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 the next time you quit.

The symptoms of alcohol withdrawal vary from person to person. Knowing the signs and symptoms of alcohol withdrawal and when to seek professional help is essential when you stop drinking.

Alcohol Withdrawal Symptoms & Timeline

Alcohol withdrawal syndrome produces various 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 6 to 8 hours after your last drink. Symptoms during this stage are mild. They typically involve mood changes 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, they’re 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. 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 complications. While a person may feel they have withdrawal under control on their own, changes can escalate quickly. This causes 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 3 to 5 percent of cases, this stage can include delirium tremens or DTs. 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 (DTs)

What is Delirium Tremens (DTs)?

Delirium tremens is the most severe and dangerous form of alcohol withdrawal. When this occurs, you may experience the following:

• Breathing problems
• Blood circulation problems
• Temperature regulation problems
• Dangerous heart rate and blood pressure levels
• Decreased blood flow to the brain
• Severe dehydration

A person experiencing DTs 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). PAWS symptoms typically occur two or more months after an alcohol-dependent person's last drink.

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

Acute alcohol withdrawal occurs during detox, the beginning of the healing process. The post-acute phase is when the brain rebalances itself.

PAWs 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 rehab. Many recovering alcoholics stay in support groups for the rest of their life.

Symptoms of PAWS include:

• Impaired thinking
• Memory problems
• Alcohol cravings
• Chronic nausea
• Irritability and anger
• Sleep problems – 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’s essential to understand the symptoms and learn how to deal with them.

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What Causes Alcohol Withdrawal Symptoms?

Alcohol is a depressant. When it enters the body, it sedates 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 time, their brain develops an alcohol addiction. The brain produces more 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. 

Risk Factors for Alcohol Withdrawal Symptoms

People with an alcohol use disorder (AUD) and heavy drinkers risk 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.

Other factors that affect withdrawal symptoms include:

• How long the person has been drinking
• How often the person drinks
• The amount of alcohol consumed per day
• Whether the person uses any drugs
• If there are other health problems

How is Alcohol Withdrawal Diagnosed?

To diagnose alcohol withdrawal, your doctor will give you a physical exam. 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 help 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?

Can You Prevent Alcohol Withdrawal?

The only way to prevent alcohol withdrawal is to treat alcohol abuse. This means stopping alcohol use completely. 

However, people with alcohol addiction aren't advised to stop drinking alcohol cold turkey. Instead, they should gradually taper off over several weeks or months.

It’s recommended to seek detox or rehab if you find it difficult to quit alcohol.  

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Alcohol Withdrawal Treatment

You should seek medical advice from your doctor or an addiction specialist if you decide to stop drinking.

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 also seek treatment at a facility. 

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

In addition, these providers and facilities offer assistance and resources to help you stay alcohol-free after withdrawal.

Alcohol Abuse & Addiction Treatment Options

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

• Inpatient programs: Inpatient treatment occurs at a licensed residential treatment center. 
• Partial hospitalization programs (PHPs): Partial hospitalization programs services include medical detox, behavioral therapy, support groups, and other customized therapies. You return home to sleep. 
• Outpatient programs: The goal of outpatient treatment is to provide therapy, education, and support in a flexible environment. They’re best for people who have a high motivation to recover and cannot leave their responsibilities at home, work, or school. 
• Medication-assisted therapy (MAT): Some medicines can help reduce the negative side effects of detoxification and withdrawal. Others can help you reduce cravings and normalize body functions. 
• Support groups: Alcoholics Anonymous and SMART Recovery are open to anyone with a substance abuse problem. 

Summary

Alcohol withdrawal is when the body shows symptoms of physical dependence to alcohol. The best way to prevent alcohol withdrawal is to stop drinking. There are different treatment options to manage alcohol addiction and alcohol withdrawal symptoms.