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 uncomfortable. If done at home without medical attention, alcohol withdrawal can even be deadly. However, this time of bodily 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.

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. 

What Is Alcohol Withdrawal?

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 — when their body experiences alcohol withdrawal symptoms once there is no more alcohol in their system. Withdrawal symptoms occur during detox, a natural bodily process that removes toxins from the system.

Withdrawal is a physically and psychologically uncomfortable experience — so much so that many heavy drinkers will continue drinking despite negative consequences. Withdrawal occurs because continued and excessive alcohol use eventually 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, resulting in 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

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 lasts months.

Alcohol withdrawal begins when someone who is addicted to alcohol stops drinking it. As the liver metabolizes ethanol and moves the drug through a person’s system, withdrawal symptoms will begin. 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 timeline

Alcohol Withdrawal Stages

Alcohol withdrawal symptoms are known to come in three different stages: minor, moderate and severe. Minor withdrawal symptoms — such as headaches, slight tremors, and nausea — is subject to start anywhere from six to 12 hours after a person’s last drink. More moderate side effects of withdrawal — such as vomiting, sweating, confusion, and fever — may follow within 12 to 24 hours. Those who experience severe withdrawal may begin to feel these symptoms — called delirium tremens — between 48 and 96 hours after discontinuing alcohol use.

  • Other symptoms of alcohol withdrawal syndrome include:

    • Anxiety
    • Agitation
    • Confusion
    • Fever
    • Heart rate changes and high blood pressure
    • Insomnia
    • Loss of appetite
    • Mood swings
    • Nausea
    • Restlessness
    • Seizures
    • Sweating and dehydration or hot flashes
    • Tremors
    • Vomiting

The severity of withdrawal symptoms can depend on many variables and vary dramatically from person to person. Such factors include how long the person has been abusing alcohol, the quantity of alcohol they consume, how frequently they drink, their history with addiction to other substances, polydrug use, family addiction history and physiological makeup (gender, weight and age). A person’s preexisting mental and physical health conditions may influence the withdrawal syndrome.

Symptoms of Delirium Tremens During Withdrawal

Some alcoholics going through withdrawal may experience a particularly dangerous set of symptoms called delirium tremens. Delirium tremens is a potentially fatal medical emergency that most commonly occurs in those who drink in excess daily for months or even years. Research shows 5% of the roughly 2 million Americans who seek alcohol addiction treatment each year experience delirium tremens, also known as alcohol withdrawal delirium. The mortality rate for delirium tremens can range from 3–15% each year.

  • 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?

Scientists are still determining what causes delirium tremens. Although former research pointed to vitamin deficiencies, more recent studies show the brain releases glutamate during alcohol withdrawal to compensate for the alcohol’s enhancement of gamma-aminobutyric acid in the brain. Glutamate is a type of excitatory neuron, which may explain the autonomic hyperactivity and other delirium tremens symptoms.

Fatal complications from delirium tremens include oversedation, respiratory arrest, cardiac arrhythmias, 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 illness
    • Have abnormal liver function
    • Experience intense alcohol cravings
    • Drink large amounts of alcohol daily
    • Have abused alcohol for an extended period
    • Have experienced delirium tremens before

Delirium tremens can be difficult to diagnose, as some symptoms overlap with those of acute alcohol withdrawal. However, 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.

We surveyed 2,136 American adults who either wanted to stop drinking alcohol or had already tried to (successfully or not). Of those surveyed, 1,559 had detoxed before. We asked them about their alcohol use, reasons for drinking, alcohol-related outcomes, health and more.

Of those surveyed, 1 in 10 (11.4%) reported Delirium tremens. Compared to others during detox, heavy drinkers were 90% more likely to experience Delirium Tremens.

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 in and of itself is also a dehydrating substance. Combining alcohol’s pre-existing dehydrating qualities with withdrawal-related dehydration can easily induce seizures and may even 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 Detox Process

Detoxification is the natural bodily process of removing toxins. Any time you consume alcohol, the body naturally begins to detoxify, using the liver to metabolize ethanol and remove it from your system. Those who drink frequently never truly detoxify from the substance because they are always adding more into their system. When someone with alcoholism chooses to get sober, the first thing they must do is stop drinking alcohol and let the body detoxify.

There are two ways to detox: all at once, or by gradually lowering alcohol dosages, called tapering. Most people who choose to detox on their own at home resort to the cold turkey method. However, cold turkey detox can be dangerous, as the onset of withdrawal symptoms is more severe. In the face of the alcohol detox symptoms, the person going through detox may end up relapsing and putting themselves in danger of alcohol poisoning.

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.

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.

Common Questions About Alcohol Withdrawal

  • How Long Does Alcohol Withdrawal Last?

    Alcohol withdrawal usually occurs within 8 hours after the last drink but can occur days later. Symptoms usually peak by 24 to 72 hours but may go on for weeks. Several factors like how long a person has been drinking, age or weight can also impact the length or severity of withdrawal symptoms.

  • How Long Does Alcohol Stay in Your System?

    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

  • Can Alcohol Withdrawal Cause Muscle Spasms?

    Muscle spasms are one of the most common symptoms of alcohol withdrawal syndrome, 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.

  • Can Alcohol Withdrawal Cause Chest Pain?

    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.

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