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.
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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 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:
- Heart rate changes and high blood pressure
- Loss of appetite
- Mood swings
- Sweating and dehydration
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:
- Autonomic hyperactivity, including shortness of breath, sweating, dry mouth and palpitations
- 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.