Alcohol Withdrawal Symptoms: What Are They and Who Is At Risk?

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Alcohol withdrawal syndrome is the name for a constellation of withdrawal symptoms a physically dependent individual may experience when they abruptly quit drinking alcohol.

Dependence occurs when someone’s body adapts to the presence of alcohol to the extent with which they must keep drinking in order to prevent unpleasant and potentially life-threatening withdrawal symptoms from emerging. Physical dependence on alcohol is a sign of alcoholism or alcohol addiction, a problematic pattern of compulsive drinking regardless of negative consequences.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms vary considerably, ranging from mild signs of withdrawal like fatigue to severe and dangerous symptoms, such as grand mal seizures. The signs and symptoms of alcohol withdrawal include:^1,2

Fatigue
Depression
Anxiety
Irritability
Shakiness or tremors
Mood swings
Nightmares
Sweating, clammy skin
Headache
Insomnia
Nausea and vomiting
Rapid heart rate
Paleness
Loss of appetite
Auditory, visual, or tactile hallucinations
Grand mal seizures

If you or someone you know is experiencing alcohol withdrawal, call 800-681-1058 (Who Answers?) to get help finding a detox program. Professional detox will help you or your loved one stay safe while withdrawing from alcohol.

Is Alcohol Withdrawal Dangerous?

Alcohol withdrawal can be life-threatening, due to the risk of grand mal seizures. An estimated 3 to 5% of people with alcoholism experience grand mal seizures during alcohol withdrawal.³ Without professional detox, these seizures can result in death. Other complications that may prove fatal during alcohol withdrawal are hyperthermia (dangerously high body temperature) and irregular heartbeat.³

Delirium tremens (DTs) is a form of severe alcohol withdrawal in which the individual experiences autonomic nervous system hyperactivity (tremor, hypertension, sweating, and rapid heart rate) combined with mental disturbances, such as hallucinations, disorientation, clouded thinking, and more. While delirium tremens itself is not life-threatening, these alcohol withdrawal symptoms can lead to erratic and violent behavior, which may increase the risk of injury, accident, or death.⁴

Because of these potentially fatal risks of alcohol withdrawal syndrome, it’s important that you seek out a professional detox program before you decide to quit drinking, especially if you’ve been drinking large amounts of alcohol over many years. That way, a staff of medical professionals can provide you with the proper support and medical care to keep you safe during alcohol detox.

Who is at Risk for Severe Alcohol Withdrawal?

Anyone who is physically dependent on alcohol will experience alcohol withdrawal symptoms but there are some people who have a greater risk of experiencing severe withdrawal, such as someone who:⁵

Has been abusing alcohol for a long period of time
Frequently drinks large amounts of alcohol in one sitting
Combines alcohol with other substances
Has previously gone through alcohol withdrawal
Has intense cravings for alcohol
Has elevated liver enzymes
Has nervous system disturbances
Has a co-occurring mental health disorder

The term “kindling” refers to the phenomenon that occurs after someone has had several alcohol withdrawal episodes. It is characterized by long-term changes in the brain that lead to increasingly more severe withdrawal episodes over time.² If you’ve previously experienced signs or symptoms of alcohol withdrawal then it’s especially important for you to seek out medical detox treatment that can provide you with around-the-clock support.

Alcohol Withdrawal Timeline

Everyone’s alcohol withdrawal timeline is going to vary a bit depending on many factors, such as mental health issues, physical health conditions, age, average quantity consumed, and duration of heavy drinking. But below you can get a general idea as to what an alcohol withdrawal timeline may look like:²

6-12 hours: Minor withdrawal, such as anxiety, GI problems, headache, heart palpitations, anorexia, insomnia, and tremors
12-24 hours: Auditory, visual, or tactile hallucinations
24-48 hours: Generalized tonic-clonic seizures
48-72 hours: Delirium tremens, hallucinations, disorientation, high blood pressure, rapid heart rate, agitation

Minor alcohol withdrawal symptoms, such as anxiety, insomnia, and trembling, may appear early on, even when the patient still has a measurable blood alcohol level (.5% or even higher).^2,4 But typically, signs of alcohol withdrawal appear anywhere from 1-3 after your last drink and most symptoms resolve within 7 days.⁴

Once acute alcohol withdrawal has resolved, some individuals may experience prolonged withdrawal, or post-acute withdrawal symptoms (PAWS), such as fatigue, mood changes, and sleep disturbances, that may last for several months.⁴

Treatment: Detox Treatment & Medications

Detoxification is a set of interventions managing acute alcohol withdrawal symptoms, and detox programs help monitor and treat you while the alcohol safely is eliminated from your body. Detox, which is often considered the first step toward addiction recovery, is not a replacement for alcohol abuse treatment but it does help stabilize you before you can enter a rehab program.

Detoxing without professional treatment is often referred to as “quitting cold turkey,” and in the case of quitting drinking, this can have deadly results—this is why it’s important to find a medical detox program, where you will receive medicine and medical support supervision that can help mitigate complications due to alcohol withdrawal and keep you safe.

The two main settings for alcohol withdrawal treatment are inpatient and outpatient, although inpatient is safer since you receive 24-hour support, and the safest type of inpatient includes medical treatment using alcohol detox medications, such as benzodiazepines and antipsychotics if necessary.^4,7

Without medical care, death due to delirium tremens may be as high as 20% but with medication like a benzodiazepine, mortality is about 1%.⁴ Benzodiazepines can help prevent or manage hallucinations, delirium, tremors, and grand mal seizures. Around-the-clock detox treatment also ensures that you are evaluated on an ongoing basis so that the medical team can make any adjustments to your detox treatment plan if needed.

Although inpatient detox is always the safest route, there are certain individuals who are particularly recommended to seek out inpatient detox, such as:⁷

People with a lack of reliable support
People who are pregnant
People with a history of severe alcohol withdrawal symptoms
People with a history of delirium tremens or withdrawal seizures
People with co-occurring psychiatric or medical illness

If you are struggling with alcoholism and want to quit drinking safely, call 800-681-1058 (Who Answers?) to speak to a treatment support specialist about detox and rehab options.

References

S. National Library of Medicine. Medline Plus: Alcohol withdrawal.
Bayard, M., Mcintyre, J., Hill, K. R., & Woodside, J., Jr. (2004). Alcohol Withdrawal Syndrome. American Family Physician, 15(69), 6th ser., 1443-1450. Retrieved from https://www.aafp.org/afp/2004/0315/p1443.html
Schuckit, M. (2014). Recognition and Management of Withdrawal Delirium (Delirium Tremens). The New England Journal of Medicine.
Mainerova, B., Prasko, J., Latalova, K., Axmann, K., Cerna, M., Horacek, R., Bradacova, R. (2015). Alcohol withdrawal delirium- diagnosis, course, and treatment., Biomed Papers Medical Facility University Palacky Olomouc Czech Republic, 159(1): 44-52.
Trevisan, L., Boutras, N., Petrakis, I., Krystal, J. (1998). Complications of Alcohol Withdrawal. Alcohol Health & Research World, V. 22 (N) 1.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
Hugh Myrick, M.D., and Raymond F. Anton, M.D. (1998). Treatment of Alcohol Withdrawal. Alcohol Health & Research World; 22(1): 38-43.