What Is Alcohol Withdrawal?

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Alcohol is a dangerous substance and kills thousands of people around the world. For example, it is estimated that 2.5 million people across the globe die annually from alcohol-related causes. 

While not everyone who drinks will have an alcohol problem, it’s very important to cut back or quit drinking altogether if drinking above recommended guidelines.  

But, withdrawing from alcohol can be complicated, even life-threatening. If you abruptly stop drinking or cut back your alcohol intake after excessive use, it may cause a range of health problems in you. So, one should consult a doctor first.

In this guide, you will get information on the following topics:

1. What is alcohol withdrawal syndrome?
2. Causes of alcohol withdrawal
3. Signs and symptoms of alcohol withdrawal
4. How long do alcohol withdrawal symptoms last?
5. Diagnosis of alcohol withdrawal syndrome
6. Treatment of alcohol withdrawal
7. Medicines for alcohol withdrawal
8. How to handle alcohol withdrawal?

What Is Alcohol Withdrawal Syndrome?

If you drink heavily for weeks or months, over time, your body and brain become dependent on alcohol. When you try to stop drinking abruptly, your body becomes deprived of alcohol and craves for it.

Your body needs time to detox from alcohol and adjust to functioning without it. In this period, you may face a lot of painful alcohol withdrawal symptoms.

These alcohol withdrawal symptoms can be mild or severe, triggering life-threatening health problems. 

Alcohol withdrawal syndrome is a clear sign of alcohol use disorder (AUD), often referred to as alcohol addiction or alcoholism. 

If you are not a heavy drinker or drink once in a while, it’s less likely that you will develop alcohol withdrawal symptoms when you call it quits. But if you have a previous history of alcohol withdrawal, the probability of going through it again increases drastically. 

Causes of Alcohol Withdrawal

Alcohol hits multiple bodily as well as brain functions at the same time. 

Alcohol has a depressant effect. It interacts with particular neurotransmitters in the brain, called gamma-aminobutyric acid (GABA) and glutamate. Alcohol increases GABA activity, which is inhibitory and slows down your brain activity, and suppresses glutamate which is excitatory.

That is why people initially feel relaxed and happy after drinking alcohol.

When you drink excessively, your brain is continuously exposed to the effects of alcohol, and brain chemistry changes in effort to maintain balance. This causes your brain to develop tolerance for and a dependence on alcohol. Tolerance is where your brain requires more alcohol to get the same effect.

The neurotransmitter receptors are no longer exposed to alcohol when you quit drinking abruptly, and your body takes time to adjust to this chemical imbalance, causing the debilitating symptoms of withdrawal from alcohol.

Signs and Symptoms of Alcohol Withdrawal

Symptoms of alcohol withdrawal aren’t equal for every person. They range from mild symptoms like anxiety and sleep disturbance to severe symptoms like alcoholic hallucination and delirium tremens. 

The timeline of alcohol withdrawal is different for different people. 

Withdrawal symptoms start to show about 6 to 8 hours after your last drink. And symptoms often peak within 24 to 48 hours. This is the period when the most uncomfortable withdrawal symptoms occur.

The severity of alcohol withdrawal symptoms is affected by different factors, such as the degree of alcohol intake, how long you have been using alcohol, and previous history of alcohol withdrawal.

Not everyone experiences alcohol withdrawal symptoms equally. While some may experience minimal withdrawal symptoms, others may suffer from fatal repercussions.

Mild Withdrawal

Mild alcohol withdrawal symptoms start to show as early as 6 hours after you call it quits.

Common Symptoms of Mild Alcohol Withdrawal Syndrome

• Anxiety
• Depression
• Mood swings
• Headache 
• Nausea
• Vomiting
• Shaky hands
• Excessive sweating
• Dilated pupils
• Pale Skins
• Tremor

Alcohol Hallucination

Generally, after 12 to 24 hours, the symptoms of alcohol withdrawal intensifies. And you may experience disorientation, confusion and see or hear things that are not there. These hallucinations can be very vivid and detailed. You may see moving objects or people that are not there.

Alcohol hallucinations can last for 1 to 2 days from the day you stop drinking. 

Alcohol Withdrawal Seizure

Seizures can occur within 48 hours after you stop drinking alcohol. Seizures can occur as a generalized tonic-clonic seizure or as small episodes of multiple seizures.

Delirium Tremens (DTs)

About 48 to 72 hours after the last drink, the most severe consequences of alcohol withdrawal can start to show. It’s called delirium tremens or “DTs.” But it may delay for more than a week. The effects usually intensify 4 to 5 days after the last drink.

Signs of Delirium Tremens

• Excessive and uncontrolled breathing
• Extreme agitation
• Fever
• High blood pressure
• Seizures
• Reduced blood flow
• Confusion
• Loss of consciousness

Not everyone experiences delirium tremens. Around 3–5% of people who withdraw from drinking face severe effects of delirium tremens.  

The acute symptoms of alcohol withdrawal typically improve within 5 to 7 days. However, a small number of people may experience prolonged symptoms of alcohol withdrawal. 

The severity and duration of alcohol withdrawal symptoms depend on several factors like the frequency of drinking, the amount of alcohol consumed, and the length of alcohol usage.  

Post-Acute Alcohol Withdrawal (PAWS)

Post-Acute Alcohol Syndrome can also occur in people with alcohol use disorder after the initial withdrawal symptoms have subsided. 

PAWS can last for years after acute withdrawal and can make post-rehabilitation life very difficult for people. 

Symptoms of Post Acute Alcohol Withdrawal Syndrome

• Emotional Outbursts
• Anxiety
• Depression
• Dizziness
• Memory loss
• Insomnia
• Delayed reflex
• Nausea

PAWS is a leading cause of relapse. 

PAWS symptoms are not continuous. People typically experience it in cyclic waves. One day you don’t feel anything, and the next day you are plagued by depression and the intense urge to drink alcohol.

These spontaneous symptoms make it hard to resist the temptation to drink. But if you can hang in there for the time frame, the symptoms often disappear as quickly as they appear.

How Long Do Alcohol Withdrawal Symptoms Last?

The first stage of alcohol withdrawal symptoms usually starts to show within 8 to 10 hours after calling it quits, but it may even arise days later. Symptoms intensify after 48 to 72 hours but can last through several weeks. 

In many cases, symptoms are more likely to decrease and resolve within 5 to 7 days.

Learn more about Alcohol withdrawal timeline and stages of alcohol withdrawal here.

Diagnosis of Alcohol Withdrawal Syndrome

Alcohol withdrawal syndrome is primarily diagnosed by physicians with physical examinations. The physical examination typically looks for the following:

• Abnormal heart rate
• Dehydration
• Fever
• Shakes
• Abnormal breathing
• Dilated pupils

Apart from that, blood and urine tests, along with a toxicology screen may be done to diagnose alcohol withdrawal.

Clinical Institute Withdrawal Assessment for Alcohol or CIWA

Many hospitals use a 10-item scale to assess and manage the level of alcohol withdrawal. This is called the Clinical Institute Withdrawal Assessment for Alcohol or CIWA protocol.

The ten items that are evaluated on the scale are –

• Nausea and vomiting
• Tremor
• Sweats that come and go
• Anxiety
• Agitation
• Tactile disturbances (abnormal feeling of itch)
• Auditory disturbances
• Visual disorder (hallucinations)
• Headache
• Confusion

The CIWA scale helps to provide efficient and consistent measures to assess alcohol withdrawal. 

Treatment of Alcohol Withdrawal

There is no ‘one-size-fits-all’ approach when it comes to the treatment of alcohol withdrawal, often called detoxification or detox. Symptoms can shift quickly from mild to severe in a matter of hours. 

• Inpatient Treatment. People with moderate to severe withdrawal symptoms often are required to be put in a hospital or a facility to monitor signs of hallucination or delirium tremens. Treatment includes

1. Monitoring heart rate, blood pressure, body temperature
2. Giving sedation medicines through the vein. (IV)

• Outpatient Treatment. If your withdrawal symptoms are mild to moderate, outpatient treatment allows you to stay at home and possibly attend to daily responsibilities. While you likely will have medications to help manage symptoms, it’s important to not be alone in case symptoms worsen. So, during this time, someone needs to stay with you and keep an eye on you. 

Treatments may include:

1. Medications
2. Blood Tests
3. Counselling of patients and their family

• Support Group. Treatment of alcohol use disorder doesn’t stop after successful withdrawal. Support groups offer an outlet to discuss treatment goals and support each other in their journey towards alcohol recovery. 

Medicines for Alcohol Withdrawal

There are several medicines that a doctor may prescribe to manage the symptoms of alcohol withdrawal syndrome. 

Benzodiazepines

Benzodiazepines are one of the most effective medications to treat alcohol withdrawal. 

They share a similar mechanism to alcohol so they alleviate withdrawal symptoms. Benzodiazepines with long half-lives (that is, the effects last longer) are typically used.

Most Commonly Used Benzodiazepines 

• Chlordiazepoxide (Librium)
• Clorazepate (Tranxene)
• Diazepam (Valium)
• Oxazepam (Serax)

Although benzodiazepines are very useful and safe in the treatment of alcohol withdrawal, they need to be used carefully and according to prescribed instructions. If used uncontrollably, there is a risk of getting addicted to benzodiazepine as well. 

The combined effect of benzodiazepines and alcohol dependence can increase the adverse effects of withdrawal symptoms and may cause depressive effects and suicidal actions. The combination also increases risk for overdose since they both depress the central nervous system (CNS).

Barbiturates

Barbiturates are used to treat alcohol withdrawal syndrome for benzodiazepine-resistant cases. In particular, they are most useful in the emergency department or in the ICU to treat severe withdrawal symptoms. However, additional studies are needed to clarify the effects of barbiturates in alcohol withdrawal symptoms. 

Alternative Medicines

Apart from benzodiazepines, other drugs may also be used to reduce the intensity of alcohol withdrawal symptoms. 

• Antipsychotic (e.g. haloperidol)
• Anticonvulsant (e.g. carbamazepine)
• Centrally Acting Alpha-2 Agonists (e.g. Clonidine)
• Baclofen

Vitamins

Alcoholics often suffer from nutrient deficiencies, which can cause several complications during alcohol withdrawal like Wernicke Syndrome. 

To prevent this from happening, individuals should consume a multivitamin preparation with enough folic acid and thiamine. These multivitamins may be given by intravenous administration to individuals. 

How to Handle Alcohol Withdrawal?

Alcohol withdrawal can be very uncomfortable. But there are some activities people can do to get through the process.

1. Drink Plenty of Fluids

People with alcohol dependence often suffer from dehydration during their withdrawal. Drinking lots of water with electrolytes helps the body to hydrate and provide essential ions to make your body function normally.

2. Avoid Drinking Buddies

One of the most important things to do when going through alcohol withdrawal is to stay away from your drinking buddies and bad influences. These people will likely trigger your brain to again go into the vicious cycle of drinking. 

3. Exercise

When you are going through withdrawal symptoms, you may not have the energy to do exercise or yoga, but it is one of the best tools to cope with withdrawal. Exercises elevate the mood and release feel-good hormones in your brain. Additionally, you may feel more energetic and more confident which can help you with your recovery.

4. Meditate

Meditation can help you maintain your focus on recovery and stay relaxed during withdrawal.

Alcohol withdrawal can be a painful process, but one thing to remember when going through the treatment is to stay strong. When pain shows up, don’t allow it to break you down. Lean onto those who will support and help you, and take a stand against your addiction. Be sure to seek medical advice before quitting alcohol, so withdrawal symptoms can be managed safely and as comfortable as possible.

Good things don’t come easy and recovering from alcohol addiction is no different. People can and do overcome alcohol addiction to live a healthy life afterwards.