If you or a loved one struggle with drinking and want to quit, you are not alone. Drug and alcohol use has been increasing during the COVID-19 pandemic, leaving many people unsure about the best way to quit. Because alcohol withdrawal can be dangerous, make sure you have medical advice from your doctor or a rehab facility when you decide to stop drinking.
Alcohol Withdrawal
When your body becomes used to the presence of alcohol, it starts to expect its presence. This phenomenon is called physical dependence. When you drink heavily over the long term, there is abnormal activity of neurotransmitters in your brain, including dopamine, serotonin, glutamate and gamma-aminobutyric acid (GABA).
If you suddenly stop drinking, your brain has a chemical imbalance. This leads to a variety of side effects known as alcohol withdrawal syndrome, or AWS.
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Alcohol Withdrawal Syndrome Symptoms
AWS has many symptoms. While some symptoms are common and just uncomfortable, other symptoms can be more severe and potentially deadly.
Common Symptoms
Many common symptoms of alcohol withdrawal exist. These symptoms can range from mild to moderate to severe. They are usually rated on a scale called the CIWA (pronounced SEE-wah). This scale ranges from 0 to 7, where 0 is the absence of the symptom, and 7 is a severe form of the symptom. Symptoms include:
- Nausea/vomiting
- Tremors
- Anxiety
- Agitation
- Sweating
- Lack of awareness of surroundings
- Abnormal skin sensations, like feeling like bugs are crawling over the skin
- Visual hallucinations
- Auditory hallucinations
- Headache
Severe Alcohol Withdrawal Symptoms
AWS symptoms can be severe in some cases. The most serious condition that can occur is called delirium tremens, which is severe mental or nervous system changes that occur after stopping alcohol. Symptoms of delirium tremens can include:
- Sudden confusion
- Tremors
- Reduced mental function
- Agitation
- Irritability
- Excessive sleep, fatigue, stupor
- Excitement or fear
- Hallucinations
- Changes in energy
- Changes in mood
- Restlessness
- Sensitivity to light, sound, and touch
- Seizures
- Death
Delirium tremens is most likely to occur in those who have previously gone through AWS, drink excessively, and/or have been drinking for more than ten years.
Alcohol Withdrawal Symptoms Timeline
Alcohol withdrawal symptoms can start soon after a person stops drinking and can last for days. Although every person experiences withdrawal differently, a common timeline is:
- Between six and 24 hours after the last drink, AWS symptoms begin.
- Within five days of the last drink, a person is at risk for common alcohol withdrawal symptoms, like those on the CIWA.
- Between 48 hours and ten days after the last drink, delirium tremens symptoms can begin.
In a recent study of alcohol drinkers who had detoxed before, 95% of respondents experienced withdrawal symptoms for 2–8 days.
Factors that Influence Withdrawal Severity
Many factors can influence the severity of alcohol withdrawal symptoms. Known risk factors for severe withdrawal include:
- Previously experiencing AWS
- Drinking heavily
- Chronic heavy drinking
In a recent survey, heavy alcohol users across the board reported withdrawal symptoms more than average. Heavy alcohol users doubled their risk for hallucinations during detox, being 2.39 times more likely than moderate or light alcohol users to experience them. Compared to others during detox, heavy drinkers were:
- 90% more likely to experience delirium tremens
- 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
The survey also showed that polysubstance use, or using multiple substances at the same time, increases your chances of experiencing more severe withdrawal symptoms during alcohol detox. Compared to those detoxing from alcohol only, people detoxing from alcohol and at least one other substance were:
- 2.25 times more likely to experience seizures
- 2.14 times more likely to experience delirium tremens
- 1.60 times more likely to experience hallucinations
Managing Withdrawal Symptoms in Alcohol Detox
Alcohol withdrawal symptoms are difficult to manage on your own at home, which is one of the factors that makes withdrawal so dangerous. Symptoms can be more easily managed when you are under medical supervision in a rehab facility. In medical detox, you are monitored for withdrawal symptoms as the alcohol slowly leaves your body and treated accordingly.
Your medical team can treat alcohol withdrawal symptoms in multiple ways, including managing your nutrition, environment and medications. A patient with severe symptoms is sometimes treated with a long-acting benzodiazepine like diazepam (Valium), which can help block alcohol withdrawal symptoms. You may also receive vitamins like thiamine (vitamin B1) during withdrawal to prevent a condition called Wernicke’s Encephalopathy linked to heavy drinking.
Diagnosing Alcohol Withdrawal
Alcohol withdrawal is usually diagnosed based on whether a person has recently stopped drinking and is experiencing withdrawal symptoms. Doctors will often try to rule out other causes of symptoms consistent with alcohol withdrawal, like dehydration, infection, heart problems, lab abnormalities, stomach bleeding and traumatic injury.
Can You Prevent Alcohol Withdrawal Symptoms?
Alcohol withdrawal symptoms are inevitable but can be managed if the person is under around-the-clock medical care while experiencing withdrawal. Using the CIWA symptom tracker for alcohol withdrawal, doctors and nurses can closely monitor a person. When a person begins to experience symptoms, they can then be quickly treated with medication and other supports to make the experience as comfortable as possible.
Outlook for Alcohol Withdrawal
Detox is only the first step in becoming sober. If a person only goes through detox, their chances of remaining sober long-term are low.
Alcohol rehab is recommended after detox is complete to continue recovery. In rehab, you learn to explore why you began to use alcohol in the first place and learn coping strategies for living an alcohol-free life. After rehab is complete, aftercare options, including relapse prevention plans, continuing care and support groups like Alcoholics Anonymous, can help you stay sober over the long term.
Choosing How to Detox from Alcohol
To avoid alcohol withdrawal symptoms, including severe complications like delirium tremens, it is safest to detox while under medical supervision. Undergoing detox at home or suddenly quitting heavy drinking cold-turkey are not recommended because of the dangers some alcohol withdrawal symptoms pose when you are not in a medical setting.
How Do I Find Alcohol Detox Centers Near Me?
The Recovery Village operates a network of alcohol detox centers nationwide, including our Palmer Lake center in Colorado. Call our caring alcohol recovery experts today to learn more about how we can help you learn to live an alcohol-free life.
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“Alcohol Withdrawal Assessment Scoring Gu[…]elines (CIWA – Ar)”. November 2003. Accessed April 27, 2021.
U.S. National Library of Medicine. “Delirium Tremens.” April 2, 2021. Accessed April 27, 2021.
World Health Organization. “Clinical Guidelines for Withdrawal Manag[…]e in Closed Settings.” 2009. Accessed April 27, 2021.
Federal Bureau of Prisons. “Detoxification of Chemically Dependent Inmates.” February 2014. Accessed April 27, 2021.
Newman, Richard K.; Gallagher, Megan A. Stobart; Gomez, Anna E. “Alcohol Withdrawal,” StatPearls, December 26, 2020. Accessed April 27, 2021.
The Recovery Village at Palmer Lake 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.