Alcohol Withdrawal: Symptoms, Causes, Diagnosis, and Treatment
Alcohol withdrawal refers to a set of symptoms that may happen if you stop or significantly reduce alcohol intake after a prolonged period of heavy drinking.
Symptoms can start within hours of your last drink and usually peak within three days afterward. While most cases of alcohol withdrawal are mild and don’t require medical intervention, some people may experience severe symptoms, which could become life-threatening.
Alcohol withdrawal usually affects people with alcohol use disorder, but it can also occur in some cases of binge drinking. If you drink in moderation — meaning one drink or less per day for women or two drinks or less per day for men — withdrawal symptoms are unlikely to occur when you stop drinking.
Treatment for alcohol withdrawal typically involves easing symptoms, preventing complications, and addressing underlying problems, such as alcohol use disorder or binge drinking.
Alcohol is a central nervous system depressant, which means it slows down brain activity by disrupting communication between neurons. In response, the brain increases activity to try to maintain balance.
The body adapts to frequent and excessive drinking and, over time, becomes dependent on alcohol to function. If alcohol use abruptly stops, the brain temporarily stays overly active, causing the symptoms of alcohol withdrawal.
Certain types of drinking patterns can lead to withdrawal symptoms if consumption suddenly stops or significantly lessens. These include binge drinking and heavy alcohol use. Binge drinking refers to excessive alcohol consumption in a short period and is defined as follows:
Five or more drinks within two hours for men
Four or more drinks within two hours for women
Heavy drinking is defined as:
At least 5 drinks on any day or 15 drinks a week for men
At least 4 drinks on any day or 8 drinks a week for women
Both binge drinking and heavy alcohol use increase the chance of developing alcohol use disorder, a condition characterized by an inability to stop drinking despite harmful consequences. People with this disorder are at a higher risk for withdrawal symptoms if they stop drinking.
Heavy and prolonged drinking increases alcohol tolerance. As a result, your body can become dependent on alcohol to function. This physiological dependence triggers withdrawal symptoms if you suddenly stop drinking or significantly reduce alcohol consumption.
Hallucinations (seeing or hearing things that aren’t there)
Seizures
Timeline of Alcohol Withdrawal Symptoms
Alcohol withdrawal symptoms usually begin within a few hours of your last drink, with intensity peaking by 72 hours after stopping. The severity and length of symptoms depend on a variety of factors, but withdrawal commonly follows this timeline:
6–12 hours after you stop drinking: Mild symptoms begin. These symptoms may include headache, small tremors, mild anxiety, insomnia, or upset stomach.
12–48 hours after you stop drinking: Symptoms may worsen and could include hallucinations or seizures in severe cases. During a hallucination, you may see, hear, smell, taste, or touch things that aren’t present. Seizure risk is highest 24 to 48 hours after your last drink.
48–72 hours after you stop drinking: Most symptoms peak and start to resolve, but some may continue for a few weeks or longer. Alcohol withdrawal delirium, or delirium tremens, is a severe condition that may occur during this time. Symptoms can include fever, agitation, confusion, fast heart rate, hallucinations, disorientation, and high blood pressure. If you think you may be experiencing delirium tremens, seek immediate emergency medical care. Although rare, delirium tremens can be life-threatening and requires hospitalization. It has a mortality rate of up to 37 percent if untreated. With immediate and proper treatment, delirium tremens can last up to five days.
If you are concerned about any lingering withdrawal symptoms after 72 hours, reach out to your doctor for help.
Healthcare professionals, such as physicians, nurse practitioners, and psychiatrists, can diagnose alcohol withdrawal. They’ll review your symptoms, drinking history, and medical history. They may also perform a physical exam or order laboratory tests, such as blood, breath, or urine tests, in some cases. These tests are not drug tests. Rather, they are given to help guide the patient’s medical care, as some medical conditions could affect the course of alcohol withdrawal or treatment.
To diagnose alcohol withdrawal, healthcare professionals often use a diagnostic guide called the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for alcohol withdrawal are:
Discontinuation or reduction of alcohol use that’s been heavy and prolonged
Two or more withdrawal symptoms that develop hours or days after alcohol intake lessens or stops. Possible symptoms include sweating, increased heart rate, tremors, insomnia, nausea or vomiting, hallucinations, agitation, anxiety, or seizures.
Symptoms cause significant distress or impairment
Symptoms are not due to another medical condition and not better explained by another mental health issue, such as intoxication or withdrawal from a different substance.
Alcohol withdrawal treatment is often based on your drinking history, the severity of your symptoms, and the kinds of support that are available to you.
If symptoms are mild and your drinking history doesn’t pose a risk for severe withdrawal, your doctor may allow you to recover at home. In these cases, it’s important to have someone with you who can monitor your condition if symptoms worsen. But if your symptoms are moderate to severe (or there is a concern for moderate to severe symptoms), you may need treatment in a hospital or other clinical setting, such as an outpatient or residential treatment facility.
Depending on the symptoms you have as your body detoxifies from alcohol, doctors may recommend certain supplements or medications. They could include:
Supplements and Fluids These can help replenish electrolytes and nutrients, such as thiamine and folate. People with alcohol withdrawal often have vitamin deficiencies, so replacing these is crucial in preventing certain complications. Supplements can be administered through IV or intramuscular injection. If you’re detoxing at home, your doctor may recommend oral supplementation.
Benzodiazepines These medications can make your brain less active and can help prevent or lessen withdrawal symptoms. It’s important to only take these medications under the direction and monitoring of your doctor, as they come with risks, including the risk of overdose if combined with drinking.
Antiseizure Medications These can help prevent or treat seizures.
Antipsychotic Medications These medications help manage hallucinations.
Once the acute symptoms of alcohol withdrawal resolve, the next step is to address and treat the drinking patterns that led to withdrawal symptoms, such as alcohol use disorder or binge drinking. With professional support, you can overcome alcohol use disorder and avoid future episodes of alcohol withdrawal.
Alcohol withdrawal can happen when someone suddenly stops or significantly decreases heavy drinking. Symptoms can be mild, severe, or even life-threatening, requiring immediate treatment. If you’re experiencing withdrawal symptoms of any severity, seek professional help. Recovery is possible.
