The Alcohol Withdrawal Syndrome OR What is Alcohol Withdrawal Syndrome?
In people who develop alcohol dependence after a period of heavy and prolonged drinking, a characteristic alcohol withdrawal syndrome may develop within a few hours to several days after drinking stops.3 Though the extent of the associated symptom development may vary greatly from one person to the next, it has been estimated that more than 80% of those with an alcohol use disorder may experience withdrawal after being hospitalized.3
The acute alcohol withdrawal syndrome is thought to arise as a function of various changes in brain chemistry.4 Though the neurochemical details are somewhat complicated, these changes 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.4
When a person with significant alcohol dependence suddenly stops drinking, the brain and nervous system may become temporarily hyperexcitable, potentially giving rise to:4,5
- Upset stomach.
At times, a person might develop more severe symptoms, such as high fevers, hallucinations, grand mal seizures, and severe mental confusion.5 Severe and/or complicated alcohol withdrawal can be life threatening, and may require close medical monitoring for symptom development in addition to the use of certain sedating medications (e.g., benzodiazepines) to minimize seizure risks during the withdrawal period.5 Medical detox can help keep an alcohol dependent patient as safe and comfortable as possible during withdrawal, which helps to prepare them for additional rehabilitation and recovery work.4
The more you drink heavily, the more likely you are to experience alcohol withdrawal. Though alcohol withdrawal occurs most commonly in adults, adolescents and teenagers may also be at risk.6 Other factors that may influence the character and severity of alcohol withdrawal include the following:4
- An underlying medical or psychiatric condition.
- How long you have been abusing alcohol?
- How much you drink?
- How recently you last used alcohol?
- Whether have previously experienced alcohol withdrawal complications such as seizures.
Alcohol Withdrawal Timeline
Depending on the level of physiological alcohol dependence, the severity of acute alcohol withdrawal will vary for different individuals.
The American Academy of Family Physicians outlines 3 potential stages that a person in withdrawal may experience. These include:7
- 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.
Without treatment by a healthcare professional, some people can progress from Stage 2 to Stage 3 rapidly.7
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:4, 6
- 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.4 It is important to note, however, that most people recover fully with proper medical detox and withdrawal management services.6
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.
What Is Delirium Tremens (DTs)?
Some people with alcohol dependence will develop a condition known as delirium tremens (DTs), which is a very severe, potentially-fatal presentation of alcohol withdrawal. 8
Symptoms of DTs most commonly raise within 4 days of the last drink, though they may develop later than this. Symptoms, when left untreated, may quickly grow worse. Such symptoms include:8
- Sudden onset, severe confusion (i.e., delirium).
- Increased fear or excitement.
- Increased sensitivity (e.g., to light, sound, touch).
- Sudden mood changes.
- Body tremors.
- Seizures (seizures may develop in absence of other DT symptoms).
Delirium tremens is a serious and, in some cases, life threatening type of alcohol withdrawal.8 It can be fatal when unmanaged, so if there’s a concern that you or someone you know is experiencing DTs symptoms, seek medical treatment imminently. 8
DTs can be fatal in 5% to 10% of cases.5 Treatment may involve extensive laboratory evaluation, frequent vital sign checks, serial mental status evaluation, IV fluids, adequate nutrition, and other supportive care during the withdrawal period. In addition, medications such as benzodiazepines will be used to help control seizures and minimize the risk of other complications.5
Medical Detox and Alcohol Withdrawal Management
Before beginning treatment or rehabilitation for alcohol use disorder, many people first undergo a supervised medical detox to minimize the risk of severe, potentially lethal withdrawal complications, such as seizures and DTs.
You should not try to do an alcohol detox on your own. To keep you safe and comfortable, a doctor or other treatment professional can best determine the level of supervision and medical intervention you might need for appropriate withdrawal management.7 Medical detox programs, such as those offered at AAC, can provide you with a safe and supportive setting in which to safely detox from alcohol and/or other drugs as you begin your journey to recovery.
You can expect to be carefully evaluated for any significant medical or mental health issues at the start of detox treatment. Throughout the withdrawal timeframes illustrated in previous sections, you will also receive ongoing evaluation throughout your stay to assess whether withdrawal is being adequately managed to minimize the risks of certain complications like seizures and DTs.4
Medical detox will involve constant supervision of your medical and emotional needs, and adjustments to the corresponding treatment based on your symptoms. Medication can be used to help control your symptoms. Benzodiazepines such as diazepam or chlordiazepoxide may be used to help prevent seizures and manage certain alcohol detox symptoms.3
Effective withdrawal management is also extremely important in people who struggle with alcohol use disorder and co-occurring disorders such as anxiety, depression, and bipolar disorder.10 (Introduction) If you or your loved one needs alcohol withdrawal treatment, AAC has numerous treatment centers throughout the U.S. that offer up-to-date alcohol withdrawal treatment and medical detox, in addition to treatment of co-occurring mental health and substance abuse issues.
Treatment After Detox
The Substance Abuse and Mental Health Services Administration (SAMHSA) points to fostering patient readiness for and entry into substance abuse treatment as one of the three key goals of the detox process.9 Detox alone is no substitute for comprehensive rehabilitation services. Ongoing support is critical to long-term recovery.4
Various treatment approaches and settings that follow a period of alcohol detox can help provide this necessary ongoing support for recovery, based on individual needs. These options include: 4
- Formal rehabilitation programs, including inpatient or outpatient treatment.
- Therapeutic varieties such as family therapy and cognitive behavioral therapy (CBT).
- 12-step meetings, such as AA.
- Participation with other mutual support groups such as Smart Recovery.
- AAC’s free online virtual support meetings.
What happens to your body when you give up alcohol?
If physiological dependence has developed, abruptly quitting drinking can lead to acute alcohol withdrawal, which could be dangerous.
How long do anxiety withdrawal symptoms last?
According to the DSM-5, symptoms of anxiety—as part of the acute alcohol withdrawal syndrome—may develop within several hours to a few days after the last drink. While many symptoms resolve by the fourth or fifth day, more mild cases of anxiety have been reported to persist for up to 3-6 months after drinking has stopped.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol facts and statistics.
- Substance Abuse and Mental Health Services Administration. (2019). Key Substance use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Bayard M, McIntyre J, Hill KR, Woodside J Jr. (2004) Alcohol withdrawal syndrome. Am Fam Physician. 69(6):1443-1450.
- Patel, P. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67.
- National Library of Medicine. (2020). Alcohol withdrawal.
- Muncie Jr., H. L., Yasinian, Y., & Oge, L. K. (2013). Outpatient management of alcohol withdrawal syndrome. American Family Physician, 88(9), 589-595.
- National Library of Medicine. (2019). Delirium tremens.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.