If you have been drinking heavily for weeks, months, or years, you may face various physical and psychological symptoms when trying to cut back or quit alcohol consumption abruptly. These responses to the absence of alcohol are known as alcohol withdrawal symptoms. It is a key contributor to relapse among those trying to recover from alcohol use disorder (AUD).
The withdrawal process from any addictive substance is unpleasant. However, alcohol detoxification is highly distressing and perhaps dangerous without appropriate medical attention. Inpatient care is recommended to overcome alcohol withdrawal syndrome safely and comfortably.
What Causes Alcohol Withdrawal?
Alcohol is a central nervous system (CNS) depressant that changes how your brain functions. It causes the brain to produce more gamma-aminobutyric acid (GABA), a neurotransmitter that produces feelings of calmness and relaxation, and less glutamate, a neurotransmitter that makes you feel excitable. With continued use, your brain produces less GABA and more glutamate to balance things out. A neurotransmitter imbalance, leading to alcohol withdrawal symptoms, can occur when alcohol consumption is suddenly reduced or stopped.
Withdrawal symptoms can range from mild to severe, depending on individual factors. Individuals who have experienced withdrawal symptoms or required medical alcohol detoxification in the past are at a higher risk of experiencing severe alcohol withdrawal syndromes such as seizures and delirium tremens (DTs).
Symptoms of Alcohol Withdrawal
The severity of alcohol withdrawal depends on the individual’s history of alcohol withdrawal, the amount of alcohol consumed, the length of time the individual has been abusing alcohol, and whether or not other addictive substances were combined.
The most common symptoms include the following:
- Elevated blood pressure
- Loss of appetite
- Cravings for alcohol
Most of these symptoms go away within a few hours to a few days, even without intervention. Severe manifestations, however, can be fatal and always necessitate medical care.
Severe withdrawal symptoms include the following:
- Alcoholic hallucinosis
- Delirium tremens
Alcohol withdrawal seizures are generalized tonic-clonic convulsions, which typically occur within 12 to 48 hours after the last drink. The risk of seizures is high in individuals with a history of alcohol withdrawal. In contrast, alcoholic hallucinosis develops within 12 to 24 hours following abstinence from alcohol and usually includes auditory, visual, and tactile hallucinations.
Alcohol withdrawal delirium is another severe form of alcohol withdrawal. According to the U.S. National Library of Medicine, nearly 5% of alcohol-dependent patients who experience DTs die from metabolic or cardiovascular complications, trauma, or infections. DTs occur within 48 to 96 hours of the alcohol withdrawal timeline and are characterized by hallucinations, disorientation, tachycardia, hyperthermia, hypertension, agitation, and profuse sweating. Risk factors for developing DTs include a history of heavy drinking or binge drinking, a history of withdrawal seizures or delirium tremens, older than 30, and the presence of a concurrent medical or psychiatric condition.
Alcohol Withdrawal Timeline
Although the alcohol withdrawal timeline may vary from person to person, most people experience alcohol withdrawal in three stages.
- Stage 1 (6-12 hours after the last drink) – Alcohol withdrawal symptoms can begin within six hours after the last drink. The initial mild symptoms include anxiety, headache, nausea, vomiting, insomnia, sweating, alcohol cravings, and changes in blood pressure. This stage of alcohol withdrawal can last up to seven days.
- Stage 2 (12-48 hours after the last drink) – Cravings for alcohol and anxiety may intensify during the second stage of alcohol withdrawal. Additional symptoms include trouble breathing, high blood pressure, an irregular pulse, profuse sweating, irritability, fever, and confusion. Severe manifestations, such as seizures or visual, tactile, or auditory hallucinations, can also develop within 48 hours after the last drink and last up to a week. If you haven’t developed any severe symptoms within 48 hours, you will likely only have minor symptoms, although there is still a slight possibility you could develop them later.
- Stage 3 (48-72 hours after the last drink) – Most people develop DTs within 48 to 96 hours after the last drink. DTs generally resolve within one to five days. However, seeking medical care during this period is crucial as DTs can be life-threatening.
Some individuals may experience prolonged withdrawal symptoms. This withdrawal state is known as post-acute withdrawal syndrome (PAWS). PAWS is one of the most challenging aspects of overcoming alcoholism. Compared to acute withdrawal, post-acute withdrawal symptoms are more centered around psychological symptoms.
Diagnosis and Treatment of Alcohol Withdrawal
Medical professionals often use the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) to diagnose alcohol withdrawal syndrome. The scale measures various clinical manifestations, including nausea, alcoholic hallucinosis, and anxiety, and can also help gauge the severity of withdrawal. Your healthcare provider may also perform a physical examination to identify possible complicating medical conditions such as arrhythmias, congestive heart disease, gastrointestinal bleeding, pancreatitis, and coronary artery disease and a toxicology screen to determine the alcohol levels in your body.
Treatment for alcohol withdrawal starts with a medically-assisted detoxification program. Regardless of the severity of alcohol withdrawals, alcohol-dependent patients are recommended to seek treatment at an inpatient treatment facility. Heavy drinkers with moderate to severe withdrawal symptoms will benefit greatly from the round-the-clock supportive care and medical supervision provided by inpatient alcohol detox. The ultimate goal of alcohol detox treatment is to help patients overcome their withdrawal comfortably and safely.
Despite its importance in the clinical management of alcohol withdrawal, alcohol detox does not address the root cause of addiction. Treatment of alcohol dependence is required following alcohol withdrawal treatment to achieve long-term sobriety. Alcohol addiction treatment includes counseling and behavioral therapies, such as cognitive-behavioral therapy (CBT) and family therapy, in an inpatient or outpatient setting. Some people may also benefit significantly from joining 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) during their recovery journey.
Tips to Get Through Alcohol Withdrawal
Apart from seeking medical advice and support, you can also follow the below strategies to manage mild symptoms of alcohol withdrawal:
- Drink plenty of fluids containing electrolytes – Many people with an alcohol dependence suffer from dehydration and nausea during withdrawal. Drinking fluids with electrolytes, such as sodium, calcium, potassium, and magnesium, can help prevent dehydration and replenish your body with essential nutrients.
- Eat healthily – Since your body metabolizes alcohol into sugar, your body may be accustomed to a lot of sugar. Eating healthy fruits and vegetables can help keep your sugar levels balanced.
- Take a cold shower – A cold shower can help you take your mind off alcohol cravings and may also help with symptoms such as sweating and clammy skin.
- Engage in moderate exercise – Moderate physical activity may benefit you during alcohol withdrawal, even if you don’t feel up to doing anything that’s particularly taxing. Studies indicate that exercise can be an effective mind-body tool for alcoholic patients dealing with withdrawal symptoms.
- Practice deep breathing techniques – Deep breathing can help you reactivate the prefrontal cortex, which is responsible for critical thinking and reasoning. Practicing it during withdrawal can help you maintain your critical thinking ability.
- Meditate – The mind can be calmed through meditation, allowing for more focused thought. Shifting from a reactive to a proactive mentality can be a powerful tool for dealing with alcohol withdrawal.
- Ask for support – Having someone supportive with you throughout the recovery journey can be very motivating. If someone cannot stay with you the whole time, consider asking your friends or a family member to check on you at regular intervals.
Concerned about how to properly navigate alcohol withdrawal to achieve sobriety for yourself or a loved one addicted to alcohol? Futures Recovery Healthcare is here to help. Futures boasts a dynamic team of experts committed to providing evidence-based, effective treatment options to help you combat alcohol withdrawal syndrome. We provide both inpatient and outpatient treatment options to ensure individualized treatment.