Individuals with an alcohol use disorder (AUD) or alcohol dependence may experience a set of symptoms when they immediately reduce their alcohol intake or suddenly quit drinking. This set of symptoms is the result of a condition known as alcohol withdrawal syndrome (AWS).
It’s crucial to understand the symptoms of alcohol withdrawal because they can be serious and sometimes life-threatening. Understanding the signs of AWS can help you or someone you care about prepare for or overcome unpleasant and severe withdrawal symptoms and receive the appropriate treatment.
What Is Alcohol Withdrawal Syndrome?
Alcohol withdrawal syndrome is a severe health condition that primarily affects heavy drinkers or people with severe alcohol dependence who abruptly reduce or quit their alcohol consumption. Heavy drinking stimulates and irritates the central nervous system. Chronic alcohol abuse can eventually lead to physical dependence on the substance. When this occurs, the central nervous system cannot adapt quickly to the absence of alcohol, causing significant distress.
According to the U.S. National Library of Medicine, each year, more than 1.5 million people in the United States either seek alcohol addiction treatment or are hospitalized as a result of alcohol dependence-related medical complications. Like many other individuals who stop drinking without supportive care, these patients develop severe alcohol withdrawal symptoms.
Symptoms of Alcohol Withdrawal Syndrome
The symptoms one would experience from quitting heavy drinking or reducing their alcohol intake are closely proportionate to the duration of their alcohol abuse and the severity of their alcohol use disorder. In addition, the underlying risks for AWS may also be influenced by factors such as the presence of coexisting medical conditions, variations in genetic influences, and a history of substance use disorder. Therefore, not everyone who quits drinking will suffer the same symptoms of alcohol withdrawal syndrome.
Withdrawal symptoms frequently include a variety of physical, psychological, and emotional symptoms that appear within a few hours following the last drink. The most common symptoms of withdrawal include:
- Hand tremors
- Nausea and vomiting
- Loss of appetite
- Restlessness or agitation
- Insomnia or vivid dreams
- Rapid mood swings
- Elevated blood pressure
The most severe manifestations of alcohol withdrawal are seizures, hallucinosis, and delirium tremens (DTs or alcohol withdrawal delirium). Hallucinosis and seizures are severe symptoms that may appear within one or two days of quitting or reducing alcohol intake in individuals with a severe alcohol use disorder. These symptoms can be fatal if not treated properly in a medically assisted detox program.
Delirium tremens (DTs) are also a severe manifestation of AWS that often appear two to four days after the last drink. Disorientation and autonomic signs are characteristics of delirium tremens. Other symptoms may include:
- Rapid heartbeat
- High Blood Pressure
- Seizures or convulsions
Delirium tremens is a medical emergency that requires immediate medical attention. Medical complications associated with delirium tremens include cardiac arrhythmia, respiratory arrest, oversedation, and aspiration pneumonitis. These conditions are associated with a significant risk of severe infection or death.
Timeline of Alcohol Withdrawal Syndrome
The alcohol withdrawal timeline may differ from one person to another, depending on the duration and their level of alcohol consumption. The physical symptoms of alcohol withdrawal commonly occur within six hours after the last drink. These symptoms generally subside within five to 10 days, though some individuals may experience prolonged symptoms for months or years.
The three main stages of acute alcohol withdrawal include the following:
Stage 1 – Mild Withdrawal Symptoms
Mild symptoms may appear around six to 12 hours after the last drink. At this stage, a person may experience the following symptoms:
- Nausea and vomiting
- Elevated Heart Rate
- High body temperature
- Rapid breathing
- Cravings for alcohol
The first stage of alcohol withdrawal can last up to seven days.
Stage 2 – Moderate Withdrawal Symptoms
Moderate symptoms may appear around 12 to 48 hours after the last drink. Mild withdrawal symptoms, like anxiety and alcohol cravings, can worsen over the next 12 to 24 hours. Some individuals may experience seizures and hallucinations during this stage. The most common moderate withdrawal symptoms that are most likely to occur at this stage include:
- Excessive sweating
- Rapid heart rate
- High Blood Pressure
- Arm and leg tremors
- Rapid, shallow breathing
The second stage of alcohol withdrawal usually peaks between 24 to 72 hours after the last drink.
Stage 3 – Severe Withdrawal Symptoms
In the 48 to 72 hours that follow, mild and moderate withdrawal symptoms can become severe and life-threatening. Patients are most at risk of developing delirium tremens during this stage. Delirium tremens can last up to five days, and the severity of the condition can increase over time. Patients may also experience alcohol withdrawal hallucinations and alcohol withdrawal seizures during this stage. This highlights the need for immediate medical treatment.
The third stage of alcohol withdrawal symptoms typically lasts between two and three days but can last up to one week in some individuals. To avoid potentially fatal complications, those who intend to abstain from alcohol should seek medical assistance.
Factors That Influence the Timeline of Alcohol Withdrawal
Alcohol withdrawal timelines may vary among individuals based on a range of factors, including:
- Duration of alcohol misuse
- Frequency of heavy alcohol consumption
- Family history of alcoholism
- Medical history
- Coexisting physical and mental health conditions
- Polysubstance abuse
- Gender, weight, and age
Treatment of Alcohol Withdrawal
Proper medical care is important to reduce or eliminate the risks associated with alcohol withdrawal symptoms. Healthcare professionals frequently utilize the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) to determine the severity of an individual’s withdrawal symptoms. This scale evaluates many symptoms, such as nausea, hallucinations, and anxiety. A medical professional may also perform a physical exam and a blood test to determine the level of care and the most effective treatment approach.
Alcohol withdrawal treatment begins with a medically assisted detoxification program in an inpatient or outpatient treatment setting. Regardless of the severity of their symptoms, most patients should be considered for inpatient care as it’s the safest and most comfortable way to detox from alcohol.
Although medical detoxification is an essential component of alcohol withdrawal treatment, it does not address the underlying causes of alcoholism that must be addressed to achieve long-term recovery. Therefore, alcohol detoxification should be followed by alcohol dependence treatment.
Is It Safe to Detox From Alcohol on Your Own?
The smartest and safest way to treat alcohol withdrawal syndrome is under the supervision of healthcare professionals. Even if you are experiencing mild to moderate symptoms, it is always recommended that you seek inpatient care, as these symptoms can swiftly turn severe or life-threatening. A healthcare provider is the best person to assess your risk for alcohol withdrawal complications, such as DTs. Only they can monitor you carefully during withdrawal to ensure moderate symptoms do not turn severe.
If you or someone you love is having a hard time quitting alcohol or struggling with alcohol withdrawal symptoms, Futures Recovery Healthcare is here for you. The Core program at Futures Recovery Healthcare specializes in treating adults with substance use disorder, addiction, and co-occurring mental health disorders. Futures offers a variety of addiction treatment and wellness programs, including inpatient detox, residential treatment with specialized treatment tracks, and outpatient services.