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People affected by alcoholism have a physical dependence on alcohol use. When alcohol intake comes to a halt or drops sharply, dependent individuals will experience something called alcohol withdrawal syndrome. This syndrome, which can produce a broad range of symptoms, typically proceeds along a general timeline. However, the timeline is influenced by a variety of factors, and can differ widely from person to person. Those who believe that because it is a legal substance alcohol is harmless have never witnessed the body experiencing the symptoms of alcohol withdrawal.

Let’s take a closer look at the stages of withdrawal.

Early Stage Withdrawal

Most people dependent on alcohol will go into early stage alcoholism withdrawal if they stop drinking for at least eight hours or so. The first stage of alcohol withdrawal is marked by tremors. These tremors usually begin eight to 12 hours after the person has stopped consuming alcohol. The tremors can be made worse if the person experiences any kind of agitation. Typically, these symptoms will begin to wane after the initial 24 hours.

The symptoms experienced in this stage are relatively minor, and may include:

  • A nervous or anxious mental state
  • A “down” or depressed mental state
  • An irritable mental state
  • Restlessness or jumpiness
  • Moods that change drastically and/or rapidly
  • An inability to think clearly
  • An unusual lack of energy
  • Pupil dilation
  • Nightmares
  • Headaches
  • An accelerated heartbeat
  • Sleeplessness
  • Lack of appetite
  • Trembling limbs
  • Nausea
  • Vomiting
  • Cool, moist (i.e. clammy) skin
  • Unusually high sweat output

These symptoms typically reach maximum severity in one to three days, although some people continue to experience them for longer periods of time.

Second-Stage Withdrawal

Some people going through alcohol detox will experience a second wave of more severe withdrawal symptoms. Typically, you or your loved one has a greater chance of experiencing these symptoms if excessive alcohol use is prolonged or heavy, or if you have gone through alcohol withdrawal before. This stage of withdrawal is marked by blood pressure spikes and hallucinations. Hallucinations tend to begin 12 to 24 hours after the person stops drinking. Hallucinations are experienced by one-fourth of alcohol-dependent people in withdrawal. In this stage, the person may hear or see things that are not there, but these instances are punctuated by periods of clear-headed understanding. Patients in stage two often continue to experience symptoms from stage one and those symptoms may worsen during this time. Another potential second-stage symptom is withdrawal-related seizures. The type of seizure that occurs — known as a grand mal or generalized tonic-clonic seizure — produces indicators such as:

  • Full-body muscle rigidity
  • Loss of bowel and bladder control
  • Breathing difficulties or disruptions
  • Jaw or teeth clenching
  • Uncontrolled biting of the tongue or cheek

Third-Stage Withdrawal

About 30% of patients experience this stage of withdrawal, which can begin from three to four days after a person stops drinking to as long as two weeks afterward. In severe cases, the alcohol withdrawal symptoms in this stage may include a dangerous condition called delirium tremens (the DTs). Potential symptoms of the DTs include:

  • Full body muscle tremors
  • Grand mal seizures
  • A delirious mental state
  • A disoriented or confused mental state
  • Sight- or sound-based hallucinations
  • Rapid mood changes
  • Unusual touch, sound or light sensitivity
  • An excited or fearful mental state
  • A state of deep sleep that extends for 24 hours or more
  • A potentially fatal change in heart rhythm

In addition, people experiencing delirium tremens may accidentally injure themselves, or purposefully injure themselves or other people while in a delirious state of mind.

You or your loved one have increased chances of experiencing the DTs if you have consumed alcohol in heavy amounts for a prolonged amount of time, have a history of seizures during previous alcohol withdrawal, have a previous history of the DTs during withdrawal, are middle-aged or older, or have liver problems or other serious medical issues. When it occurs, delirium tremens usually appears within two to three days of drinking cessation. Symptoms typically reach their most severe point in about five days.

Symptoms of stage-three withdrawal also include inattention, confusion, hallucination, fever, rapid heartbeat, sweating and pupil dilation. If the person is not receiving medical care, this stage can be deadly.  About 15% of those in stage three who do not get medical treatment will die, mostly from respiratory or cardiovascular collapse.

Medicines called benzodiazepines can lessen alcohol withdrawal symptoms. Commonly used medicines in this group include chlordiazepoxide (Librium) and lorazepam (Ativan).

Most alcohol abusers who are having withdrawal symptoms have a shortage of several vitamins and minerals and can benefit from nutritional supplements. In particular, alcohol abuse can create a shortage of folate, thiamine, magnesium, zinc and phosphate. It also can cause low blood sugar.

Resources

U.S. National Library of Medicine – MedlinePlus: Alcohol Withdrawal https://medlineplus.gov/ency/article/000764.htm

American Family Physician: Alcohol Withdrawal Syndrome http://www.aafp.org/afp/2004/0315/p1443.html

U.S. National Library of Medicine – MedlinePlus: Delirium Tremens https://medlineplus.gov/ency/article/000766.htm