Alcohol Withdrawal & Detox: Symptoms, Treatment & More

Alcohol addiction 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 rehab and learn sober living skills that will help you during the lifelong process of recovery.

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 dependence — 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.

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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. Withdrawal occurs because continued and excessive alcohol use interferes with the brain’s natural functions, disrupting neurotransmitters that send messages to the central nervous system.

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 a long-term heavy drinker suddenly stops drinking, dopamine production also halts, causing physical and psychological withdrawal symptoms.

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.

Common Withdrawal Symptoms

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:

• Sweating
• Higher heart rate, often over 100 beats per minute
• Trouble sleeping with intense dreams and nightmares
• Nausea and vomiting
• Poor appetite
• Restlessness
• 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%)

Severe Withdrawal Symptoms

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

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.

Symptoms of Delirium Tremens During Withdrawal

Some alcoholics going through withdrawal may experience a particularly dangerous set of symptoms called delirium tremens. Delirium tremens (DTs) is a potentially fatal medical emergency that most commonly occurs in those who drink in excess daily for months or even years. A recent survey by The Recovery Village found roughly 1 in 10 people (11.4%) undergoing alcohol withdrawal will experience delirium tremens.

Symptoms of Delirium Tremens Include:

• Agitation
• Autonomic hyperactivity, including shortness of breath, sweating, dry mouth and palpitations
• Confusion
• Disorientation
• Extreme tremors
• Rapid heart rate or tachycardia
• Vivid hallucinations

What Causes Delirium Tremens?

Delirium tremens is caused by the neurotransmitter imbalance that results from the lack of alcohol in the system. Without the typical supply of alcohol, the brain loses the expected GABA stimulation and the usual influence on N-methyl-D-aspartate (NMDA), a type of glutamate receptor. These differences result in the excessive nervous system stimulation that produces DTs.

Fatal complications from delirium tremens include oversedation, respiratory arrest (where a person stops breathing), cardiac arrhythmias (irregular heartbeat), and aspiration pneumonitis, which occurs when a person inhales toxic substances into the lungs, resulting in infection.

You may be at risk for delirium tremens if you:

• Are middle-aged or a senior citizen
• Have experienced seizures during previous alcohol withdrawal
• Have a co-occurring mental health condition
• Have abnormal liver function
• Experience intense alcohol cravings
• Have experienced delirium tremens before
• Have abused alcohol for an extended period
• Drink large amounts of alcohol daily (recent data shows this increases your risk by 90%)
• Are detoxing from other substances in addition to alcohol (recent data shows this doubles your risk)

Delirium tremens can be difficult to diagnose, as some symptoms overlap with those of acute alcohol withdrawal. DTs most often occurs between 3 and 10 days following the last drink, which results in some people believing they are out of withdrawal danger.

Acute alcohol withdrawal is rarely deadly, while alcohol withdrawal delirium can be lethal in many cases. If you undergo detox at an accredited detox facility with experienced addiction professionals, you have a greater chance of experiencing safe alcohol withdrawal. Delirium tremens often require advanced pharmacotherapy, and in extreme cases, may even require a stay in a hospital’s intensive care unit.

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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:

• 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 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

Alcohol withdrawal 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.

Stage 1: Minor Withdrawal Symptoms

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
• Nausea
• Vomiting
• Insomnia

Stage 2: Major Withdrawal Symptoms

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
• Vomiting
• High blood pressure
• Intense sweating

Stage 3: Withdrawal Seizure Symptoms

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.

Stage 4: Withdrawal Seizure Symptoms

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.

Professionals will gather information about the expected alcohol withdrawal symptoms, including:

• Sweating
• Increased heart rate
• Hand tremors
• Insomnia
• Nausea or vomiting
• Hallucinations
• Agitation
• Anxiety
• Seizures

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.

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How Is Alcohol Withdrawal Treated?

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.

Evaluation

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.

Stabilization

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 and barbiturates
• Anticonvulsants like carbamazepine
• Antipsychotics like haloperidol
• Blood pressure medications like clonidine

Facilitating Entry into Aftercare

The professional alcohol detox process is relatively short, so it will be crucial to connect patients to the next stages in the continuum of care. Inpatient or outpatient treatment programs are available depending on the needs, abilities and goals of the patient.

Location: Detox At Home or Under Medical Supervision

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, detoxing at home 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.

Can You 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 alcohol addiction. 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.

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
• Dehydration
• Choking on vomit in the airway
• Kidney dysfunction
• Liver dysfunction
• Seizure
• Seizure-related head injury
• Delirium tremens
• Aggression triggered by hallucinations

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 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.

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.

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