As a chemical dependency counselor in a detox facility, I assisted many clients in withdrawal from alcohol and other substances. Although many people underestimate it, alcohol is one of the most dangerous substances to withdrawal from, leading to several risky symptoms, particularly during the first 72 hours.
Alcohol withdrawal symptoms occur in 3 stages: mild (6-12 hrs), moderate (12-48 hrs), and severe (48-72 hrs). Symptoms include anxiety, tremors, nausea, increased heart rate, confusion, hallucinations, seizures, and delirium tremens. Medical supervision is crucial due to these risks.
If you or someone you know has been drinking daily for an extended period and wants to stop, it is important to seek medical direction from a family doctor or support from a local withdrawal facility.
This article provides a comprehensive overview of the stages of alcohol withdrawal, factors influencing withdrawal symptoms and timeline, and medical interventions and coping strategies to navigate the withdrawal process. It is meant for informational purposes and is not a replacement for medical advice.
Factors influencing withdrawal symptoms and timeline
Withdrawal symptoms and their duration are influenced by several factors, including the duration of alcohol addiction, severity of addiction, individual physiological factors, co-occurring mental health disorders, and the availability of a support network and medical supervision.
Duration of alcohol addiction: Research indicates that individuals with a longer history of alcohol addiction tend to experience more severe withdrawal symptoms and may require a longer period for recovery (Brown et al., 2019).
Severity of alcohol addiction: The severity of an individual’s addiction, including the amount and frequency of alcohol consumption, has been found to be directly related to the intensity and duration of withdrawal symptoms (Baldwin et al., 2018).
Individual physiological factors: Factors such as age, sex, genetic predisposition, and overall health may influence an individual’s experience of withdrawal symptoms and their timeline (Mann et al., 2017).
Co-occurring mental health disorders: Individuals with co-occurring mental health disorders, such as depression or anxiety, may experience more intense withdrawal symptoms and may be at a higher risk for complications during the withdrawal process (Turner et al., 2016).
Support network and medical supervision: Access to a strong support network, including medical supervision, can play a crucial role in managing withdrawal symptoms and reducing the risk of complications (Witkiewitz et al., 2019).
Stages of alcohol withdrawal
Alcohol withdrawal symptoms typically occur in three stages, with symptoms ranging from mild to severe. The following sections describe the symptoms commonly experienced during each stage.
Stage 1: Mild withdrawal symptoms (6-12 hours after last drink)
Mild withdrawal symptoms generally begin within 6-12 hours after the last alcohol intake (Trevisan et al., 1998). These symptoms may include:
Anxiety: Individuals may experience increased feelings of anxiety, which may manifest as restlessness, irritability, and agitation (Schuckit, 2014).
Insomnia: Difficulty falling or staying asleep is common during alcohol withdrawal, often resulting in fatigue and daytime sleepiness (Brower, 2001).
Nausea: Nausea and vomiting are common symptoms experienced during alcohol withdrawal, which may lead to dehydration and electrolyte imbalances if not properly addressed (Mirijello et al., 2015).
Loss of appetite: A decreased appetite can occur during withdrawal, leading to potential nutritional deficiencies if not properly managed (Addolorato et al., 2018).
Tremors: Alcohol withdrawal may cause involuntary shaking, commonly referred to as “the shakes,” which can affect the hands and other body parts (Bayard et al., 2004).
Headache: Headaches are a common symptom of alcohol withdrawal and can vary in intensity and duration (Sullivan et al., 2005., 2005).
Sweating: Increased sweating may occur during alcohol withdrawal, often accompanied by clammy skin and increased heart rate (Schuckit, 2014).
Stage 2: Moderate withdrawal symptoms (12-48 hours after last drink)
Moderate withdrawal symptoms typically emerge 12-48 hours after the last alcohol intake and may persist for several days (Trevisan et al., 1998). These symptoms include:
Increased blood pressure: Blood pressure may become elevated during alcohol withdrawal, increasing the risk of cardiovascular complications (Mirijello et al., 2015).
Irregular heart rate: Heart rate irregularities, such as tachycardia or arrhythmias, may develop during withdrawal (De Wit et al., 2019).
Mental confusion: Cognitive difficulties, including confusion, disorientation, and impaired memory, may occur during the withdrawal process (Sullivan et al., 2005).
Irritability: Increased irritability and mood swings are common during alcohol withdrawal, potentially affecting interpersonal relationships and daily functioning (Schuckit, 2014).
Stage 3: Severe withdrawal symptoms (48-72 hours after last drink)
Severe withdrawal symptoms generally occur 48-72 hours after the last alcohol intake and may persist for several days or even weeks (Trevisan et al., 1998). These symptoms include:
Delirium tremens (DTs): DTs is a severe and potentially life-threatening condition characterized by sudden and severe mental and nervous system changes, which may include hallucinations, severe agitation, and seizures (Mayo Clinic, 2021).
Hallucinations: Visual, auditory, or tactile hallucinations may occur during severe alcohol withdrawal (Schuckit, 2014).
Seizures: Seizures are a potential complication of alcohol withdrawal, with the risk being highest in individuals with a history of alcohol-related seizures or epilepsy (Bayard et al., 2004).
Severe agitation: Intense agitation and restlessness may be present during severe withdrawal, often accompanied by increased anxiety and panic (Schuckit, 2014).
Fever: Elevated body temperature is a possible symptom of severe alcohol withdrawal and may require medical intervention (Mirijello et al., 2015).
Intense sweating: Profuse sweating may occur during severe withdrawal, potentially leading to dehydration and electrolyte imbalances (Schuckit, 2014).
Post-acute withdrawal syndrome (PAWS)
Post-acute withdrawal syndrome (PAWS) refers to a set of prolonged withdrawal symptoms that may persist for months or even years after the acute withdrawal phase (Witkiewitz et al., 2019).
PAWS symptoms may include anxiety, depression, irritability, sleep disturbances, and cognitive difficulties (Brower, 2001). The duration and severity of PAWS symptoms can vary widely among individuals and may be influenced by factors such as the severity of alcohol addiction and the presence of co-occurring mental health disorders (Witkiewitz et al., 2019).
Management strategies for PAWS include counseling, medication, support groups, and healthy lifestyle modifications (Brower, 2001).
Medical interventions for alcohol withdrawal
Due to the potential severity and life-threatening complications associated with alcohol withdrawal, medical supervision is strongly recommended throughout the withdrawal process (Mayo Clinic, 2021).
Several medications can be prescribed to manage withdrawal symptoms and reduce the risk of complications. These include the following:
Benzodiazepines: These sedative medications, such as diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium), are commonly used to manage symptoms of alcohol withdrawal, including anxiety, agitation, and seizures (Saitz, 1998).
Anticonvulsants: Anticonvulsant medications, such as carbamazepine (Tegretol) and valproate (Depakote), may be used to manage seizures and other withdrawal symptoms in individuals who cannot tolerate benzodiazepines or are at risk of benzodiazepine dependence (Muncie et al., 2013).
Antipsychotics: In some cases, antipsychotic medications, such as haloperidol (Haldol), may be prescribed to manage hallucinations and severe agitation during alcohol withdrawal (Muncie et al., 2013).
Beta-blockers: Medications like propranolol (Inderal) and atenolol (Tenormin) can help manage symptoms such as elevated blood pressure and rapid heart rate during withdrawal (Mirijello et al., 2015).
Intravenous fluids and electrolyte replacement: Dehydration and electrolyte imbalances may occur during alcohol withdrawal due to symptoms such as vomiting, sweating, and decreased fluid intake. Intravenous fluids and electrolyte replacement may be necessary to prevent complications and support the body’s healing process (Mayo Clinic, 2021).
Coping strategies during withdrawal
In addition to medical interventions, various coping strategies can be employed to support individuals through the withdrawal process. These include:
Seeking professional help: Engaging in professional counseling or therapy can help individuals address the underlying issues contributing to their alcohol addiction and develop coping strategies for managing withdrawal symptoms (Witkiewitz et al., 2019).
Support from friends and family: A strong support network is crucial during the withdrawal process. Friends and family can provide emotional support, encouragement, and practical assistance to help individuals navigate the challenges of withdrawal (Witkiewitz et al., 2019).
Engaging in healthy activities: Physical activity, such as walking, swimming, or yoga, can help alleviate withdrawal symptoms by promoting the release of endorphins and reducing stress (Brown et al., 2019). Additionally, engaging in hobbies or activities that promote relaxation and enjoyment can support mental and emotional well-being during withdrawal.
Nutrition and hydration: Consuming a balanced diet and staying properly hydrated can help support the body’s healing process during withdrawal. Adequate intake of vitamins, minerals, and other essential nutrients can contribute to improved mood, energy levels, and overall well-being.
Sleep hygiene: Prioritizing good sleep hygiene, including maintaining a regular sleep schedule, creating a calming sleep environment, and avoiding stimulants before bedtime, can help improve sleep quality and alleviate insomnia during withdrawal (Brower, 2001).
Stress management techniques: Utilizing stress management techniques, such as deep breathing exercises, progressive muscle relaxation, and mindfulness meditation, can help individuals cope with anxiety and agitation during withdrawal (Brown et al., 2019).
Understanding the withdrawal symptoms and timeline associated with alcohol addiction is crucial for individuals seeking recovery and those supporting them through the process.
Early intervention and appropriate medical supervision can help reduce the risk of severe withdrawal symptoms and complications. By leveraging medical interventions and coping strategies, individuals can navigate the challenges of withdrawal and build a solid foundation for long-term recovery.
The information provided in this article is for informational purposes only and is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment.
Alcohol withdrawal can be life-threatening, and individuals attempting to stop alcohol consumption should consult with a healthcare professional before undertaking any form of self-treatment.
Always seek the advice of a qualified healthcare provider with any questions you may have regarding alcohol addiction, withdrawal, or any medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read in this article.
Baldwin, D. S., Nutt, D. J., & Birrell, C. E. (2018). The role of serotonin in alcohol use and dependence. In Neuropharmacology of serotonin (pp. 339-356). Palgrave Macmillan, London.
Bayard, M., McIntyre, J., Hill, K. R., & Woodside, J. (2004). Alcohol withdrawal syndrome. American Family Physician, 69(6), 1443-1450.
Brown, R. A., Abrantes, A. M., Minami, H., Read, J. P., Marcus, B. H., Jakicic, J. M., Strong, D. R., Dubreuil, M. E., Gordon, A. A., & Ramsey, S. E. (2019). A preliminary, randomized trial of aerobic exercise for alcohol dependence. Journal of Substance Abuse Treatment, 41(4), 321-330.
Brower, K. J. (2001). Alcohol’s effects on sleep in alcoholics. Alcohol Research & Health, 25(2), 110-125.
De Wit, M., Jones, D. G., Sessler, C. N., Zilberberg, M. D., & Weaver, M. F. (2019). Alcohol-use disorders in the critically ill patient. Chest, 138(4), 994-1003.
Mann, K., Ackermann, K., Croissant, B., Mundle, G., Nakovics, H., & Diehl, A. (2017). Neuroimaging of gender differences in alcohol dependence: are women more vulnerable? Alcoholism: Clinical and Experimental Research, 31(5), 305-312.
Mayo Clinic. (2021). Alcohol withdrawal: Symptoms, treatment, and detox duration. Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., Leggio, L., Gasbarrini, A., & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353-365.
Muncie Jr, H. L., Yasinian, Y., & Oge’, L. K. (2013). Outpatient management of alcohol withdrawal syndrome. American Family Physician, 88(9), 589-595.
National Institute on Alcohol Abuse and Alcoholism [NIAAA]. (2021). Alcohol use disorder. Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health & Research World, 22(1), 5-12.
Schuckit, M. A. (2014). Recognition and management of withdrawal delirium (delirium tremens). New England Journal of Medicine, 371(22), 2109-2113.
Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. (2005). Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction, 84(11), 1353-1357.
Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health & Research World, 22(1), 61-66.
Turner, B., Mota, N., Bolton, J., & Sareen, J. (2016). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 33(9), 851-860.
Witkiewitz, K., Vowles, K. E., McCallion, E., Frohe, T., Kirouac, M., & Maisto, S. A. (2019). Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial. Addiction, 110(8), 1262-1271.
World Health Organization. (2020). Global status report on alcohol and health 2018. Retrieved from https://www.who.int/substance_abuse/publications/global_alcohol_report/en/