Symptoms of Alcohol Withdrawal

Excessive, long-term alcohol use affects your brain chemistry. When you stop drinking, the brain is unable to function correctly. This leads to withdrawal.

Alcohol withdrawal syndrome (AWS) is a condition that occurs within hours or a few days after the brain stops receiving alcohol. If you don't drink frequently or drink excessively, you probably won't experience alcohol withdrawal. But if you undergo withdrawal symptoms once, you'll probably go through it again next time you quit.

The symptoms of alcohol withdrawal vary from person to person. For some, they may be mild and simply uncomfortable.

In more severe cases, symptoms can be life-threatening. Knowing the signs and symptoms of alcohol withdrawal, and when to seek professional help, is essential when you stop drinking.

Symptoms of alcohol withdrawal vary. They can be mild, severe, or even life-threatening. Anyone undergoing alcohol withdrawal should receive professional medical monitoring until symptoms subside.

What Causes Alcohol Withdrawal Symptoms?

Alcohol is a depressant. This means that when it enters the body it has a sedating effect on the brain and central nervous system (CNS). This is what makes you feel good when you drink alcohol.

However, if someone drinks heavily for a long period of time, their brain develops an alcohol addiction. When this occurs, it starts producing increased amounts of stimulating chemicals (serotonin and norepinephrine) to balance the brain. 

When you suddenly stop drinking, your brain continues producing these stimulating chemicals. This results in alcohol withdrawal symptoms. 

Moderate Drinking vs. Excessive Drinking

Many health experts believe it is possible to consume limited amounts of alcohol safely. According to their recommendations, moderate alcohol consumption is two drinks per day or less for men and one drink or less per day for women. 

The following measurements represent one standard drink:

• 12 ounces of beer (5% alcohol content)
• 8 ounces of malt liquor (7% alcohol content)
• 5 ounce glass of wine (12% alcohol content)
• 1.5 ounces of 80-proof (40% alcohol content) distilled spirits 

Health experts define heavy alcohol use as more than three drinks per day or more than 7 days per week for women and four drinks per day or more than 14 drinks per week for men. SAMHSA defines heavy alcohol consumption as drinking five or more days a month.

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Who is at Risk for Alcohol Withdrawal Symptoms?

People with an alcohol use disorder (AUD), and those who drink heavily (binge) on a regular basis, are at risk of experiencing alcohol withdrawal. This includes people who binge drink multiple times per month.

Alcohol withdrawal, or AWS, is more common in adults. However, children and teens who drink heavily can also experience AWS.

Alcohol Withdrawal Symptoms & Timeline

Alcohol withdrawal syndrome produces a wide range of symptoms. Everyone’s body reacts differently to it. The typical symptoms of alcohol withdrawal are separated into three stages.

Symptoms typically peak between 24 to 72 hours and usually resolve within a week. In some cases, symptoms can last longer.

Stage One – Mild Symptoms

Stage one occurs within the first six to eight hours after your last drink. Symptoms during this stage are mild in nature. They typically involve changes in mood and mild physical symptoms. 

In many ways, the symptoms that occur in stage one are similar to a normal hangover. While these initial symptoms may not appear serious in nature, they are just the beginning. Dismissing these early symptoms can be dangerous. 

Side effects of alcohol withdrawal can escalate quickly. Once symptoms begin, a person undergoing alcohol withdrawal should be under medical monitoring. 

Symptoms may include:

• Anxiety
• Depression
• Mood swings
• Headaches
• Nausea and vomiting
• Abdominal cramping
• Insomnia
• Mild tremors or shakes
• Loss of appetite
• Problems thinking
• Fatigue
• Heart palpitations

Stage Two – Moderate Symptoms

During stage two, moderate symptoms begin. This usually happens within 12 to 48 hours after alcohol consumption stops. During this stage, symptoms from stage one may continue. In addition, more intense symptoms that affect vital signs will begin. 

Because of this, a health professional should monitor the patient to prevent any complications. While a person may feel they have withdrawal under control on their own, changes can escalate quickly, causing life-threatening health issues. 

Symptoms may include:

• High blood pressure
• Rapid breathing
• Irregular heartbeat
• Difficulty breathing
• Fever
• Confusion and trouble thinking
• Sweating
• Anger and irritability

Stage Three – Severe Symptoms

The severe symptoms associated with stage three typically begin 48 to 72 hours after you stop drinking.

In three to five percent of cases, this stage can include delirium tremens, or the DT’s. This, along with severe seizures, can be life-threatening.

During this stage, it is essential to have regular monitoring by a medical professional or detox facility. Severe withdrawal symptoms that occur during stage three include:

• Agitation
• Hallucinations – these can include tactile, auditory, or visual disturbances
• Confusion
• Profuse sweating
• Seizures
• Delirium tremens (DT’s)

What are Delirium Tremens (DTs)?

Delirium tremens is the most severe and dangerous form of alcohol withdrawal. When this occurs, you may experience problems with breathing, blood circulation, and your body’s ability to control its normal temperature.

Your heart rate and blood pressure can get dangerously high. Blood flow to the brain commonly decreases and you may experience severe dehydration. A person experiencing DT’s must be monitored by a medical professional until symptoms subside.

What is Post-Acute Withdrawal Syndrome (PAWS)?

Alcohol withdrawal syndrome is only the beginning of the detox process. This is known as acute alcohol withdrawal. This stage typically lasts about one week.

However, approximately 75 percent of recovering alcoholics are likely to experience post-acute withdrawal syndrome (PAWS). Symptoms of PAWS typically occur two or more months after an alcohol-dependent person's last drink.

Symptoms are primarily psychological in nature, affecting a person’s mood, sleep patterns, and response to stress.

Acute alcohol withdrawal occurs during detox, which is the beginning of the healing process. The post-acute phase is when the brain works to rebalance the brain chemistry affected by alcohol.

Symptoms typically come and go, lasting a few days at a time. However, this phase can last up to two years while the brain continues to rebalance. This is why aftercare treatment is so important, even after completing rehab. Many recovering alcoholics stay in support groups for the rest of their life.

Symptoms of PAWS include:

• Impaired thinking
• Memory problems
• Urges and cravings for alcohol
• Chronic nausea
• Irritability and anger
• Problems with sleep – this can include insomnia or vivid dreams
• Fatigue
• Depression, anxiety, or panic attacks
• Mood swings
• Fine motor coordination problems
• Chronic pain
• Weight gain, or in some cases weight loss
• Lack of libido

Post-acute withdrawal is a major risk for relapse. So, it is essential to understand the symptoms and learn how to deal with them.

Learning new coping mechanisms, practicing self-care, following a healthy lifestyle, and seeking professional help can make this stage of withdrawal more manageable and successful. This can help you sober up.

How is Alcohol Withdrawal Diagnosed?

To diagnose alcohol withdrawal, your doctor will give you a physical. They will take your medical history, and likely administer a blood test. This is to rule out other medical conditions.

Physical symptoms are the primary indicator of alcohol withdrawal syndrome. These include:

• Tremors
• High blood pressure
• Dilated pupils
• Increased heart rate
• Fast breathing
• Fever

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale can also be used to diagnose withdrawal symptoms. This scale measures the symptoms using the following questions:

• Is the patient experiencing tremors?
• Is the patient experiencing anxiety or agitation?
• Is the patient sweating?
• Does the patient have nausea?
• Is the patient vomiting?
• Is the patient confused?
• Does the patient have a headache?
• Is the patient experiencing auditory, tactile, and/or visual disturbances?

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Treatment for Alcohol Withdrawal

If you have made the decision to stop drinking, you should seek medical advice from your doctor or an addiction specialist.

In many cases, your doctor will advise detox in a medical or rehab facility so they can monitor you. Anyone with a mental health disorder and an alcohol use disorder (co-occurring disorders) should seek treatment at a facility as well. 

There are medications that can help make withdrawal symptoms more tolerable. Should you experience severe symptoms or delirium tremens, doctors and nurses are available to provide emergency treatment, such as breathing assistance.

In addition, these providers and facilities can provide assistance and resources to help you stay alcohol-free after withdrawal is complete.

Treatment Options for Alcohol Abuse & Addiction

There are many treatment options available for alcohol abuse and addiction, including:

• Inpatient Programs — Inpatient treatment takes place at a licensed residential treatment center. These programs provide 24/7 comprehensive, structured care. You'll live in safe, substance-free housing and have access to professional medical monitoring. The first step of an inpatient program is detoxification. Then behavioral therapy and other services are introduced. These programs typically last 30, 60, or 90 days, sometimes longer. Most programs help set up your aftercare once you complete the inpatient portion of your treatment.
• Partial Hospitalization Programs (PHPs) — Partial hospitalization programs (PHP) are sometimes referred to as intensive outpatient programs (IOP). Compared to inpatient programs, partial hospitalization programs provide similar services. These include medical services, behavioral therapy, and support groups, along with other customized therapies. However, in a PHP program, you return home to sleep. Some services provide food and transportation, but services vary by program. PHPs accept new patients as well as people who have completed an inpatient program and still need intensive treatment.
• Outpatient Programs — Outpatient treatment is less intensive than inpatient or partial hospitalization programs. These programs organize your treatment session based on your schedule. The goal of outpatient treatment is to provide therapy, education, and support in a flexible environment. They are best for people who have a high motivation to recover and cannot leave their responsibilities at home, work, or school. Outpatient programs are often part of aftercare programs once you complete an inpatient or PHP program.
• Medication-Assisted Therapy (MAT) — Sometimes, medications may be used in alcohol addiction treatment. Some medicines can help reduce the negative side effects of detoxification and withdrawal. Others can help you reduce cravings and normalize body functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone are the most common medications used to treat AUD. When combined with other evidence-based therapies (such as cognitive behavioral therapy), MAT can help prevent relapse and increase your chance of recovery.
• Support Groups — Support groups such as Alcoholics Anonymous and SMART Recovery are open to anyone with a substance abuse problem. They are peer-led organizations dedicated to helping each other remain sober. They can be the first step towards recovery or part of a long-term aftercare plan.