Alcohol Withdrawal: Symptoms, Treatment, & Prevention

What Is Alcohol Withdrawal?

Alcohol withdrawal syndrome occurs as the body detoxifies itself from alcohol. Greater consumption over extended periods heightens the risk of severe cases of withdrawal, as individuals may develop physical alcohol dependence. Neurophysiological changes ensue in the brain, affecting tolerance and withdrawal symptoms.

Age, weight, gender, and so forth impact how individuals experience alcohol withdrawal symptoms. Those who moderately consume alcohol may feel mild adverse effects, while others who habitually binge drink may struggle after alcohol cessation.

Alcohol Withdrawal Symptoms

Symptoms of alcohol withdrawal may occur around 6-12 hours after the last drink.¹ Individuals who excessively drink alcohol or are daily binge drinkers may experience severe symptoms after 24 hours, possibly including visual, auditory, or tactile hallucinations.

Alcohol withdrawal symptoms range from mild to severe, and extreme cases may require medical detox due to delirium tremens (DTs). DTs are the onset of sudden and intense psychological and neurological symptoms that can be fatal. Accordingly, for those who consume a liter of hard alcohol daily just to feel normal, quitting “cold turkey” may lead to severe consequences or death.^2.3 High-risk factors for severe withdrawal syndrome include a history of chronic heavy drinking, generalized seizures, and delirium tremens.⁴

Seeking emergency medical attention when DT symptoms occur is highly recommended. Medical attention may still be needed for typical alcohol withdrawal symptoms, 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 vomit).

Common 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
• Sweating
• Tremors or shakes¹

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
• Vomiting⁵

What Causes Alcohol Withdrawal?

Excessive drinking damages physiology by negatively affecting the nervous system, while physiological dependency impacts the body and brain. When alcohol consumption ceases, systems work to retain homeostasis when detoxing, resulting in unpleasant withdrawal symptoms. Not everyone will experience the effects of alcohol withdrawal, but certain populations may be more at risk.

Populations at higher risk for alcohol withdrawal include those who are:^6,7

• Pregnant or might be pregnant
• Younger than 21 years of age
• Experiencing various medical conditions
• Taking medications that can interact with alcohol
• Recovering from an alcohol use disorder or are unable to control the amount they drink

Diagnosis of Alcohol Withdrawal Syndrome

Those who frequently experience alcohol withdrawal symptoms may have a diagnosable form of alcohol withdrawal syndrome (AWS). During a diagnostic exam, professionals may verify if AWS symptoms are present before determining a treatment plan to initiate recovery. 

Self-diagnosis is dangerous, and individuals should seek professional guidance at the first sign of alcohol withdrawal. 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 diagnose alcohol withdrawal syndrome 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

Recognizing the signs of alcohol withdrawal can help you enact coping skills to deal with symptoms or seek medical advice. However, the best way to manage and relieve alcohol withdrawal symptoms is to stop drinking immediately. Consuming alcohol again further reinforces the cycle, leading to more extensive damage. Healthy practices like consistent self-care and prosocial support can make a big difference, especially when terminating or minimizing alcohol use.

Coping skills that work for some individuals do not work for others. Find what suits your needs, stick with it, and move forward. Recovery from alcohol withdrawal is possible, and help is available if you need assistance.

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)

Treatment of Alcohol Withdrawal

Many professionals recommend holistic (comprehensive) treatments for pervasive substance use disorders and corresponding conditions. These often involve an integrated health model that uses therapy, group programs, inpatient/outpatient care, and sometimes medication for alcohol use disorder.

Alcohol withdrawal symptoms need not be severe to seek treatment. The earlier one seeks treatment, the better. More severe cases usually require more invasive treatments, such as intensive outpatient (IOP) or residential programs.

At-Home Care

Detoxing from alcohol at home may prove a viable option. However, the dwelling should be a safe space for recovery, devoid of persons, places, and things that trigger alcohol consumption. Along with prosocial support, healthcare providers may accompany the individual during at-home treatment to provide emotional support and help them remain accountable.

Hospitalization & Inpatient Care

Acute alcohol withdrawal symptoms may require medical intervention. Physicians may assess for toxicology and the presence of any other conditions. Traditional detox from alcohol takes around 72 hours, but many residential programs are 30, 60, or 90 days.

In a residential setting, individuals participate in counseling, support groups, medical management (as needed), psychoeducation, and family services. Given that these programs focus on the whole individual, they gradually address each problem area while highlighting strengths. Ultimately, inpatient programs aim to reduce the desire to drink and improve overall quality of life.

Medications

Medications, such as benzodiazepines, may be administered for more severe cases of alcohol withdrawal. These should be met with caution as they are highly addictive, and cross-addiction from alcohol to benzodiazepines leads to additional problems. B1, B2, B3, B6, and C vitamins are also beneficial.

Rehab & Outpatient Services

When recovering from alcohol withdrawal symptoms or alcohol use disorder, many opt for detox and rehabilitation centers. These programs may offer 24-hour access and beds for weekly or extended stays. Individuals are first medically detoxed to ensure stability before beginning with IOP or more frequently scheduled outpatient appointments. There is no predetermined timeline, as individual needs vary.

Detoxing from Alcohol Safely

Alcohol withdrawal symptoms are preventable with abstinence. Still, individuals struggling with alcohol withdrawal or alcohol use disorder can safely detox with a medical professional and care team. Either way, safely stopping alcohol consumption is the best way to avoid or cope with alcohol withdrawal.

Final Thoughts

The adverse effects of alcohol withdrawal vary depending on the individual. 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 promising. Recovery from alcohol withdrawal symptoms or dependence begins with you making the change.