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Alcohol Withdrawal Symptoms, Treatment, and Timeline

The National Dietary Guidelines recommends a cautious approach to alcohol consumption, with women limiting themselves to 1 drink daily (7 per week) and 2 drinks daily for men (14 per week). Consuming more than this level of alcohol increases a person’s risk of liver disease, cardiovascular disease and other injuries. Even drinking within the recommended limits or at lower levels may increase a person’s cancer risk and can increase their risk of physiological dependence.1

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This article will introduce problematic patterns of alcohol consumption in the United States and the risks of developing an alcohol use disorder (AUD). It will also explore what happens to your brain and body when you are dependent on alcohol and suddenly stop drinking or reduce your alcohol intake—including symptoms of alcohol withdrawal, the approximate timeline for alcohol detox symptoms, what delirium tremens (DTs) is, how withdrawal can affect your mental health, and what to expect from treatment for alcohol withdrawal.

Alcohol Abuse & Misuse

Alcohol abuse in America

Misuse of alcohol, often called “alcohol abuse,” refers to excessive alcohol use or any other way that can place you at risk for experiencing physical, mental health and social problems.

Having more than 1 drink daily for women (7 per week) or 2 drinks daily for men (14 per week) is generally considered alcohol misuse.2 Binge drinking, a form of alcohol misuse, is when a man has 5 or more drinks or a woman has 4 or more drinks within a short period of time.2,3

Binge drinking or alcohol misuse can increase someone’s risk of developing alcohol use disorder, more commonly known as “alcoholism” or having an “alcohol addiction.4 AUD is a disease characterized by the inability to control alcohol use despite negative, harmful consequences. Craving alcohol, having a tolerance to the effects of alcohol, and experiencing withdrawal symptoms when you try to stop drinking are but some of the criteria that point toward having AUD.2,4 When a person has a physiological dependence on alcohol, the withdrawal symptoms that are experienced after they significantly reduce or stop drinking an be extremely distressing and uncomfortable, and people commonly return to drinking alcohol as a way of relieving their discomfort.4

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What is Alcohol Withdrawal Syndrome?

Alcohol withdrawal syndrome is a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking or drastically reduces their alcohol intake.

Causes of Alcohol Withdrawal

Alcohol withdrawal is thought to arise as a function of various changes in brain activity caused by prolonged and excessive alcohol use. Though the neurochemical details of alcohol withdrawal syndrome are somewhat complicated, its associated symptoms reflect a compensation for previous disruptions in both excitatory and inhibitory neurotransmitter activity—the balance between the two having been upended to begin with as a result of prolonged alcohol use.5

“Alcohol withdrawal is thought to arise as a function of various changes in brain activity caused by prolonged and excessive alcohol use.”

The effects alcohol has on the body are complex, but two particular neurochemicals contribute to both short-term effects of drinking as well as the development of alcohol withdrawal syndrome when someone stops drinking: the brain’s main inhibitory chemical, gamma aminobutyric acid (GABA) and the brain’s main excitatory chemical, glutamate.6 When a person drinks alcohol it changes the functioning of GABA receptors as well as certain glutamate receptors, resulting in a slowdown of brain functioning that a person typically experiences as decreased anxiety and sedation. The brain reacts by decreasing the amount of GABA being released and increasing glutamate signaling to compensate for how alcohol alters these levels.6 This adaptation functions as long as you continue to drink alcohol—this is known as “tolerance.”

If you stop or significantly reduce alcohol intake, it disrupts your brain activity, causing a hyper-aroused state which leads to a range of withdrawal symptoms that can appear within hours after your last drink.4,7 The withdrawal symptoms a person experiences as well as their severity may vary greatly from one person to the next, and it has been estimated that more than 80% of those with an alcohol use disorder may experience withdrawal symptoms.4

When To Seek Help

You may be wondering how to tell if you need help for your drinking. Generally, you may need alcoholism treatment when you can no longer control the amount you drink or how long you drink for. You may also know that you need help with alcohol misuse when you begin experiencing consequences directly related to your alcohol misuse – but you still can’t stop or cut back on the amount that you’re drinking. To learn more about when you may need help for alcohol misuse, visit our informational page on How to Help an Alcoholic or take our “Am I an Alcoholic?” self-assessment.

Take Our “Am I an Alcoholic?” Self-Assessment

Take our free, 5-minute “Am I an Alcoholic?” self-assessment below if you think you or someone you love might be struggling with an alcohol use disorder (AUD). The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an AUD. The test is free, confidential, and no personal information is needed to receive the result.

Signs of Alcohol Withdrawal

Signs and symptoms of the various stages of alcohol withdrawal may include:

  • headaches
  • anxiety
  • tremors
  • insomnia
  • fatigue
  • mood changes
  • gastrointestinal disturbances
  • heart palpitations
  • increased blood pressure or heart rate
  • hyperthermia
  • rapid abnormal breathing
  • hallucinations
  • seizures

Alcohol Withdrawal Timeline & Stages

What happens to your body when you give up alcohol may hinge on a variety of factors. Depending on the level of physiological alcohol dependence, the severity of acute alcohol withdrawal will vary for different individuals.3,8

The American Academy of Family Physicians outlines 3 potential stages that a person in withdrawal may experience. These include:9

  • Stage 1 (mild): symptoms may include headache, insomnia, anxiety, hand tremor, gastrointestinal disturbances, and heart palpitations.
  • Stage 2 (moderate): symptoms my include Stage 1 mild symptoms in addition to increased blood pressure or heart rate, confusion, mild hyperthermia, and rapid abnormal breathing.
  • Stage 3 (severe): symptoms include Stage 2 moderate symptoms in addition visual or auditory hallucinations, seizures, disorientation, and impaired attention.
alcohol abuse withdrawal

Without treatment by a healthcare professional, some people can progress from Stage 2 to Stage 3 rapidly.8

While a precise timeline for alcohol withdrawal will vary from person to person based on several factors (average quantity and duration of heavy drinking behavior, the concurrent presence of physical and mental health issues, etc.), a general symptom timeline for alcohol detox may look something like:7,9

  • 6-12 hours after the last drink, the relatively mild symptoms of early withdrawal may begin to be felt, including some headache, mild anxiety, insomnia, small tremors, and stomach upset.
  • By 24 hours, some people may have begun to experience visual, auditory, or tactile hallucinations.
  • Within 24-72 hours, various symptoms may have peaked and begun to level off or resolve (though some more protracted symptoms may stick around for weeks or longer). Seizure risks may be highest from 24-48 hours after the last drink, requiring close monitoring and seizure prophylaxis. Withdrawal delirium (i.e., DTs) may appear from 48-72 hours after drinking has stopped.

More rarely, some people experience more persistent withdrawal related symptoms—such as sleep disturbances, fatigue, and changes in mood—that last for months.9 It is important to note, however, that most people recover fully with proper medical detox and withdrawal management services.11

While quitting alcohol is never easy, consider what compulsive drinking might be costing you. At the American Addiction Centers (AAC) website, this addiction calculator can provide an estimate as to how much an alcohol addiction or certain other types of substance addiction are costing you and impacting your quality of life.

Treatment, Coping & Prevention

Detox is often considered the first stage of treatment.9 It will help you navigate the difficult process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use.6,11 Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.5,9

  • Inpatient or residential treatment involves living at a facility for the duration of treatment while you receive around-the-clock support and intensive therapy in group and individual sessions.
  • Outpatient treatment involves living at home and attending group and individual therapy sessions at regularly scheduled appointments. This allows you to practice what you learn in treatment in real-world situations while managing stressors.

In general, the course of alcohol withdrawal is highly variable and somewhat unpredictable. Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms. Those experiencing mild alcohol withdrawal symptoms or who are concerned about experiencing withdrawal symptoms will benefit from the advice of a physician or clinician trained to assess and treat patients in alcohol withdrawal.

Those experiencing moderate to severe symptoms of alcohol withdrawal, or those who are at risk of experiencing moderate to severe symptoms (i.e., if you’ve had severe alcohol withdrawal symptoms in the past) typically require inpatient monitoring and treatment of withdrawal symptoms at an acute care hospital or detox-equipped facility. Outpatient treatment may be available for mild-to-moderate symptoms of alcohol withdrawal, however, should symptoms become severe, inpatient care may be required.

Other post-detox resources include:

Alcohol Withdrawal Medications

To prevent or lessen withdrawal symptoms or medical complications that can occur with severe alcohol withdrawal, doctors may prescribe benzodiazepines. These drugs can stop certain withdrawal reactions from proceeding to serious consequences.8

Other medications may also be used to stabilize patients or for supportive care (e.g., anticonvulsants, antipsychotics, beta blockers and alpha-adrenergic agonists.) Patients who are dehydrated or malnourished may be given fluids or certain vitamins.8

Dangers of Alcohol Withdrawal

Moderate-to-severe alcohol withdrawal can be extremely dangerous and sometimes life-threatening. The most severe form of alcohol withdrawal, delirium tremens, has a mortality rate of 1-4%.8,12

Experiencing severe alcohol withdrawal symptoms is somewhat rare, however, it can be difficult to predict those who will experience them and those who will only experience mild withdrawal symptoms.8 Despite this, studies have identified some predictors of severe alcohol withdrawal (e.g., withdrawal seizures or DTs). These include:5,13

  • Heavy daily alcohol use.
  • Being of older age.
  • History of DTs or alcohol withdrawal seizures.
  • Comorbid illnesses.
  • Dehydration.
  • Electrolyte disturbances.
  • Brain lesions.
  • Abnormal liver function.

How Much Do I Have to Drink to Get Withdrawals?

It is impossible to accurately predict who will experience alcohol withdrawal, what the course of withdrawal may be, or the severity of withdrawal. Whether or not you develop alcohol withdrawal symptoms depend heavily on your body chemistry, the amount of alcohol you drink daily, how old you are, whether you have any other co-occurring physical or mental health conditions, and many other factors.8

Frequently Asked Questions Regarding Alcohol Withdrawal

Sources:

  1. Centers for Disease Control and Prevention. (2020). Dietary Guidelines.
  2. Centers for Disease Control and Prevention. (2018). Alcohol and substance misuse.
  3. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. American Family Physician. (2004). Alcohol Withdrawal Syndrome.
  6. Bayard, M., McIntyre, J., Hill, K.R., & Woodside, J. Jr. (2004). Alcohol withdrawal syndrome. American Family Physician, 69(6), 1443-1450.
  7. Gortney, J.S., Raub, J.N., Patel, P., Kokoska, L., Hannawa, M., & Argyris, A. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67-79.
  8. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  9. Muncie Jr., H. L., Yasinian, Y., & Oge, L. K. (2013). Outpatient management of alcohol withdrawal syndrome. American Family Physician, 88(9), 589-595.
  10. National Library of Medicine. (2020).Alcohol withdrawal.
  11. National Institute on Drug Abuse.(2020). Principles of drug addiction treatment: A research-based guide (Third edition).
  12. Wolf, C., Curry, A., Nacht, J., & Simpson, S. A. (2020). Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open access emergency medicine : OAEM12, 53–65.
  13. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research : JCDR9(9), VE01–VE07.
  14. National Health Service. (2018). Overview: Alcohol-related liver disease
  15. National Institute of Alcohol Abuse and Alcoholism. The neurotoxicity of alcohol.
Last Updated on September 1, 2021
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