
- A history of delirium tremens
- Being over the age of 30
- Having another illness
- Developing alcohol withdrawal after two or more days
Mild, moderate and severe alcohol dependence and withdrawal
The American Psychiatric Association (APA) has outlined a checklist to help people understand whether they are experiencing mild, moderate or severe alcohol dependence. The category a person falls into will also help them to determine whether they are likely to experience mild, moderate or severe alcohol withdrawal.
The symptoms and behaviors the APA has outlined are as follows:
- The need to drink more alcohol to produce the same desired effect as previously
- Failed attempts to cease drinking
- Daily routine changes due to alcohol
- Withdrawal symptoms after drinking
- Unable to control the amount of alcohol consumed or the amount of time spent drinking
- Relationships affected due to drinking
- Alcohol is affecting success at work, school or at home
- Being under the influence of alcohol in dangerous situations, like driving or operating machinery
People exhibiting two or three symptoms are said to have mild alcohol dependence; people exhibiting four or five symptoms are said to have moderate alcohol dependence; and people exhibiting six or more symptoms are said to have severe alcohol dependence.
Alcohol withdrawal causes
The symptoms of alcohol withdrawal occur when a period of sustained and heavy alcohol consumption suddenly stops. Most people who experience alcohol withdrawal have an alcohol dependency.
Alcohol affects the part of the brain responsible for the fight-or-flight response. Alcohol suppresses this response, making us relaxed. When withdrawing from alcohol use, the chemical balance of the brain is temporarily altered, meaning individual’s enter this fight-or-flight state, even without the presence of danger. It is this state that causes both the physical and psychological symptoms of alcohol withdrawal.
Alcohol withdrawal diagnosis
A doctor will typically be able to diagnose alcohol withdrawal after an individual answers a series of questions about their drinking habits and the symptoms which are being experienced, and once a physical examination has been performed.
Treatment for alcohol withdrawal
Alcohol withdrawal requires both short-term and long-term treatment. The short-term treatment relates to managing a person’s physical and mental reactions to stopping drinking alcohol, and long-term treatment focuses on providing support to help a person maintain their abstinence.
The first step in treating alcohol withdrawal will typically involve helping the affected person as they undergo a process of alcohol detoxification, commonly referred to as detox. This will usually be a supervised process, undertaken at a specialised treatment centre, in which individuals are helped to overcome the symptoms that may result from alcohol withdrawal.
During the detox, people are recommended to:
- Drink plenty of fluids
- Eat regularly
Doctors will very often prescribe vitamin B1 (thiamine) to people going through alcohol withdrawal. A deficiency of this vitamin affects around 80 percent of people who have experienced prolonged alcohol exposure.
If a person is experiencing particularly strong symptoms of alcohol withdrawal, medications may be prescribed. The medications most commonly prescribed to help alleviate the symptoms of alcohol withdrawal are called benzodiazepines. These can help prevent minor alcohol withdrawal symptoms from becoming worse, e.g. in people for whom delirium tremens is considered to be a risk. Medications are not usually part of a typical first-line treatment plan for alcohol withdrawal, and these medications will be administered at the discretion of the medical professionals who monitor the detox process.
The second step in treating alcohol withdrawal involves psychological evaluation to identify the underlying causes of a person’s alcohol dependency. These causes may be psychological, physical and/or social. Doctors will work with the affected person to identify these causes and to devise a long-term treatment plan tailored to their needs in order to help them remain abstinent from alcohol on a long-term basis.
After the detox, people with a severe alcohol dependence will require the assistance of a qualified treatment or rehabilitation centre to help them recover from alcohol dependency. This period, which can last weeks or months, can be undergone as an inpatient or an outpatient, depending on the needs of the affected person and their family. Most people with mild to moderate alcohol withdrawal symptoms will find treatment as an outpatient sufficient.
To help people recover in the long-term, treatment centres will also provide advice on how to overcome alcohol dependency and on self-care and establishing living habits that promote their overall health and happiness.
Alcohol withdrawal support groups and programs
A person recovering from alcohol dependency may also be advised to attend support groups and programs to help them remain abstinent from alcohol. Larger, well-known support groups, such as Alcoholics Anonymous (AA), Secular Organizations for Sobriety (SOS) and Al-Anon, a support group specifically for friends and family of alcohol-dependent people, are present in most towns and cities; most places will also have several local support groups.
These groups can be useful to people recovering from alcohol addiction, providing them with a network of support from people who have been through similar challenges. People should ask their doctor about the groups operating in their local area.
Many support groups also provide free resources online and over the phone. Good online resources for people going through alcohol withdrawal include this resource from the Help Guide and this from the National Institute on Alcohol Abuse and Alcoholism.
Alcohol withdrawal prevention
Alcohol withdrawal is caused by prolonged exposure to large amounts of alcohol and can therefore be prevented through limiting one’s exposure to alcohol, so as not to develop an alcohol dependency. Methods of doing this include:
- Quitting alcohol completely
- Having frequent alcohol-free periods (days, weeks or months)
- Not exceeding the recommended daily intake guidelines for alcohol. According to the US Department of Health, this is 1 drink per day for women and 2 drinks per day for men.
- Beer: 12 ounces of 5 percent alcohol
- Malt liquor: 8 ounces of 7 percent alcohol
- Wine: 5 ounces of 12 percent alcohol
- Distilled spirits or liquor: 1.5 ounces of 40 percent alcohol
Alcohol withdrawal FAQs
Q: Is there a difference between alcohol withdrawal and a hangover?
A: Yes. Although the effects of a hangover are sometimes compared to mild alcohol withdrawal, there is a difference between the two. Alcohol withdrawal is a physical reaction to stopping drinking after prolonged and heavy consumption. People experiencing alcohol withdrawal will also typically be dependent on alcohol. A hangover, on the other hand, can be experienced by anyone, typically after a single bout of drinking alcohol. Alcohol withdrawal is a serious condition that can lead to acute and chronic complications, whereas a hangover is non-serious in the majority of cases.
Q: How long does alcohol withdrawal last?
A: The symptoms of alcohol withdrawal will typically begin to subside after 10-12 days in most cases. The timeline of alcohol withdrawal can be roughly split into three stages, with differing symptoms in each (see: the alcohol withdrawal timeline). The affected person should maintain their abstinence from alcohol for the rest of their lifetime, seeking help from available services whenever they feel the need to consume alcohol.
Q: Can alcohol withdrawal cause death?
A: While it is not very common, alcohol withdrawal can cause death. This will most likely be due to delirium tremens, a severe reaction to alcohol withdrawal. People experiencing symptoms such as severe agitation and trembling, heavy sweating and an increased heart rate should seek emergency medical attention. If the affected person is agitated and at risk of harming themselves or others, an ambulance should be called without delay.
Q: Can alcohol withdrawal cause seizures?
A: Yes, in some cases, alcohol withdrawal can cause seizures. This is rare, however, and most people will not experience this symptom. Convulsions can also be a symptom of delirium tremens, a severe reaction to alcohol withdrawal. People experiencing seizures should seek urgent medical attention and are advised to call an ambulance to transport them to the hospital.
Q: Can alcohol withdrawal cause diarrhea?
A: Yes, alcohol withdrawal can, in some cases, cause diarrhea. Other nonspecific symptoms of gastrointestinal upset, including indigestion, excess gas, bloating and constipation, may also occur.
Q: Do alcohol detox kits work?
A: Products are available to help people detox from alcohol at home. This method is not recommended. The help and supervision of a medical professional is necessary to ensure the process is safe, and that symptoms of alcohol withdrawal are appropriately managed.
NCBI. “Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification.” April, 2014. Accessed October 30, 2018. ↩
“Management of moderate to severe alcohol withdrawal syndromes.” UpToDate. 17 September 2017. Accessed: 27 February 2018. ↩ ↩
NCBI. “Appendix B: DSM-IV-TR Diagnostic Criteria for Alcohol Abuse and Dependence.” 2007. Accessed August 27, 2018. ↩ ↩
NIH. “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5.” Accessed October 30, 2018. ↩
“Effects of alcohol dependence and withdrawal on stress responsiveness and alcohol consumption.” Alcohol Research: Current Reviews. 2012. Accessed: 27 February 2018. ↩
“Comparative Effectiveness and Costs of Inpatient and Outpatient Detoxification of Patients with Mild-to-Moderate Alcohol Withdrawal Syndrome.” The New England Journal of Medicine. 09 February 1989. Accessed: 27 February 2018. ↩