What to Expect From Alcohol Withdrawal

Written by Steve Rose

Steve Rose, PhD, is an addiction specialist, counsellor, and rogue academic committed to making research engaging and accessible for all.

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As a chemical dependency counselor in a detox facility, I watched many people go through withdrawal from substances. Coming off opioids is the most painful, coming off stimulants leads to a lot of eating and sleeping, but coming off depressants like alcohol is the most dangerous. Although it is difficult, I’ve seen many people successfully go through the process and see the benefits of living a sober life.

Many people underestimate the danger of alcohol withdrawal since the substance is so widely available and socially acceptable.

The reason why alcohol withdrawal is so dangerous is because it can lead to severe seizures. While working with individuals coming off of alcohol, I had to keep a close eye on them, regularly monitoring their symptoms in case emergency medical support was required. 

Alcohol withdrawal symptoms range from mild shaking in the hands to severe anxiety, restlessness, and full-body trembling, depending on the severity of the substance use.

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.  

What is Alcohol Withdrawal?

Alcohol withdrawal happens when a person dependent upon alcohol suddenly stops drinking or drastically reduces their intake. 

Alcohol withdrawal is the result of a neurological rebounding effect. The process is initiated by two categories of neurotransmitters: excitatory (stimulating) and inhibitory (relaxing). 

Excitatory neurotransmitters increase the likelihood that a neuron will fire an action potential. Inhibitory neurons are the exact opposite, and their effect decreases potential neural firing. Alcohol consumption increases inhibitory neurons and decreases excitatory neurons. 

The brain’s main inhibitory chemical is GABA (gamma-aminobutyric acid), and the main excitatory chemical is Glutamate. When a person drinks alcohol, the brain signals GABA to increase, and Glutamate decreases, resulting in the sedating effect. Over prolonged use, your brain adapts to the sedation by boosting Glutamate, resulting in tolerance to alcohol. Therefore, you need more alcohol to get the same sedating effect since your brain’s Glutamate system is on overdrive to counterbalance the increased GABA.

If you suddenly stop consuming alcohol after your brain habituates to being sedated by its effects, your brain is pushed off balance into a hyper-stimulated state. As described before, this can mean shaking, anxiety, restlessness, or seizures.

Alcohol Withdrawal Severity

According to a person’s level of physical alcohol dependence, symptoms will vary. This dependence severity includes the amount of alcohol, the frequency of consumption, and the length of time this level of consumption has been occurring.

The American Academy of Family Physicians have identified three stages a person experiencing withdrawal may go through:

Stage one (mild):

This is the beginning of alcohol withdrawal symptoms such as hand tremors, gastrointestinal issues, mild anxiety, headaches, and insomnia. This may be the extent of the symptoms for many people experiencing withdrawal. 

Stage two (moderate):

Along with the symptoms of stage one in mild frequency, stage two symptoms will include increased abnormal rapid breathing, increased blood pressure, and mild hyperthermia. This stage is from 1-3 days after discontinuing alcohol.

Stage three (severe):

Stage 3 includes symptoms of stage two and may also cause hallucinations, seizures, attentional issues, and disorientation. This stage can start at a week and can last up to several weeks.

While the specific alcohol withdrawal symptoms will vary from person to person, these stages are a rough guideline to categorize severity. If you are experiencing symptoms, it is important to seek immediate medical support. 

Although most people recover from their symptoms without medical detox, support from a medical professional can minimize risk.

A Timeline of What to Expect

Alcohol detox symptoms can occur for up to 5-10 days after your last drink. Most detox facilities offer 24-hour supervision for five days, covering the period when you are most at risk. Although it is different for everyone, here is a general timeline of what to expect: 

6-12 hours after last drink

The mild symptoms of stage 1 may start to appear, including mild anxiety, headaches, insomnia, and upset stomach.

24 hours after last drink

Some people start to experience hallucinations at this point, including visual, tactile, and auditory hallucinations. However, this is not common for persons going through mild withdrawal.

24-72 hours after last drink

At the 24-48 hour mark, seizure risk increases. Again, seek medical supervision if the shaking in the hands becomes severe or you have a history of seizures. From 48-72 hours, withdrawal delirium may also appear. 

After the acute symptoms subside, some people may experience fatigue, mood changes, and sleep disturbances for months as the brain continues to adjust. 

Treatment for Alcohol Withdrawal 

Detox is the first step in treatment if you are experiencing alcohol withdrawal. It is essential to talk to your doctor or seek support from a local withdrawal facility during this stage of the process. 

A standard prescription protocol given by medical doctors for alcohol withdrawal consists of a benzodiazepine taper. In plain language, this generally consists of being prescribed an anti-anxiety medication like Valium over five days, slowly lowering the dosage each day. 

The benzodiazepine taper can be ordered for a person to do at home with constant supervision or in a withdrawal facility under the supervision of nursing staff or chemical dependency counselors.

Other commonly prescribed medications include clonidine to manage acute high blood pressure and extra strength ibuprofen to manage the discomfort.  

Although treating the physical symptoms is the first step, there is a high likelihood of relapse if it is not immediately followed by counseling or residential programming. This is because the detox only addresses the physical aspects of withdrawal and not the cognitive or behavioral characteristics of the addiction. 

Inpatient or residential treatments

Inpatient treatments involve around-the-clock support and programming. Some residential treatment facilities offer medical detox, and most offer group therapy, individual therapies, and other recreational activities. Some may also provide aftercare groups or more intensive aftercare programming such as a sober house.

Outpatient treatments

Outpatient treatments consist of individual counseling, such as the service I offer. This includes having weekly or bi-weekly conversations about the cognitive and behavioral elements driving the addiction and developing a plan to navigate challenging situations, reducing the risk of relapse effectively. 

Outpatient group therapies can also be another option for treatment. This generally consists of attending a regularly scheduled group program. One of the benefits of outpatient treatment is that you can practice skills in your real-world context between sessions, integrating them into your daily life. 

Another resource that can be drawn on after detox includes peer-support groups such as 12 step AA meetings. The benefit of 12 step programming is that it is free and widely available. 

The 12 step process also allows individuals to gain a mentor in the form of a “sponsor”. This person helps guide you through the steps, often offering immediate peer-support when thoughts of relapsing occur. This kind of programming gives a sense of belonging, connection, structure, and the sense of not being alone in one’s struggles.  

Conclusion 

Recovery can be challenging at times, but with the proper support, you can safely make it through the process. The initial stage of withdrawal can be physically demanding, and the long-term process can be psychologically challenging. 

If you notice signs of alcohol withdrawal, it is crucial to seek immediate medical support. Talk to your doctor if you plan to discontinue alcohol after a sustained period of regular use. This is especially important if you have a history of seizures. 

Getting over the initial physical symptoms allows you to seek ongoing forms of psychological support where you can delve into what drives your addiction and how to move forward more effectively, gaining long-term freedom from addiction. 

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Want to Try Online Counseling?

Here are a few options worth checking out:

BetterHelp.com is one of the most flexible forms of online counseling. Their main benefit is lower costs, high accessibility through their mobile app, and the ability to switch counselors quickly and easily, until you find the right fit.

It’s almost like having a counselor in your pocket, since you can text, voice-message, or set up video calls whenever you need support. 

For persons struggling with anxious thoughts, depressed moods, low self-esteem, low motivation, or loneliness, check out Better Help here.

Online-therapy.com also offers support for persons looking to optimize their mental toolbox. Click here to learn more about their program based on the evidence-based practice of Cognitive-behavioral Therapy (CBT).

*As an affiliate partner with Better Help and Online-therapy.com, I may receive a referral fee if you purchase products or services through the links provided.

If you are looking for a specialist near you, use the Psychology Today therapist directory here. Although prices are generally higher on this directory, many of the practitioners accept insurance. 

As always, it is important to be critical when seeking help, since the quality of counselors are not consistent. If you are not feeling supported, it may be helpful to seek out another practitioner. I wrote an article on things to consider here.


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