Symptoms of alcohol withdrawal develop when someone stops drinking after a long period of alcohol abuse, when they’ve become physically dependent on alcohol.

There are two different stages of alcohol withdrawal, with different symptoms and treatments.

What Is Alcohol Withdrawal Syndrome?

Alcohol withdrawal occurs because long-term or heavy alcohol abuse makes your brain dependent on the regular presence of alcohol in your system. The brain adjusts its own natural chemistry. Abruptly withdrawing from alcohol disrupts this adjustment. Your brain chemistry gets destabilized, leading to all the symptoms of alcohol withdrawal syndrome.

Symptoms of Alcohol Withdrawal Syndrome

First-Stage Symptoms

Most people who are dependent on alcohol experience at least some first-stage alcohol withdrawal symptoms. These symptoms usually appear around eight hours after you stop consuming alcohol. They peak over the course of one to three days and taper off over several more days.

  • A depressed or “down” mental state
  • Irritability, nervousness, or anxiousness
  • Unusual jumpiness or jitteriness
  • Unstable or shifting moods
  • Nightmares
  • Insomnia
  • Pupil dilation
  • Nausea
  • Vomiting
  • An unusually rapid heart rate
  • Headaches
  • Trembling hands

Second-Stage Symptoms

These alcohol withdrawal symptoms aren’t as common as the mild first-stage symptoms. Second-stage withdrawal symptoms usually appear 12 hours to 4 days after stopping alcohol. They can include:

  • High blood pressure
  • Fever
  • Body tremors
  • Confusion or other changes in mental function
  • Mood changes, such as agitation or irritability, excitement, fear or restlessness
  • Alcoholic hallucinosis (a hallucinatory state that can include visual or audio hallucinations, delusions and mood disturbances)
  • Grand mal seizures

These symptoms can progress to a condition called delirium tremens (known informally as the DTs), which is potentially life-threatening. As well as these symptoms, the DTs can lead to serious and even lethal changes in heart rate.

The DTs can develop in second-stage withdrawal or after a period of heavy drinking ends. For instance, if you abuse alcohol every day for several months and then reduce your intake, you may develop the DTs even if you don’t completely stop drinking. In this context, you’re a “heavy drinker” if you consume any of the following every day for at least several months:

  • 4 to 5 pints (1.8 to 2.4 liters) of wine,
  • 7 to 8 pints (3.3 to 3.8 liters) of beer or
  • 1 pint (0.6 liters) of hard liquor

The DTs may also develop in someone with a long history of alcohol abuse, particularly if they have any kind of illness. They’re common in people who have a long history of alcohol abuse (e.g. 10 years or more) or a history of frequent alcohol withdrawal.

In most cases, the DTs develop within 48 to 96 hours after the last drink, but it’s possible for the onset of symptoms to begin up to 10 days later.

Treatment for Alcohol Withdrawal

There are several options for treatment of alcohol withdrawal symptoms. Withdrawing at home is generally not recommended due to the risk of second-stage symptoms. It’s much safer to go through the process in a treatment center or hospital setting that treats alcohol withdrawal.

For first-stage symptoms, treatment usually focuses on making the patient more comfortable, and ensuring they don’t suffer from complications such as dehydration. IV fluids may be used to offset the loss of fluids from vomiting and sweating.

Medication for first-stage symptoms usually includes benzodiazepines, such as Valium®, Ativan® and Xanax®. A doctor may prescribe these on a set schedule or for use as needed.

If you have second-stage withdrawal symptoms, in particular delirium tremens, you need more specialized care. Patients with the DTs are hospitalized in an intensive care unit, so their vital signs and other critical functions can be monitored. They’re sedated until their condition stabilizes and are given IV fluids and other medications if needed.

Patients are often assessed on a 10-point scale called the Clinical Institute Withdrawal Assessment for Alcohol, or CIWA. Medical professionals use this scale to gauge how severe your withdrawal symptoms are. This helps them assess the level of risk and prescribe an appropriate treatment.

Why Safe Withdrawal Matters

Symptoms range from mild to severe withdrawal. In the most severe cases, they can be fatal. Some people detox at home, but making a guess about whether you need medical supervision or not can be risky. Even if they don’t need it, many people choose medical alcohol detox to ensure they’re comfortable and safe while they withdraw. This offers the best chance of moving successfully through withdrawal and on to the next phase of treatment.

Another reason a medical detox is helpful is that even mild alcohol withdrawal symptoms can get worse quickly, with little warning. And if you have any health conditions or you’ve undergone withdrawal before, a medical detox is the best and safest option.

Seek Expert Help for a Safe Withdrawal

Do you or a loved one have a problem with alcohol addiction? It’s important to seek help from a qualified addiction expert to ensure a safe and productive withdrawal and recovery. Only a professional who understands how addiction affects your mind and body can properly safeguard your health while you’re undergoing withdrawal.

Once you’ve detoxed completely, an expert addiction and recovery specialist can assess your progress and help you decide on an appropriate substance treatment program. With the right help, you can build an alcohol- and addiction-free life.

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Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

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