Alcohol withdrawal symptoms can be challenging and sometimes harmful. The decision to end alcohol abuse is a great start to a healthier life, but it should be taken seriously.
Alcohol dependence or alcohol use disorder can ruin a person’s life, and yet many continue to abuse the drug knowingly to avoid alcohol withdrawal. Detox and withdrawal are infamous in the addiction community for being physically and psychologically distressing. If done at home without medical attention, alcohol withdrawal can even be deadly. However, this time of cleansing is the first step to putting your life back on track. Following detox, you will be ready to enter alcohol rehab and learn sober living skills that will help you during the lifelong process of recovery.
Article at a Glance
Alcohol withdrawal symptoms occur when a person has become dependent on alcohol and there is no more of it in the body.
Alcohol detox takes 7-10 days but the withdrawal process is different for everyone.
The symptoms of alcohol withdrawal range from minor (headaches and nausea) to moderate (vomiting and fever) and severe (delirium tremens).
Delirium tremens can be fatal and often requires advanced pharmacotherapy.
A person can detox from alcohol by lowering alcohol intake gradually or all at once.
It is important for people detoxing from alcohol to be in a medical facility to avoid fatal complications.
Alcohol Detox at The Recovery Village
Professional medical detox is the safest option when it comes to stopping drinking. At The Recovery Village, we monitor patients 24/7 to ensure their discomfort during withdrawal is managed, their vitals are at healthy levels and they are not experiencing any life-threatening symptoms.
Following detox, you will be ready to begin treatment for alcohol addiction. The Recovery Village offers many different treatment options, including inpatient and outpatient rehab. Rehab is a proven treatment method for alcohol addiction because it addresses both the physical and psychological sides of the disease.
What Is Alcohol Withdrawal?
Alcohol withdrawal is a set of distressing and dangerous symptoms that stem from the brain lacking alcohol’s influence in the system. Withdrawal is a process that begins within a few hours after last use and creates acute symptoms that can last for 4-5 days.
Alcohol withdrawal is a product of physical dependence in the body. When a person has reached a state of alcohol-dependent — the physical state where the body and brain require alcohol to feel well and function normally — their body experiences alcohol withdrawal symptoms once there is no more alcohol in their system. Withdrawal symptoms occur during detox, a natural process where the body works to remove toxins from the system and reach a new equilibrium.
Withdrawal is a physically and psychologically uncomfortable experience — so much so that many heavy drinkers will continue drinking despite negative consequences just to avoid withdrawal. Alcohol is a Central Nervous System (CNS) depressant. With continued and excessive alcohol consumption, alcohol interferes with the brain’s natural functions, disrupting neurotransmitters that send messages to the CNS.
The Science Behind Alcohol Withdrawal Symptoms
The primary neurotransmitter tied to relaxation is gamma-aminobutyric acid (GABA). GABA also helps produce endorphins in the brain, which produce a sense of well-being. Excessive alcohol use causes a GABA imbalance that the brain becomes accustomed to, so it regulates its neurotransmitter production to account for the influence of alcohol. When alcohol use ends, the brain’s chemical balance is disrupted, which results in the negative physical and mental symptoms of alcohol withdrawal.
Alcohol abuse also affects dopamine, a neurotransmitter linked to the body’s reward system. This neurotransmitter regulates energy, enjoyment and motivation. Dopamine also assists with the body’s sense of attention, motor coordination, cognition and mood. Alcohol releases dopamine when ingested. As the body begins to build a higher tolerance for alcohol, the brain becomes more dependent on the substance for feel-good neurotransmitters. When chronic heavy drinking is suddenly stopped, dopamine production also halts, causing physical and psychological withdrawal symptoms.
Related Topic: Sudden alcohol intolerance
Post-Acute Withdrawal Syndrome (PAWS)
Post-Acute Withdrawal Syndrome, or PAWS, refers to a number of withdrawal symptoms experienced following the acute withdrawal phase of recovery. While the acute stage of recovery involves intense physical symptoms over a period of one to two weeks, PAWS symptoms can persist, disappear and reappear for months.
Related Topic: Alcohol and Post-Acute Withdrawal Syndrome (PAWS)
Alcohol Withdrawal Timeline & Symptoms
Alcohol withdrawal creates a range of undesirable mental and medical symptoms. Although the effects are somewhat predictable, there is no way to know with certainty which symptoms will emerge and how intense they will become for each person.
Like with other drugs of abuse, alcohol withdrawal symptoms usually occur in a way that opposes the intoxicating effects. With intoxication, alcohol makes people feel calm and relaxed, but alcohol withdrawal produces symptoms like:
- Higher heart rate, often over 100 beats per minute
- Trouble sleeping with intense dreams and nightmares
- Nausea and vomiting
- Poor appetite
- Poor memory and decision-making
- Higher sensitivity to light, sounds or touches
From a mental health perspective, a person enduring alcohol withdrawal will note a sharp increase in their anxiety. With the change in GABA activity in the brain, excitation and anxiety build. The same happens with irritability and agitation. These could result in aggressive or violent behavior.
The Recovery Village surveyed people experiencing alcohol withdrawal and found interesting results. Among those who underwent alcohol detox (either detoxing from alcohol at home or at a facility), some of the most common withdrawal symptoms were:
- 1 in 2 people reported irritability (46.8%)
- 1 in 2 people reported fatigue (42.3%)
- 1 in 2 people reported sweating (44.9%)
- 1 in 2 people reported stress or anxiety (48.6%)
- 1 in 3 people reported hand tremors (33.5%)
- 1 in 4 people reported nausea or vomiting (23.6%)
- 1 in 4 people reported mood swings (23.6%)
- 1 in 5 people reported rapid heart rate (22.9%)
With their ability to impact a person’s physical and psychological health, alcohol withdrawal symptoms are troubling, but severe withdrawal symptoms can put people in substantial danger.
Some of the severe alcohol withdrawal symptoms include:
- Delusional thinking, where a person believes something despite a lack of evidence
- Hallucinations, where a person sees, hears, feels, tastes or smells something that is not present
- Seizures, caused by abnormal electrical activity in the brain
- Delirium tremens (DTs)
According to the survey conducted by The Recovery Village of people who withdrew from alcohol, roughly:
- 1 in 8 reported hallucinations (13.4%)
- 1 in 12 reported seizures (8.2%)
These effects can result in a real risk to the individual experiencing withdrawal as well as their loved ones who could be in harm’s way.
Alcohol Withdrawal Severity Factors
The severity of withdrawal symptoms can depend on many variables and vary dramatically from person to person. Precisely how someone will withdraw from alcohol is impossible to predict, but addiction experts assess a variety of factors to gain insights.
Some factors affecting the severity of withdrawal include:
- Alcohol dependence
- How long the person has been abusing alcohol
- The quantity of alcohol they consume
- How frequently they drink
- Their age
- Their history with addiction to other substances
- Family addiction history
- Pre-existing mental and physical health conditions
So, a person over 30 with anxiety who has been a daily heavy drinker for a long time will have a much greater risk of serious withdrawal than someone under 30 with no co-occurring mental health conditions and short-term alcohol use. At times, a person’s previous experiences with withdrawal can be the best predictor of future withdrawal, so individuals and professionals should always assess detoxification history.
Across the board, heavy alcohol users report withdrawal symptoms more than those who do not drink heavily. Heavy alcohol users double their risk for hallucinations during withdrawal, being 2.4 times more likely than moderate or light alcohol users to experience them.
Compared to others during detox, The Recovery Village found heavy drinkers were:
- 90% more likely to experience delirium tremens (DTs)
- 45% more likely to experience seizures
- 95% more likely to experience rapid heart rate
- 147% more likely to experience hand tremors
- 69% more likely to experience sweating
- 65% more likely to experience nausea or vomiting
- 35% more likely to experience irritability
- 28% more likely to experience fatigue
- 28% more likely to experience stress or anxiety
- 27% more likely to experience mood swings
Polysubstance use, the use of multiple substances simultaneously, also increased the likelihood of experiencing more dangerous or severe withdrawal symptoms and medical conditions during alcohol detox. Compared to those detoxing from alcohol only, The Recovery Village survey discovered people detoxing from alcohol and at least one other substance were:
- 2.1 times more likely to experience delirium tremens (DTs)
- 2.3 times more likely to experience seizures
- 1.6 times more likely to experience hallucinations
Alcohol Withdrawal Timeline
While alcohol detox takes between 7–10 days, alcohol withdrawal is different for every person who goes through it. For some, the process lasts days. For others, it can take months for the protracted withdrawal symptoms to diminish. According to The Recovery Village survey, 95% of respondents said withdrawal symptoms lasted for between two and eight days.
Alcohol withdrawal begins when someone who is physically dependent on alcohol stops drinking it abruptly or significantly reduces their consumption. Most alcohol detox programs last anywhere from a few days to over a week, with withdrawal symptoms usually subsiding within seven or more days of the program. However, alcohol cravings, sleep problems and other minor side effects may continue for some time after detox.
Alcohol Withdrawal Stages
Withdrawal-related symptoms are known to come in four different stages: minor, major, withdrawal seizures and delirium tremens. It is important to understand that not all people will experience all stages with all withdrawals.
Minor withdrawal symptoms tend to occur within 6–24 hours after a person’s last alcohol consumption. The syndrome is uncomfortable but not dangerous for the individual and usually involves expected symptoms like:
- Tremor/shaky hands
- Higher anxiety and stress
Major withdrawal is a more significant and distressing condition that begins between 10–72 hours after the last consumption. These mental and physical symptoms mark a major departure from normal functioning and include:
- Visual hallucinations — seeing things that are not there
- Auditory hallucinations — hearing things that are not there
- Tremors affecting the whole body
- High blood pressure
- Intense sweating
Withdrawal seizures, sometimes called “rum fits,” can emerge between 6–48 hours after last use. This level of alcohol withdrawal is marked by seizures in people who have had no previous issues with seizures. These seizures tend to be brief and generalized.
For some people, withdrawal seizures may be their only symptoms of alcohol withdrawal. Alcohol withdrawal seizures may reoccur over about six hours. Roughly 8% of people withdrawing from alcohol experience seizures.
Related Topic: Alcoholic seizures treatment
Those who experience severe withdrawal may begin to feel delirium tremens (DTs) symptoms between 48–96 hours after discontinuing alcohol use. If you are at risk for delirium tremens, it is highly recommended you undergo your detox under medical supervision for your safety, as DTs symptoms can be fatal.
How Is Alcohol Withdrawal Diagnosed?
Medical or mental health professionals will diagnose alcohol withdrawal through a combination of interviews, lab testing and observation of the client’s symptoms. Since alcohol withdrawal can appear similar to other issues, a thorough assessment and evaluation are essential to ensure the proper condition is identified and treated. See More: Clinical Institute Withdrawal Assessment for Alcohol Scale Revised (CIWA-Ar)
Professionals will gather information about the expected alcohol-related symptoms, including:
- Increased heart rate
- Hand tremors
- Nausea or vomiting
- Hallucinations or hallucinosis
- Anxiety, jitters or jumpiness
If even two of these symptoms emerge within a short time after heavy and prolonged alcohol use ends, alcohol withdrawal will be the appropriate diagnosis. From there, the clinician will recommend an appropriate level of care to manage symptoms. It’s vital to be honest and open about your alcohol use and symptoms so you can get the best treatment and support possible.
Related Topic: How to detox from alcohol
Alcohol Withdrawal Treatment
Professional alcohol withdrawal treatment and medical detox focus on creating a safe, stable and comfortable environment for the client to experience the withdrawal process. Depending on the individual’s symptoms and risks, detox may include observation and monitoring only, while others may include intense medical interventions to limit danger and life-threatening consequences.
Alcohol withdrawal treatment is separated into three main segments: evaluation, stabilization and connecting to follow-up care.
An accurate assessment is a vital part of the treatment process. Medical teams test the bloodstream, screen for co-occurring mental and physical conditions, note symptoms and complete a thorough background so treatment can proceed in the desired direction.
See More: Testing and Screening for Alcoholism
In this phase, professionals assist with the acute symptoms of withdrawal in a variety of settings. The goal is to achieve medical stability, reduce distress and add comfort to the process.
For alcohol withdrawal, many treatments will involve the use of prescribed medications to relieve symptoms during a short inpatient admission.
Some medications used during alcohol withdrawal management include:
- Sedating medications like benzodiazepines (diazepam, lorazepam, chlordiazepoxide and oxazepam) and barbiturates
- Anticonvulsants like carbamazepine
- Antipsychotics like haloperidol
- Blood pressure medications like clonidine
In a recent study by The Recovery Village, 72% of people detoxed at home and 28% detoxed at a rehab facility or medical center. Depending on the level and duration of alcohol use, home remedies for alcohol withdrawal can be too dangerous. If you are even slightly at risk for severe withdrawal symptoms, professionals recommend medical detox at a hospital, rehab facility or detox center to manage symptoms.
Using more than one drug or substance at the same time is an important risk factor. Polysubstance abuse can complicate the detox process and make medical care more necessary. In a recent study on alcohol withdrawal, 37% of people detoxing at a rehab facility or medical center were detoxing from multiple substances, compared to only 15% of people detoxing at home.
How to Prevent Alcohol Withdrawal
Though people may be looking for a quick and easy alcohol detox without the distress and discomfort of alcohol withdrawal, there is no proven method that prevents symptoms. As always, the only way to avoid withdrawal is to avoid substance abuse entirely.
In theory, a person could very gradually and methodically reduce their alcohol use over time in a way that allows the brain to slowly adjust to the decreased activity, but this rarely works in practice. This is called tapering off alcohol. Lack of control over alcohol intake is a common symptom of alcoholism. Addiction, tolerance and physical dependence encourage people to drink more alcohol over time, not less.
Professional alcohol detox can create a safe and supportive environment for detox to occur. For many, this is their best option.
Outlook for Alcohol Withdrawal
The long-term outlook for someone experiencing alcohol withdrawal is highly dependent on what happens after detox. Meaningful recovery comes from a strong commitment to an extended period of treatment after detox.
Professional detox is a vital first step, but alone, it is not enough to change the dysfunctional behavior patterns that result in addiction and dependence. To control the outlook and shape their future, a person who’s finished their detox should invest plenty of time and energy into ongoing treatment for their addiction and co-occurring disorders.
Related Topic: Drug and Alcohol Use Increase During COVID-19
Can You Die From Alcohol Withdrawal?
Alcohol withdrawal and detox can be deadly in certain circumstances, so it’s incredibly important for those detoxing from alcohol to do so in a medical facility. Detox can be dehydrating to the body as it uses any means — most notably vomiting, diarrhea and sweating — to expel alcohol and its toxins. Alcohol itself is also a dehydrating substance. Combining alcohol’s pre-existing dehydrating qualities with withdrawal-related dehydration can easily induce seizures and may prove lethal in some cases.
Alcohol withdrawal can cause many deadly symptoms, including:
- Heart palpitations
- Heart arrhythmia
- High blood pressure
- Choking on vomit in the airway
- Kidney dysfunction
- Liver dysfunction
- Tonic–clonic seizures
- Seizure-related head injury
- Delirium tremens
- Aggression triggered by hallucinations
Alcohol poisoning can be fatal. If you suspect someone is experiencing alcohol poisoning, call 911 immediately. Do NOT be afraid to seek help. If you do not have access to a phone contact Web Poison Control Services for online assistance.
Common Questions About Alcohol Withdrawal
It is important to contact a physician if you plan to end use or if you begin to feel any withdrawal symptoms after you stop using alcohol, as withdrawal symptoms can become life-threatening if not treated appropriately. Here are twenty things that you can do to help cope with alcohol withdrawal.
Alcohol withdrawal usually starts within 8 hours after the last drink but can occur days later. Symptoms usually peak by 24–72 hours but may go on for weeks. In a recent study, 95% of people had symptoms that lasted between 2-8 days. Several factors like how long a person has been drinking, age or weight can also impact the length or severity of withdrawal symptoms.
If you drink alcohol, you may wonder how long alcohol stays in your system. A healthy liver can process roughly one drink per hour, so for driving purposes, one drink will typically stay in your system for one hour. However, if you take a blood, urine, breath or even a hair test, alcohol can be found in your body for much longer.
- Alcohol can stay in the urine for up to 80 hours.
- Alcohol can stay in hair follicles for up to three months.
- Alcohol can stay in the blood for up to 24 hours.
Related Topic: How to cleanse your liver from alcohol
Muscle spasms are one of the most common alcohol withdrawal symptoms and will usually start within a few hours of your last drink and last up to a few days. Because complications of AWS can be deadly, never try to wait out your tremor from AWS or manage it on your own. Some people will have only a mild hand tremor or muscle twitching in alcohol withdrawal. However, other people will have more serious problems, like a full-body seizure.
Alcohol withdrawal can cause pain in the chest, including chest tightness. This tightness is normally side effects of heart damage from excessive alcohol use. If you stop drinking alcohol suddenly after years of alcohol use, the risk of hurting the heart increases. Alcohol withdrawal may cause uncomfortable chest symptoms that can damage the heart.
When withdrawal symptoms worsen over time after several setbacks, the “kindling effect” is said to be taking place. After every setback and subsequent attempt at quitting, the next withdrawal can become even harder. Because of the neurological hyperactivity in the brain, reactions to withdrawal become increasingly more severe after going through it multiple times.
Inevitably, the result of so many setbacks is a higher risk of continued future misuse of alcohol and an even more dangerous relationship with the substance.
Related Topic: Starting Alcohol Treatment with Online Rehab
National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” January 2018. Accessed March 31, 2021.
Substance Abuse and Mental Health Services Administration. “Detoxification and Substance Abuse Treatment.” October 2015. Accessed March 31, 2021.
American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition.” 2013. Accessed March 31, 2021.
Burns, Michael J. “Delirium Tremens (DTs).” Medscape, November 6, 2020. Accessed March 31, 2021.
Thompson, Warren. “Alcoholism: Practice Essentials.” Medscape, March 23, 2020. Accessed March 31, 2021.
Clapp, Peter et al. “How Adaptation of the Brain to Alcohol Leads to Dependence.” Alcohol Research and Health, National Institute on Alcohol Abuse and Alcoholism, 2008. Accessed March 31, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Understanding Alcohol Use Disorder.” December 2020. Accessed March 5, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Drinking Levels Defined.” Accessed March 31, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Alcohol Fact and Statistics.” February 2021. Accessed March 31, 2021.
National Institute on Alcohol Abuse and Alcoholism. “Alcohol’s Effects on the Body.” Accessed March 31, 2021.
Rogawski, Michael A. “Update on the neurobiology of alcohol withdrawal seizures.” Epilepsy currents, 2005. Accessed September 3, 2021.
The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.