Alcohol Withdrawal Symptoms & Treatment

Alcohol dependence, and the associated withdrawal syndrome, are commonly seen in people with alcohol use disorders. As someone develops alcohol dependence, their bodies adapt to the presence of alcohol to a point at which they essentially require alcohol to function and feel normal. Without alcohol, the body will begin to show signs of alcohol withdrawal.1

Acute alcohol withdrawal can be very uncomfortable and, in some cases, life-threatening. Because of the potential for significant health risks associated with alcohol withdrawal, a supervised medical detox is commonly sought to keep people safe during alcohol detox.1

What Happens When You Stop Drinking?

The alcohol withdrawal syndrome is one of the most serious of all the substance abuse withdrawal syndromes. Symptoms of alcohol withdrawal can range from mild to severe to life-threatening in certain cases.2,3,4

Alcohol depresses the central nervous system (CNS). With chronic exposure to alcohol, the body can become reliant on the depressant effects of the substance. When an alcohol-dependent person stops drinking as much alcohol as they’re used to, or quits drinking completely, their CNS can become overexcited, as certain types of brain activity are no longer being inhibited by alcohol.2 This overexcitement of the CNS can contribute to a range of alcohol withdrawal symptoms.2,3,4

Alcohol Withdrawal Symptoms 

  • Anxiety.
  • Agitation.
  • Problems sleeping.
  • A diminished ability to feel pleasure.
  • An inability to think clearly.
  • Headaches.
  • Bodily aches and pains.
  • Rapid heart rate.
  • Elevated blood pressure.
  • Fever.
  • Sweating.
  • Hand tremors.
  • Loss of appetite.
  • Nausea.
  • Vomiting.
  • Hallucinations (visual, auditory, or tactile).
  • Seizures.
  • Delirium tremens (see below).

What Are Delirium Tremens?

Delirium tremens, commonly called “DTs”, is a particularly severe and dangerous manifestation of alcohol withdrawal. It involves the development of significant changes in mental status  and nervous system function and is characterized by symptoms such as:5,6

  • Sudden onset of severe confusion (delirium).
  • Rapid changes in mood and/or mental functioning.
  • Agitation.
  • Profound changes in levels of consciousness (e.g., bursts of energy and stupor).
  • Sensitivity to light, touch, and sound.
  • Body tremors.
  • Hallucinations (seeing, feeling, hearing, or smelling things that aren’t there).
  • Tonic-clonic seizures. Generally known as “grand mal” seizures, these involve violent physical shaking, loss of consciousness, and stiffening of the muscles.

DTs are relatively rare. While more than 50% of people who abuse alcohol can expect to develop some symptoms of alcohol withdrawal, only an estimated 3% to 5% of people who chronically abuse alcohol develop DTs.7 Those who may be at higher risk for DTs include individuals who:7,8

  • Are older.
  • Have had DTs before.
  • Have a history of seizures.
  • Have a comorbid illness.
  • Have been through detox from alcohol in the past.
  • Are dehydrated.
  • Have an electrolyte imbalance.

Symptoms of DTs typically begin around 48 hours after your last drink and can last up to 5 days. Without treatment, people who experience the DTs have a 37% mortality rate, so it is crucial to seek treatment for alcohol withdrawal, especially if you are a heavy alcohol abuser or have experienced significant alcohol withdrawal in the past.7

How Long Does Alcohol Withdrawal Last?

The timeline for alcohol withdrawal may vary from person to person. Many people progress through several stages of alcohol withdrawal:8,9

  • The more mild symptoms such as headache, GI upset, and insomnia tend to arise first (within 6–12 hours).
  • The more severe symptoms, such as hallucinations and seizures, may begin appearing within 24 hours, though the risk of seizures may remain elevated for several days beyond this.
  • Should delirium tremens arise, it usually happens between 2 and 4 days from the last drink.

Alcohol withdrawal tends to peak in severity around the second day and drastically improve by the 4th or 5th day.4 In the case of DTs, symptoms can last for up to 7 days (or longer, in some cases) after the last drink.2

While acute withdrawal resolves within a matter of days, post-acute withdrawal symptoms such as anxiety, insomnia, dysphoria, lack of pleasure, and negative mood, can last for much longer (months or years). This can cause some people to relapse, especially if they are unable to cope with these symptoms on their own.10

How to Get Over Alcohol Withdrawal Safely

Getting over alcohol withdrawal can be uncomfortable and even dangerous if you attempt it on your own, especially if you’ve been drinking heavily for a long time, you use other CNS depressants (such as benzodiazepines), you have a family history of alcohol withdrawal, or you have risk factors for delirium tremens. 4

For those who do experience severe withdrawal symptoms, medical supervision is necessary to ensure doctors can intervene in an emergency. This is why the Substance Abuse and Mental Health Services Administration advises that people undergoing alcohol withdrawal receive detox in a hospital or another inpatient setting with 24/7 medical care.1

What is Medical Detox for Alcohol?

The alcohol withdrawal protocol in medical detox involves multiple components. In a supervised medical care setting, you will receive round-the-clock monitoring and attention, as well as immediate medical support for severe or life-threatening symptoms. For many people, especially those with moderate or severe symptoms, medication is often required to help keep the person as safe and comfortable as possible. Some of the medications used include:1,9

  • Benzodiazepines, such as chlordiazepoxide (Librium), which are used to treat seizures, insomnia, and anxiety.
  • Barbiturates, such as phenobarbital, which can help ease withdrawal symptoms, although these medications are no longer commonly used due to the risks of addiction and overdose.
  • Other anticonvulsants, such as carbamazepine, which may help inhibit seizures not well managed with benzodiazepine treatment.
  • Adrenergic medications (e.g., beta blockers, clonidine), which can help to manage some of the autonomic symptoms of withdrawal, such elevated blood pressure and rapid pulse.

Alcoholism Treatment: What Happens After Detox

A treatment plan for alcoholism involves more than just detox, as the detox stage primarily addresses the physical symptoms of withdrawal; it does not address the underlying reasons that you developed an alcohol addiction in the first place. If you do not address these underlying reasons, you can easily relapse and resume your old habits.

Once you undergo withdrawal and have safely detoxed from alcohol, further treatment can keep you on the right track. As part of a quality alcohol abuse treatment program, you can work to develop the coping, relapse-prevention, and life skills you’ll need to stay sober. The National Institute on Drug Abuse advises that “good outcomes are contingent on adequate treatment length.” Longer periods of treatment (90 days or more) are associated with improved treatment outcomes.11

Depending on your specific needs, you may enter treatment as an outpatient, where you live at home and travel to a rehab facility regularly, or as an inpatient, where you live at the facility and receive 24/7 care and monitoring. Regardless of the type of treatment you select, you should know that help is available, and with the right treatment plan for alcoholism, you can start the path to sobriety and begin leading a happier and healthier life.