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Alcohol withdrawal syndrome (AWS) is a condition that occurs within hours or a few days after the brain stops receiving alcohol.

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

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. 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. 

Unfortunately, when you suddenly stop providing the brain with alcohol, these stimulating chemicals are still increasing. 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 for women and four drinks per day 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 on a regular basis, are at risk of experiencing alcohol withdrawal.

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

Alcohol Withdrawal Timeline

Alcohol withdrawal syndrome produces a wide range of symptoms and everyone’s body reacts differently to it. Although, 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.

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Stage One – Mild Symptoms

Stage one occurs within the first six to eight hours after someone with an alcohol dependence has their 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. For example, once symptoms begin, a person undergoing alcohol withdrawal should be under regular monitoring. 

Symptoms may include:

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

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, regular monitoring by a health professional should occur in order to prevent any complications. While a person may feel they have withdrawal under control on their own, changes can escalate quickly, causing life-threatening complications. 

Symptoms may include:

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

Stage Three – Severe Symptoms

The severe symptoms associated with stage three typically being 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. Common 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.

How is Alcohol Withdrawal Diagnosed?

To diagnose alcohol withdrawal, your doctor will look for physical symptoms like:

  • 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?

Treatment for Alcohol Withdrawal

If you have made the decision to stop drinking, you should talk to your doctor or an alcohol dependency rehab program about alcohol withdrawal.

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.

What is Post-Acute Withdrawal Syndrome (PAWS)?

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

Two months or more after alcohol cessation, a condition known as post-acute withdrawal syndrome (PAWS) can occur in 75 percent of recovering alcoholics.

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

While acute alcohol withdrawal begins 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.

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
  • 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.

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Resources

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

“Post-Acute Withdrawal Syndrome (PAWS).” Post-Acute Withdrawal Syndrome (PAWS) | Semel Institute for Neuroscience and Human Behavior, https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS.

Ritter, Kacy. “What Is the Timeline for Alcohol Withdrawal?: Detox and Recovery.” Origins Behavioral HealthCare, 2 Oct. 2018, https://www.originsrecovery.com/timeline-alcohol-withdrawal/.

“What Is Post-Acute Withdrawal Syndrome (PAWS)?” What Is Post-Acute Withdrawal Syndrome (PAWS)? | Hazelden Betty Ford, https://www.hazeldenbettyford.org/articles/post-acute-withdrawal-syndrome.

“What Is Excessive Alcohol Use? | Infographics | Online Media | Alcohol | CDC.” www.cdc.gov, 30 Dec. 2019, https://www.cdc.gov/alcohol/onlinemedia/infographics/excessive-alcohol-use.html.

“Drinking Levels Defined | National Institute on Alcohol Abuse and Alcoholism (NIAAA).” Nih.gov, 2017, https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking.

“Rethinking Drinking Homepage - NIAAA.” Nih.gov, 2019, https://www.rethinkingdrinking.niaaa.nih.gov/.

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