Alcohol Withdrawal: Signs, Timeline, and Diagnosis

Last updated on December 8, 2022

People who suddenly stop consuming alcohol are particularly prone to experiencing alcohol withdrawal symptoms. These symptoms can differ in scope, duration, and intensity. They usually arise as a consequence of prolonged alcohol consumption and the way it affects one’s brain. By altering the function of an alcoholic’s brain, heavy alcohol use brings about a whole host of unpleasant symptoms. The causes of this kind of condition need to be promptly addressed with therapy and medication in order to avoid the dangers associated with alcohol withdrawal.1

What Are the Signs of Alcohol Withdrawal?

A number of symptoms accompany the alcohol withdrawal process. The severity of symptoms depends on a whole range of factors, such as sex, age, body type, and drinking habits. People who only experience mild symptoms usually feel:

Nausea
Vomiting
Sweating
Heart rate irregularities
Headache
Agitation
Anxiety
Insomnia

Other signs of alcohol withdrawal are, however, much more severe and can even lead to death. These symptoms usually constitute delirium tremens (DT) and are characterized by:

Increased body temperature
Severe tremors
Elevated blood pressure
Hallucinations
Extreme disorientation
Seizures

People who suffer from severe alcohol use disorder (AUD) who notice any of the signs of DT should call their physicians without delay. DT can lead to severe breathing and/or circulation obstructions. In case of severe heart rate or blood pressure irregularities, DT can even lead to stroke or heart attack. It is believed that around 5 percent of people going through alcohol withdrawal experience delirium tremens.2,3

What Medication Is Used for Alcohol Withdrawal?

Using alcohol withdrawal medication can present a very effective way to counteract hazardous symptoms. One of the most commonly used medicines is acamprosate (frequently sold as Campral). This medication helps patients restore the neurochemical balance they possessed before they developed an alcohol addiction.4

Besides getting the brain chemistry back in order, it is important to discourage future alcohol consumption. Naltrexone is a drug that is commonly used for this purpose. By blocking the effects that give people pleasure after they drink alcohol, naltrexone is very effective in fostering recovery. Disulfiram (also known as Antabuse) can achieve similar results by making people feel bad after they drink alcohol. In addition to these more characteristic types of alcohol withdrawal medication, doctors also frequently prescribe benzodiazepines, which alleviate some of the alcohol withdrawal symptoms.4

How to Prevent Alcohol Withdrawal?

Obviously, the most effective way to prevent alcohol withdrawal symptoms is to stop drinking or at least limit alcohol consumption. As these symptoms typically affect people who are trying to get off from alcohol, it is recommended to follow a strategy that will minimize the risk of unpleasant and dangerous experiences. Instead of going cold turkey, which is believed to significantly increase the likelihood that severe withdrawal symptoms will arise, patients are advised to gradually wean off from alcohol until they reach a point where they are feeling well even though they drink only small or no quantities of alcohol.5

Timeline of Alcohol Withdrawal

The alcohol withdrawal process usually follows a more or less predictable timeline which can help in putting a patient’s acute symptoms in context. Experts from the American Academy of Family Physicians have delineated three steps that an alcohol withdrawal sufferer may need to go through:6

Stage 1 (mild symptoms). This stage is characterized by somewhat light symptoms such as gastrointestinal pain, headache, insomnia, anxiety, and hand tremors.

Stage 2 (moderate symptoms). Some of the people experiencing mild symptoms may go on to experience something more severe. Mild hyperthermia, rapid breathing, confusion, high blood pressure, and elevated heart rate are the symptoms that may accompany the milder ones during stage 2.

Stage 3 (severe symptoms). At this stage, things may start getting much more serious. Alcohol withdrawal symptoms that join the previously mentioned ones include disorientation, impaired attention, hallucinations, and seizures. If left untreated, these conditions may lead to life-threatening complications.

These stages of alcohol withdrawal commonly follow a pattern that indicates how long it would take for certain symptoms to develop. It often takes just a few hours for certain symptoms to develop into something much more serious. This is why patients should act as soon as they start feeling bad:1,6,7

Initial symptoms, which are usually mild, start developing somewhen between 6 and 12 hours following the consumption of the last drink. Stomach discomfort, mild anxiety, headaches, and insomnia are the typical signs that occur throughout this stage and should be carefully monitored.
A period from 12 to 24 hours is how long it takes for more severe symptoms to arise. These can involve hand tremors and various sorts of hallucinations (both visual and auditory).
The most crucial part of the alcohol withdrawal process occurs between 24 and 72 hours after the last drinking session. This is the period when addiction sufferers may need to experience grave symptoms such as high blood pressure, high fever, hallucinations, and seizures. Due to the numerous risks associated with these phases, patients should be constantly monitored to achieve the best outcome.
Once a 72-hour threshold is reached, patients should feel relieved. The majority of symptoms will start being less pronounced and up until two weeks following the last drink they should be mostly gone.

What Causes Alcohol Withdrawal?

The direct cause of alcohol withdrawal symptoms is an abrupt cessation of drinking. The underlying cause of alcohol withdrawal, however, is the heavy drinking that brought the person to alcohol addiction in the first place. Most prominently, excessive alcohol consumption caused disturbances in the functioning of neurotransmitters.1

These effects on one’s neurochemistry are reinforced by pleasant and soothing experiences caused by alcohol consumption. Over time, prolonged consumption leads to the development of alcohol dependence, which then further deteriorates brain function. Once a person stops consuming alcohol, alcohol withdrawal symptoms arise as a way for the brain to adjust to the input changes it receives.1

How Is Alcohol Withdrawal Diagnosed?

The first part of alcohol withdrawal diagnosis includes a review of a patient’s medical history and a physical exam. What doctors usually look for during this exam is the presence of any hand tremors, dehydration, irregular heartbeat, or high fever. To conduct the most precise physical exams, doctors resort to various standardized tests. One of the best-known is the Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) questionnaire. This questionnaire contains a number of questions designed to determine the level of presence of certain symptoms. Some of the symptoms assessed by CIWA-Ar include headache, anxiety, sensory disturbances, and uncontrollable swelling, as well as nausea and vomiting.8

Once the initial examinations are completed, many alcohol withdrawal patients get referred to toxicology screening tests. Most commonly, urine and/or blood samples are taken so that medical experts can check for the level of alcohol poisoning in patients’ bodies. Sometimes, patients may also need to provide samples of hair or saliva. All these tests serve to identify the extent of alcohol addiction and guide future therapy.8