Alcohol Withdrawal: Common Symptoms & Treatment

Alcohol is one of the most widely consumed intoxicants in the world. In the US, people can legally drink alcohol when they reach age 21, but many adolescents and young adults illegally consume alcohol. Although there are many people who consume alcohol in moderate amounts and never experience problems aside from an occasional hangover, there are thousands of adolescents and adults in both the US and the world who suffer from severe problem drinking.

A person struggling with alcohol may have alcohol use disorder. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that 16 million US adults, ages 18 and older, struggle with AUD. In addition, millions of adults engage in binge drinking and heavy drinking, which can cause serious acute and chronic harm to a person’s health. The Centers for Disease Control and Prevention (CDC) estimates that 88,000 people die every year from complications involving problematic alcohol use. Excessive drinking was responsible for one in 10 deaths among adults, ages 20-64.

Withdrawing from Alcohol Abuse

People who struggle with alcohol use disorder will at one stage of their addiction realize that they compulsively consume alcohol and they have a problem. They may attempt to stop on their own; however, if their body has become dependent on the presence of alcohol to produce neurotransmitters and feel normal, they will experience withdrawal symptoms.

Withdrawing from alcohol abuse can be complicated, as several symptoms are serious and life-threatening. It is important to get help from medical professionals who specialize in treating alcohol use disorder when attempting to overcome this addiction. The physical complications are a large part of the reason this help is necessary.

Symptoms from alcohol withdrawal begin as soon as two hours after the person’s last drink; depending on how long the person has struggled with problem drinking, how much they drank, and how dependent their body is on the presence of alcohol, these symptoms may clear up in a matter of days, or they could last for weeks. In some instances, alcohol withdrawal symptoms can turn into a dangerous condition called delirium tremens.

Symptoms from Alcohol Withdrawal

Mild Alcohol Withdrawal Symptoms

While many people who begin withdrawing from heavy alcohol use may not characterize their symptoms as “mild,” the common symptoms most people experience are not physically dangerous. These include:

• Shakiness or tremors
• Nervousness
• Irritability and mood swings
• Anxiety
• Panic attacks
• Depression
• Nightmares
• Insomnia
• Other sleep disturbances
• Sweating
• Clammy skin
• Headache
• Loss of appetite
• Nausea
• Rapid heartbeat

These symptoms may last for up to one week and can be uncomfortable, but they are not life-threatening.

Moderate Alcohol Withdrawal Symptoms

Symptoms considered “moderate,” which may need some medical attention, include confusion related to brain state changes from consuming alcohol and then quitting; damage to the cardiovascular system, including changes in heart rate and blood pressure, which may be exacerbated by physical stress after the person stops drinking; and malnutrition, both from nutrient deficiencies associated with consistent alcohol abuse and from nausea and appetite loss when the person quits.

Severe Alcohol Withdrawal Symptoms

Alcohol withdrawal may become severe enough that it turns into one of two syndromes: post-acute withdrawal syndrome (PAWS) or delirium tremens.

PAWS describes common withdrawal symptoms, especially psychological symptoms like mood disorders or cravings, which may continue for weeks after a person has stopped consuming a drug. The syndrome is typically associated with either alcohol or opioid addiction. For alcohol, post-acute withdrawal begins after one week. Some symptoms, like sleep abnormalities, can persist for one year after drinking has stopped.

Delirium tremens (DT) is a condition that may last for longer than one week, and it is life-threatening. Symptoms of DT include:

• Extreme agitation
• Delirium
• Physical tremors
• Disorientation
• Hallucinations
• Arrhythmia
• Raised heart rate and blood pressure
• Sweating
• Seizures

Between 1 percent and 5 percent of people who develop delirium tremens will die from the condition. Seizures can be deadly, and heart conditions, secondary infections like pneumonia, or undiagnosed problems like chronic pancreatitis or liver damage may also lead to death, triggered by the physical stress from DT.

Medical Treatment to Ease Alcohol Withdrawal Symptoms

When a person decides to overcome AUD or problem drinking, consulting a doctor is a very important first step. Medical attention may be required to prevent serious complications with PAWS or DT; however, even if a person does not develop these syndromes, working with a doctor to manage the discomfort of common withdrawal symptoms is helpful.

Mild symptoms, like nausea and headaches, can be managed with over-the-counter medications. People who are at risk for DT or PAWS may receive prescription medicines to help them ease off physical dependence. Benzodiazepines, like Valium or Librium, which are long-acting, may be prescribed in moderate doses. These drugs act on the GABA receptors in the brain, like alcohol, so they can be used with a tapering schedule to help a person avoid the most dangerous withdrawal symptoms. However, many medical professionals are cautious of this pharmacological management because benzodiazepines can be very addictive, and the body quickly develops a dependence on them. People who develop DTs may also receive anti-seizure medications or other medical interventions, so they can avoid the life-threatening effects of this syndrome.

Once the person has ended their physical dependence on alcohol, their doctor may prescribe a maintenance medication like naltrexone or acamprosate. These medications ease cravings, so the person will not want to drink and will not experience pleasure from drinking. Unlike earlier alcohol addiction treatments like disulfiram, these drugs do not cause a person to become nauseous when they consume alcohol; they simply don’t want to consume the intoxicating substance, and it does not change their neurotransmitter balance.

Maintenance medicines help the person focus on therapy to overcome their addiction while reducing the risk of relapse. This way, the person can change their behaviors around substances like alcohol and stay healthy for a long time.