Alcohol withdrawal is a condition one experiences when coming down from the effects of alcohol. It is a naturally occurring phenomenon, as withdrawal will occur regardless of quantity consumed. With heavier drinking, common symptoms experienced include anxiety, agitation, vomiting, and headaches. Though abstinence is the best means of avoiding alcohol withdrawal, responsible drinking may curb the most undesirable symptoms.
What Is Alcohol Withdrawal?
As with any other foreign substances entering the body, especially substances of abuse, alcohol withdrawal occurs as one’s system detoxifies itself. Greater consumption over extended periods of time does heighten one’s risk for more severe cases of withdrawal.
Further, one’s physiology is a factor in withdrawal symptoms. Age, weight, gender, ability to metabolize, and so forth make a difference—sometimes one that is substantial. Though symptoms of withdrawal are fairly predictable, the way in which one experiences them may vary widely. For example, an individual who consumes a moderate amount of alcohol may feel mild adverse effects, while someone who habitually engages in binge drinking may struggle greatly when consumption is suddenly stopped.
According to the The Centers for Disease Control and Prevention (CDC), to reduce the risk of alcohol-related harm, women should consume no more than one drink per day while men should consume two or less drinks daily.1, 2
Populations at higher risk for alcohol withdrawal include those who are or have:1, 2
- Pregnant or might be pregnant
- Younger than 21 years of age
- Certain medical conditions
- Taking medications that can interact with alcohol
- Recovering from an alcohol use disorder or are unable to control the amount they drink
Physical Dependence vs. Addiction
Physical dependence occurs when one’s body becomes dependent on a substance. At this point, neurophysiological changes occur in the brain that are marked by tolerance and withdrawal. This can happen whether one uses a substance as recommended, prescribed (e.g., Xanax withdrawal or benzodiazepine withdrawal) or in an abusive fashion.
Dependence is not unique to drugs and alcohol. Many people are physically dependent upon everyday substances, such as sugar and caffeine, without even realizing it. Insofar as the consideration of physical dependence versus addiction, the marked difference is that an individual struggling with addiction is now cognitively, emotionally, and behaviorally involved. The cycle between dependence and addiction is reinforcing and becomes more severe over time.
Alcohol Withdrawal Symptoms
Alcohol withdrawal may occur shortly after consuming one’s last drink. Typically, mild symptoms of early withdrawal occur around 6-12 hours after the last drink.6 For those who consumed an excessive amount of alcohol or are daily binge drinkers, by 24 hours, more serious symptoms begin to occur, possibly including visual, auditory, or tactile hallucinations.
Withdrawal symptoms range from mild, to moderate, to severe. In more extreme cases, without appropriate medical detox, an individual may experience delirium tremens (DTs). DTs refers to the onset of sudden and severe psychological and neurological symptoms and can kill. Accordingly, for those who consume a liter of hard alcohol per day just to feel normal, quitting “cold turkey” may lead toward severe consequences including death.3, 5 High risk factors for severe withdrawal syndrome include chronic heavy drinking, a history of generalized seizures; and a history of delirium tremens.7
For those with more serious withdrawal symptoms, it is highly recommended that they be monitored by a medical professional throughout this time to ensure safe detox and symptom reduction.
Alcohol withdrawal symptoms may include:
- Anxiety
- Fatigue
- Gastrointestinal disturbances
- Hallucinations
- Headaches
- Heart palpitations
- Hyperthermia
- Increased blood pressure or heart rate
- Insomnia
- Irritability
- Mood changes
- Nightmares
- Rapid abnormal breathing
- Seizures
- Sweating
- Tremors or shakes6
Severe Delirium Tremens Symptoms
Delirium tremens (DTs) and seizures are signs of the most severe form of alcohol withdrawal.8 In short, DTs are characterized by sudden and substantial changes in one’s mental or nervous system.9 Though nearly half of people who abuse alcohol will experience withdrawal symptoms, only about 5% experience DTs.10
It is highly recommended that one seeks emergency medical attention in the presence of DT. Medical attention may still be needed in the absence of such, especially if one appears to have alcohol poisoning. In this case, an individual may appear to be in a deep sleep while struggling with respiratory impairment and risk pulmonary aspiration (choking on one’s own vomit).
Severe symptoms of DT that require immediate medical attention include:
- Aggression
- Agitation
- Confusion
- Hallucinations (i.e., auditory, tactile, and/or visual)
- Impaired consciousness
- Irritability
- Nausea
- Seizures
- Sweating
- Tachycardia
- Trembling
- Tremors
- Vomiting8
Causes of Alcohol Withdrawal
Excessive drinking is detrimental to one’s physiology, as it negatively affects the nervous system while physiological dependency affects the body and brain.
Short- and long-term effects of excessive drinking may include the following:
Short-term
- Injuries: such as motor vehicle crashes, falls, drownings, and burns.
- Violence: may include homicide, suicide, sexual assault, and intimate partner violence.
- Alcohol poisoning: a medical emergency that results from high blood-alcohol levels.
- Risky sexual behaviors: can include unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
- Pregnancy-related issues: miscarriage, stillbirth, or fetal alcohol spectrum disorders (FASDs) among pregnant women.11
Long-term
- High blood pressure
- Heart disease
- Stroke
- Liver disease
- Digestive problems
- Cancer
- Weakening of the immune system
- Learning and memory problems
- Depression
- Anxiety
- Social problems (e.g., family problems, job-related problems, unemployment)
- Alcohol use disorders11
Depending on the individual, amount of alcohol consumed, and frequency of consumption, the experience of alcohol withdrawal could align with a diagnosis for alcohol use disorder. Given that alcohol is a foreign substance in the human body, while detoxifying, one’s system is trying to retain homeostasis.
Diagnosis of Alcohol Withdrawal Syndrome
For those who frequently experience alcohol withdrawal symptoms, it may be likely that they have a diagnosable form of alcohol withdrawal syndrome (AWS). As with any other diagnosable condition, it is recommended that a person be formally assessed by a medical professional.
A professional may verify whether AWS or any other condition is present. From here, a treatment plan may be devised to begin the recovery process. Self-diagnosis is dangerous, as something may be missed. For those with more severe cases of alcohol withdrawal, attempting to detox without medical assistance may lead to DTs, seizures, and untimely death.
Questions a doctor may ask to determine AWS include:
- What current symptoms are you experiencing?
- How frequently do you experience these symptoms?
- How frequently do you drink?
- How much alcohol do you typically consume when you drink?
- Do you have any other diagnosable medical or mental health conditions?
- What is your general information (e.g., age, gender, height, weight, ethnicity)?
- Do you feel like you have bugs crawling under your skin?
- Do you know who I am?
- Do you know what day it is?
- Is there a ring of pressure around your head?
- Are you willing to engage in treatment?
- Do you have any prosocial support who may assist with your recovery?
Coping With Alcohol Withdrawal Symptoms
The best way to manage and relieve alcohol withdrawal symptoms is to stop drinking immediately. Though some attempt to relieve withdrawal symptoms by drinking again, this further reinforces the cycle—leading toward more extensive damage. Healthy practices, such as engaging in consistent self-care and surrounding oneself with prosocial support can make a big difference, especially when terminating or minimizing alcohol use.
Here are tips to help alleviate alcohol withdrawal symptoms:
- Stay hydrated
- Practice self-care
- Seek care from non-dependent people who provide prosocial support
- Take any prescribed medications as prescribed
- Consume a balanced diet
- Engage in regular exercise
- Attend regular doctor’s visits, even for routine check-ups (including blood work)
- If needed, locate a safe shelter or environment
- Seek professional assistance (e.g., physician, psychiatrist, psychologist, counselor)
- Attend support groups (e.g., 12-steps, SMART Recovery, NAMI Dual Diagnosis)
Though these tips are generally recommended, what works for some does not work for others. It is important to find what works best for you, which may take some time. Once you do, stick with it and move forward.
Alcohol Withdrawal Treatment
Because substance use disorders and corresponding conditions are pervasive in nature, holistic (comprehensive) forms of treatment are recommended. These oftentimes involve an integrated health model that uses therapy, group programs, inpatient/outpatient care, and even medication to address all causes of the disorder.
Symptoms need not be severe to seek treatment. The earlier one seeks treatment, the better. Less severe cases may be assisted with group or outpatient programs, while more severe ones oftentimes require something more invasive such as intensive outpatient (IOP) or residential/in-patient programs.
At-Home Care
When various factors prevent one from acquiring treatment outside of their home, at-home care may prove a viable option. However, it is important that the dwelling is a safe space for recovery. This should be an environment devoid of persons, places, and things that will trigger use.
In addition to prosocial support being available, the process may be accompanied by a healthcare provider—especially if a medically structured detox is part of the process. These individuals may provide emotional and social support while helping one remain accountable.
Some things you can do to prepare for an at home detox include:
- Have a loved one monitor symptoms
- Find a safe home environment
- Remove alcohol and/or anything triggering from the home
- Have a comprehensive list of emergency resources beyond 9-1-1
Hospitalization & Inpatient Care
When symptoms exceed one’s ability to control them, a hospital visit may be necessary; medical professionals may assess one’s toxicology as well as the presence of any other conditions. They may also provide medical and psychological support as required by the individual.
Traditional detox takes around 72 hours, while many residential programs are structured over 30, 60, 90 days or longer. In a residential setting, one participates in individual counseling, support groups, medical management (as needed), psychoeducation, family services, and so forth. Given that these programs focus on the whole individual, they gradually address each problem area while highlighting strengths—ultimately, reducing one’s desire to drink and improving overall quality of life.
Medications
In more severe cases of withdrawal, medications such as benzodiazepines may be administered. However, these should be met with caution as they are highly addictive. One does not want to face cross-addiction from alcohol to benzodiazepines, as this leads to a host of additional problems. Vitamins are also useful. Some vitamins commonly administered over the first several days of withdrawal may include B1, B2, B3, B6, and C.
Rehab & Outpatient Services
Because of the cost and time associated with inpatient stays, many opt for detox and rehabilitation centers. Rehabilitation centers may have 24-hour access and beds available for weekly or extended stays. They may also include IOP and/or traditional outpatient services.
In these settings, one is first medically detoxed to ensure stability. It is difficult to engage in recovery while actively experiencing withdrawal. From there, the individual may begin with IOP or more frequently scheduled outpatient appointments and taper treatments based on progress. There is no predetermined timeline here, as everyone’s needs vary.
Enrolling in these programs may prove challenging depending on access to resources. Many social work/casework programs aid in linkage to these programs by having an open referral line as well as collaborating in treatment (when appropriate and authorized).
Detoxing from Alcohol Safely
Completely abstaining from alcohol is the best way to avoid withdrawal, as it cannot occur unless prompted. For those struggling with alcohol withdrawal and/or a diagnosable case of AWS, the safest route for successfully withdrawing from alcohol is by working with a medical professional and care team to ensure that you stop alcohol use the right way. This may or may not entail a formal medical detox treatment. Either way, safely stopping use is the best decision for one’s treatment plan.
Final Thoughts
With any type of withdrawal, adverse effects vary depending on the individual. It’s important to discuss stopping alcohol consumption with your care team before taking the first step, as doing so suddenly may result in death. Fortunately, the prognosis for those who fully engage in treatment and maintenance is good. While there may be some irreversible damage from use, one may continue to recover. It all begins with you making the change.
