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Alcohol Withdrawal

What Is Alcohol Withdrawal?

Alcohol dependence develops when the body adapts to the presence of alcohol. Someone who is dependent on alcohol will often experience withdrawal symptoms when he or she stops drinking.

These symptoms can be life-threatening and may require medical monitoring.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms and signs can range from uncomfortable to potentially fatal and may include: 1,2,3
  • Loss of appetite.
  • Nausea and vomiting.
  • Increased heart rate.
  • Excessive sweating.
  • Hand tremors.
  • Anxiety.
  • Insomnia.
  • Irritability.
  • Disorientation.
  • Headache.

Symptoms of alcohol withdrawal can vary depending on:

  • Age.
  • How long someone was drinking.
  • How much he or she used.
  • Whether he or she has any mental health or medical conditions.
  • Whether the person has gone through withdrawal before.

Typically, alcohol withdrawal syndrome occurs in adults, but teens can experience symptoms as well.1

Risks of Withdrawal

Delirium tremens (also known as the “DTs”) is a severe form of alcohol withdrawal that causes sudden, major changes to the nervous system as well as disturbances in mental well-being. It may occur after prolonged, problematic alcohol use. The risk of DTs is more pronounced in people who have not been eating regularly and may be experiencing nutritional deficiencies.4

Delirium tremens most commonly occurs in people who have a history of alcohol withdrawal and drink daily (4-5 glasses of wine, 7-8 pints of beer, or 1 pint of hard liquor) for months as well as in those who have steadily abused alcohol for more than 10 years.4

Delirium tremens symptoms can progress quickly and may include:4

  • Profoundly altered mental status.
  • Inability to pay attention.
  • Confusion.
  • Stupor.
  • Sensitivity to touch, light, and sound.
  • Hallucinations.
  • Mood swings.
  • Fear.
  • Excitement.
  • Fatigue.
  • Deep and long sleep (for a day or longer).
  • Agitation.
  • Body tremors.
  • Seizures (which are most common in the first 12 to 48 hours and with those who have a history of complications with alcohol withdrawal).

Other complications may occur from injuries associated with the development of withdrawal symptoms (e.g., a head injury due to a fall from an alcohol withdrawal seizure).

Delirium tremens and any seizure activity can be fatal.1,4 If you suspect you or someone you know is experiencing this form of withdrawal, seek medical attention immediately.

Alcohol Withdrawal Timeline

  • 6-12 hours after the last drink. Mild withdrawal symptoms usually begin and can last a few days or longer without treatment.2,3
  • 12-24 hours after the last drink. More severe symptoms, such as hallucinations, may appear and last about a week.2,3
  • 1-2 days. Seizures may occur in more severe cases.3
  • 2-3 days. Delirium tremens may occur in more severe cases.3

Severe symptoms generally occur in those who have consumed alcohol for long periods of time in large amounts.

Post-Acute Withdrawal Syndrome

An estimated 75% of people who go through alcohol withdrawal may experience a post-acute withdrawal syndrome (PAWS). The syndrome includes symptoms that can vary in intensity and appear and reappear over a period of months or even years. 8

Symptoms of PAWS include: 8

  • Difficulty with mental tasks, such as learning, problem-solving, or memory.
  • Irritability.
  • Panic.
  • Depression.
  • Sleep problems.
  • Cravings.
  • Sensitivity to stress.

Acamprosate (Campral), which helps restore chemical imbalances in the brain after long-term alcohol addiction, has shown some effectiveness in treating PAWS symptoms. 8

Causes of Alcohol Withdrawal

Alcohol withdrawal may occur after periods of heavy alcohol abuse.

Alcohol is a depressant. It interacts with special receptor complexes in the brain known as gamma-aminobutyric acid (GABA) receptors. At the receptor level, alcohol effectively mimics the effects of GABA, an inhibitory neurotransmitter, causing a decrease in central nervous system excitability.

Long-term use of alcohol can actually decrease the number of these GABA receptors, resulting in less of an inhibitory effect when consumed. When this occurs, more and more alcohol is required to achieve the same effect.2 This phenomenon is known as tolerance.

Those who have abused alcohol regularly and in increasing amounts often develop physical dependence and will experience withdrawal effects when they stop drinking. During withdrawal, the central nervous system enters a state of overactivity after being inhibited for an extended period of time.2

Treatment for Withdrawal

Treatment options for alcohol withdrawal include:

  • Detox center. A detox center provides support during the withdrawal period. These facilities offer medical supervision and care to ensure a safe and comfortable detox. People may transition to an inpatient or outpatient program after completing treatment at a detox center.
  • Inpatient treatment. Inpatient rehab programs may offer detox or require that the person complete detox elsewhere before coming to the facility. Inpatient treatment includes group and individual therapy, addiction education, recreational activities, and aftercare planning. Treatment can last from 28 days to 90 days or more.
  • Outpatient treatment. Outpatient rehab programs may offer detox to people whose withdrawal symptoms are relatively less severe. Participants do not live at the facility, and treatment usually includes group therapy, though some programs may incorporate individual counseling as well.
  • Partial hospitalization. Partial hospitalization is a type of outpatient program where participants attend treatment a certain number of days each week for several hours a day. Like other outpatient programs, these programs may follow a person at low risk of severe withdrawal through the detox period. Participants are assessed and given an individualized treatment plan based on their needs. Treatment often includes medical management, individual therapy, group counseling, and aftercare planning.

Once a person completes detox, he or she should participate in some type of continuing inpatient or outpatient treatment program to help maintain abstinence and prevent relapse. Support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery are also available for ongoing support.

Medications for Alcohol Withdrawal

The most common medications used to manage the alcohol withdrawal syndrome are benzodiazepines,2,3 a class of sedatives that have a similar mechanism of action to alcohol. Benzos decrease the risk of severe symptoms, such as delirium tremens or seizures. After a few days, the person is gradually tapered off the medication.2 A physician should administer and supervise the use of medications.

Other medications that may be used include:

  • Anticonvulsants – standard anti-epileptic medications, such as carbamazepine (Tegretol), that can help to control severe seizures.
  • Beta blockers – may be used to treat high blood pressure and rapid heart rate.

Find a Detox Center

If you need help determining which type of withdrawal treatment is right for you, call to speak with a treatment support specialist about detox options. You can check your insurance benefits now to find out whether your insurance will cover the cost of rehabilitation. There are also free alcohol abuse and drug addiction hotline numbers you can contact.

[1]. MedlinePlus (2016). Alcohol Withdrawal.

[2]. Kattimani, S. and Bharadwaj, B. (2013). Clinical Management of Alcohol Withdrawal: A Systematic Review. Ind Psychiatry; Jul-Dec 22 (2); 100-108.

[3]. Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. Alcohol Withdrawal Syndrome. American Family Physician 69 (6), 1443-1450.

[4]. MedlinePlus (2016). Delirium Tremens.

[5]. George, A. and Figueredo, V. (2010). Alcohol and Arrhythmias: A Comprehensive Review. Journal of Cardiovascular Medicine; 11(4): 221-228.

[6]. Ricks, J., Replogle, W., and Cook, N. (2010). Management of Alcohol Withdrawal Syndrome. American Family Physician 82(4): 344-347.

[7]. Substance Abuse and Mental Health Services Administration (2016). Substance Use Disorder Treatment Providers and CCBHCs.

[8]. UCLA Dual Diagnosis Program. (2016). Post-Acute Withdrawal Syndrome (PAWS).