Alcohol Withdrawal

Nechama Reis
Medically Reviewed by
Dr. Jefferey A. Berman MD, DFASAM
Last Updated
March 9, 2023

Part of the complete guide to understanding addiction
Learn more about withdrawal
Learn more about Alcoholism and Alcohol Addiction

Table of Contents
  1. Alcohol withdrawal
  2. Alcohol withdrawal symptoms
  3. Alcohol withdrawal timeline
  4. Alcohol withdrawal factors
  5. Can alcohol withdrawal be fatal?
  6. How to manage alcohol withdrawal
  7. Alcohol addiction treatment
  8. Alcohol withdrawal medication
  9. Conclusion
  10. Sources

Alcohol Withdrawal

Alcohol is a commonly used substance in the USA; nearly 90 percent of adults consume alcohol in their lifetime. While alcohol can be safe when used in moderation, it has negative ramifications in many areas of life when abused. According to the NIAAA, alcohol accounts for 3.3 million deaths a year globally, and approximately 16 million people in the U.S.A. (around the entire population of New York) are affected by alcohol use disorder. [1]

Alcoholism is chronic, and occurs when a person’s uncontrolled drinking turns problematic. It is challenging to overcome, and it may seem insurmountable to someone who has not yet started on the path to recovery. However, sobriety is always possible with proper treatment and a long term care plan.

Alcohol withdrawal occurs when a person who consistently and heavily consumes alcohol stops drinking . The body reacts to the sudden lack of alcohol and triggers a physical response. Alcohol is a depressant that effects the brain through causing it to produce more GABA (a neurotransmitter with a calming and euphoric effect) and less glutamate (a neurotransmitter responsible for making you excitable). When alcohol is continuously misused, the opposite effect occurs, and the brain will produce more glutamate to maintain balance. Once the alcohol is withdrawn, the brain will be overstimulated due to the extra production of glutamate. This causes withdrawal symptoms , which will last until the brain readapts the absence of alcohol and resumes normal production levels. [2]

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Alcohol Withdrawal Symptoms

Alcohol withdrawal can lead to physical symptoms ranging from mildly uncomfortable to severe and dangerous.

For many people, the withdrawal symptoms can start on the more mild side but then increase over time and eventually peaking and easing.

The most typical symptoms include:

  • Shaking
  • Mild sweating
  • Mild anxiety
  • Fatigue
  • Headaches
  • Insomnia
  • Nausea
  • Vomiting
  • Irritability
  • High blood pressure
  • Elevated body temperature
  • Elevated heart rate
  • Irregular heartbeat
  • Seizures
  • Tremors
  • Depression
  • Altered consciousness
  • Hallucinations
  • Delirium tremens (DTs)

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Alcohol Withdrawal Timeline

Alcohol withdrawal starts approximately six hours after the last drink, and includes both physical and mental symptoms. Length and intensity of symptoms vary according to each individual. Among other variables, it will depend upon length and strength of abuse and each person’s physical condition. That being said, symptoms will typically develop in three stages.

First Stage: During the first stage, symptoms tend to be mild. This includes anxiety, sleeplessness, stomach pain and nausea. It is common for many people to recover from withdrawal symptoms after this stage.

Second Stage: Serious symptoms, which can include seizures, usually begin 48 hours after the last drink. More than five percent of people will experience this phase during withdrawal [3]. Symptoms can include high blood pressure, irregular heartbeat, elevated body temperature and mental confusion.

Third Stage: The third stage begins 72 hours (about 3 days) after the last drink and can include fever, seizures, agitation, and hallucinations. Delirium tremens can also develop during this stage,

Some people will experience post-acute withdrawal syndrome (PAWS) as well. This syndrome is characterized by withdrawal symptoms lingering for a longer period of time than usual.

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Alcohol Withdrawal Factors

Some of the factors which affect the severity of withdrawal symptoms include:

  • Duration and frequency of alcohol use – the greater the frequency of alcohol use, and the greater the quantity ingested, the more severe withdrawal symptoms tend to be.
  • Age – the older a person is, the more likely they are to experience severe symptoms.
  • Physical or mental disorders – both physical and mental conditions can complicate and exacerbate withdrawal symptoms.
  • Previous history of severe alcohol withdrawal symptoms – if a person has prior experience of severe withdrawal symptoms it is likely that withdrawal symptoms will be once again be intense.
  • Earlier withdrawal attempts – withdrawal symptoms increase in severity each time a person attempts to quit alcohol use.

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Can alcohol withdrawal be fatal?

Alcohol is one of the only substances that carries the risk of fatality during withdrawal. It is critical that one seeks medical care when detoxing.

The symptoms described below can be dangerous and potentially fatal. If someone experiences these symptoms, they should seek medical attention immediately. Hospitalization may be necessary.

  • Tremors can begin between five to ten hours after the last drink and can last for two days. Tremors may be accompanied by a rapid pulse, rapid breathing, increased blood pressure, as well as psychological symptoms such as anxiety, hyper-alertness, irritability, nightmares or vivid dreams and insomnia.
  • Alcohol hallucinosis can begin between 12 to 24 hours after the last drink and last for two days. Hallucinosis is experienced as mental hallucinations, such as seeing objects moving, or other detailed visions. [4]
  • Alcohol withdrawal seizures can begin between six to 48 hours after the last drink, and several seizures will usually occur within a few hours. The riskiest time for seizures is after the first 24 hours of withdrawal but seizures can occur any time between the first 6 hours up to 72 hours. [5]
  • Delirium tremens, or DTS, can begin two or three days after the last drink. It is characterized by tremors, and changes in breathing, temperature, and circulation. These shifts can divert blood flow from the brain, resulting in temporary loss of consciousness, stupor, nervous or angry behavior, irrational beliefs, soaking sweats, sleep disturbances and hallucinations.

Withdrawal Shakes

During withdrawal, patients will often experience withdrawal shakes, which can be caused by anxiety and/ or stress. However, if such tremors are unabating, they may denote a more severe condition developed through years of alcohol abuse. Tremors can be a sign of damage to the cerebellum, the area of the brain that regulates balance and movement coordination. Another cause can be liver disease, which in its later stages will cause tremor-like symptoms.

How can one stop alcohol withdrawal shakes?

If one is experiencing shakes or tremors, they should consult with a doctor to determine if there is any serious underlying cause. A doctor may prescribe anti-anxiety medication or suggest a nutritious diet and increased hydration. Whether due to withdrawal or a more serious underlying condition, tremors should not be ignored.

Sleeping During Alcohol Detox

Alcohol withdrawal can be mistaken for a commonplace hangover, and often people are left alone to “sleep it off “. Sleepiness is a common symptom during alcohol detox. Since it may signify more serious problems, it is critical that symptoms of fatigue during detox are supervised and treated medically.

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How to manage alcohol withdrawal

The withdrawal process can be challenging, but is very possible to get through safely. It is important to have support in place to safely endure the withdrawal process, and prevent failed withdrawal attempts.

Here are some ways to prepare for withdrawal.

  • Inform friends and family so they can check up on you. It is important not to be alone in case of severe symptoms.
  • Remove alcohol triggers such as friends who drink, or alcohol itself – to alleviate cravings.
  • Prepare fluids – dehydration may occur due to excessive vomiting. Stock up on fluids.
  • Call for medical help – be prepared to call for medical help in case of emergency.
  • Check into a rehab – Alcohol detox can be a matter of life and death. It is far safer to detox in a licensed facility under professional care. Reach out now if you are looking for a place to safely withdraw from an alcohol addiction.

It is helpful to keep in mind that proper nutrition in recovery can contribute to alleviating alcohol withdrawal symptoms.

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Alcohol addiction treatment

It is always best to have a professional assess alcohol withdrawal symptoms and put a treatment plan in place. A withdrawal treatment may include behavioral programs, support, and medication if necessary.

Some treatment options are.

  • Outpatient care: This will include regular office visits for counseling, medication, and support.
  • Partial hospitalization or intensive outpatient: Patients will receive outpatient care for complex needs.
  • Inpatient rehab: It is often beneficial to seek treatment in an inpatient rehab facility, where one can receive 24-hour medical support.

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Alcohol withdrawal medication

In some cases, medical treatment is needed to assist with withdrawal symptoms. For severe symptoms, hospital treatment may be needed. Otherwise, a doctor may prescribe anxiety-relief medication, such as benzodiazepines, to alleviate psychological symptoms. The FDA has also approved three nonaddictive medications for alcohol use disorder: naltrexone, acamprosate and disulfiram.

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Recovering from an addiction is a lifelong battle and can be incredibly challenging. However, there are many resources and support systems available for those looking to recover from alcoholism. With professional treatment and therapy, and a strong support system, permanent recovery is always possible. Our staff at Avenues Recovery are here waiting to help you along your journey. Reach out today, or read our online resource about tips to quit drinking for good, for more useful advice.

To learn how to support a recovering alcoholic and physical symptoms of alcoholism, read our useful resource on this topic.

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