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What Causes Alcohol Withdrawal?

Alcohol withdrawal occurs when a person suddenly stops drinking alcohol after prolonged and heavy use.

Long-term alcohol users expose their brains to alcohol so often that the brain adjusts to compensate for the sedating effect of the chemicals. An alcoholic’s brain produces serotonin and norepinephrine in higher quantities than a non-alcoholic’s brain. If that person stops drinking suddenly, their brain is overstimulated with too much of these naturally occurring chemicals.

ARH Stormcloud hanging over a man

About one in every 20 alcoholics experience delirium tremens (DTs), which is the most dangerous risk of withdrawal syndrome.

Symptoms & Dangers of Alcohol Withdrawal 

Sudden stoppage of alcohol after long-term, heavy intake causes changes within the body that trigger a variety of withdrawal symptoms, including:

  • Shaking
  • Anxiety
  • Insomnia
  • Alcohol hallucinations
  • Seizures
  • Delirium tremens (DTs)

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How Long Does Alcohol Withdrawal Last? 

Alcohol withdrawal occurs in stages and each stage has risks including some that are life-threatening. The risks increase based on how long a person has been drinking and how much they drank, as well as their biological disposition and whether or not there are any co-occurring disorders. The stages are as follows:

Stage 1

  • Begins about eight hours after a person’s last drink
  • Usually mild
  • Includes vomiting, abdominal discomfort, insomnia, fatigue, anxiety, and depression

Stage 2

  • Begins about 24 to 72 hours after a person’s last drink
  • Usually moderate
  • Includes mental cloudiness, elevated blood pressure, irregular heart rate, irritability and mood swings, excessive sweating

Stage 3

  • Peaks approximately 5 days after a person’s last drink
  • Most severe stage
  • Includes delirium tremens, hallucinations, seizures, fever, extreme agitation, and confusion

Not everyone experiences every one of these symptoms, but most heavy drinkers experience a combination of many of them. Each stage of withdrawal, especially the third stage, is uncomfortable at best and dangerous at worst. It’s extremely important to seek professional medical attention when you are detoxing from alcohol after heavy long-term use.

Alcohol Withdrawal: Timeline of Symptoms

6 to 12 Hours

Within six hours after your last drink, you’re likely to experience vomiting, abdominal discomfort, insomnia, fatigue, anxiety, and depression.

12 hours to 1 day

Within 12 to 24 hours after your last drink, you’re likely to experience sweating, problems sleeping, headache, nausea, and mild anxiety.

1 to 2 days

Within a day or two after your last drink, you’re at risk of hallucinating, experiencing memory loss, having a racing pulse and irregular heartbeat, and possibly having a seizure.

2 to 3 days 

Within two to three days after your last drink, you’ve reached the peak of withdrawal. Delirium tremens (DTs), hallucinations, seizures, fever, extreme agitation, and confusion are common during this stage.

3+ days

You are at risk of still experiencing severe withdrawal symptoms for up to 10 days after your last drink. These include delirium, severe blood pressure spikes, and intense cravings. You might sweat heavily and have a fever. Withdrawal symptoms are potentially fatal and it’s important to detox under professional medical supervision.

Does Memory Come Back After Quitting Drinking? 

Many heavy drinkers experience memory loss. They don’t remember things that occur when they are drinking and their memories aren’t as sharp as they would have been had they not been heavy drinkers. This is because excessive alcohol intake damages the brain. Stopping heavy use of alcohol might reverse some memory loss, but there are no guarantees an alcoholic’s brain will ever fully recover.

Can Your Body Go into Shock When You Stop Drinking? 

Yes, the body can go into shock if a long-term heavy alcohol user stops drinking. This is due in part to the change in the release of certain neurotransmitters when the brain is no longer exposed to alcohol. It doesn’t know what to do with the sudden change and it goes into shock. The risk of shock is one of the main reasons alcoholics should seek substance use treatment at a medically supervised treatment center.

How to Safely Detox From Alcohol

The only safe way to detox from heavy, long-term alcohol use is addiction treatment at a center with professional medical supervision. Detoxing from alcohol is a dangerous process and makes your body extremely vulnerable. 

Changes occur with the brain during the hours and days that follow heavy alcohol use that must be monitored by a medical professional. Detox is an excruciating process for many people, but the right treatment can make things a bit easier and increase the odds of successful long-term recovery. Medically supervised detox and treatment ease many of the mental health symptoms and other discomforts associated with the process. Successful, medically supervised detox increases the odds of successful long-term recovery.

Detox is the first step in recovery. It’s one of the most difficult phases of recovery, but it’s also one of the most important. 

Alcohol Withdrawal: Common Questions and Answers

Can I detox from alcohol at home?

It is not safe to detox from long-term, heavy alcohol use at home. Your brain and body are extremely vulnerable to a variety of risks when you stop alcohol consumption and begin detox. Medical supervision ensures that any emergencies are dealt with appropriately and as quickly as possible. 

Programs are available on an inpatient or outpatient basis. Once you’ve completed the initial detox and critical phase of withdrawal, you can begin treatment and seeking help from support groups.

What happens after 2 weeks of no alcohol?

If you’re a heavy drinker who regularly consumes alcohol and you stop, you’ll feel much better after two weeks. The worst detoxification symptoms usually last about three to five days. After that, you’ll begin to feel better, though your body will still crave alcohol. Some people experience unpleasant physical symptoms such as acid reflux or heartburn, due to their history of heavy drinking, but the most severe symptoms are in the past.

Can alcohol permanently damage your brain?

Yes. Heavy drinking damages your brain. Over time, some of the damage might repair itself but rarely is your brain ever the same. Heavy drinking to the point of alcohol dependence affects all of your body, from the brain to the central nervous system to individual organs. In many cases, this damage is not repairable.

Will my body repair itself after I stop drinking?

It depends on several factors, including what damage was done, your overall health, how long you were a heavy drinker, and how much alcohol you consumed while drinking. Some of the damage done does repair itself. 

For example, alcohol is damaging to the liver, but the liver is capable of repairing and even regenerating. However, it’s impossible to predict how well you’ll recover from heavy drinking, so whether or not your body can heal itself shouldn’t be a consideration when you are deciding whether or not to drink a lot. The longer and more intense your alcohol abuse the lower your odds of complete repair.

What is acute withdrawal?

Acute withdrawal is the first stage of alcohol withdrawal. Acute withdrawal occurs within two weeks after you stop using alcohol. The health conditions you experience during this time tend to change frequently and are unpredictable. This is one of the reasons it’s so important to seek professional medical care during withdrawal.

Acute withdrawal symptoms include rapid heartbeat, nausea, sweating, convulsions, shivering, and heart palpitations. A person in the acute withdrawal phase has a high risk of relapse. Most treatment programs focus on detoxification during this period and transition to recovery once the acute withdrawal phase has passed.

What are delirium tremens?

Delirium tremens or DTs is a psychotic condition that occurs during withdrawal from alcohol. The condition triggers hallucinations, tremors, anxiety, and disorientation.

What are the first signs of liver damage from alcohol?

It’s impossible to know for sure if heavy, long-term use of alcohol has damaged your liver without a doctor examining the organ. However, the early signs of liver damage include fatigue, loss of appetite, nausea and vomiting, and unexplained weight loss.

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Resources

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“Delirium Tremens: MedlinePlus Medical Encyclopedia.” Medlineplus.Gov, 2016, medlineplus.gov/ency/article/000766.htm.

 “Liver Disease, Head to Foot.” Stanford Medicine 25, stanfordmedicine25.stanford.edu/the25/liverdisease.html.

JT, Sullivan, et al. “Assessment of Alcohol Withdrawal: the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar).” British Journal of Addiction, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/2597811/.

Max Bayard, et al, "Alcohol Withdrawal Syndrome," East Tennessee State University, James H. Quillen College of Medicine, Johnson City, Tennessee Am Fam Physician. 2004 Mar 15;69(6):1443-1450. https://www.aafp.org/afp/2004/0315/p1443.html

Kosten, Thomas R., and Author AffiliationsFrom the Departments of Psychiatry (T.R.K.) and Medicine (P.G.O.). “Management of Drug and Alcohol Withdrawal: NEJM.” New England Journal of Medicine, 24 July 2003, www.nejm.org/doi/full/10.1056/NEJMra020617.

J;, Bayard M;McIntyre J;Hill KR;Woodside. “Alcohol Withdrawal Syndrome.” American Family Physician, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/15053409/.

Minozzi, Silvia, et al. “Anticonvulsants for Alcohol Withdrawal - Minozzi, S - 2010: Cochrane Library.” Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, 17 Mar. 2010, www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005064.pub3/abstract.

Richard Saitz, MD. “Individualized Treatment for Alcohol Withdrawal.” JAMA, JAMA Network, 17 Aug. 1994, jamanetwork.com/journals/jama/fullarticle/377892.

Myrick, Hugh, and Raymond F. Anton. Treatment of Alcohol Withdrawal. THE PHYSICIANS’ GUIDE TO HELPING PATIENTS WITH ALCOHOL PROBLEMS, 1998, pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf.
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