Alcohol Withdrawal Symptoms

Alcohol withdrawal results from slowing or stopping drinking after being a heavy drinker for some period of time.

The withdrawal signals that the brain and body have become dependent on alcohol.

The resulting symptoms are uncomfortable, can be life-threatening, and can easily cause a relapse in drinking.

They may include difficulty sleeping, tremors, sweating, nausea, anxiety, agitation and, in severe instances, seizures and hallucinations.

These symptoms are unique to withdrawal from substances in that they can be fatal if severe and if not medically treated. It is never safe to try to go through alcohol withdrawal alone, and the best option is to be medically supervised.

Medical treatment can save a person’s life and make the process of withdrawal more comfortable. Anyone who is showing signs of withdrawal from alcohol should be treated immediately.

Alcohol withdrawal is both a medical and a psychological condition caused by cessation of drinking. It occurs in people who are heavy, frequent drinkers and who meet the criteria for an alcohol use disorder. The hangover that a person experiences after drinking too much is not the same as withdrawal. Withdrawal only occurs after an individual has been drinking too heavily for a long period of time and has developed a physical dependence on it. Alcohol withdrawal is very serious and can be harmful or even fatal. It needs to be medically treated.

There are many possible symptoms that can be triggered by abstaining from alcohol in someone who has an alcohol use disorder. The symptoms experienced and their severity depend on how long and how heavily a person has been drinking, how severe the disorder is, and individual factors like mental and physical health. The most characteristic symptoms of alcohol withdrawal include:

• Insomnia
• Tremors or shaking
• Sweating and racing heart rate
• Nausea with or without vomiting
• Agitation, restlessness
• Anxiety
• Seizures
• Hallucinations

Hallucinations and seizures are rare symptoms, but also possible and very dangerous. They should be treated as a medical emergency.

The characteristic symptoms of withdrawal from alcohol are used to diagnose the condition, but there is also a range of other symptoms that a person may experience, including:

• Depression
• Fatigue
• Nightmares
• Mood swings
• Difficulty thinking, confusion
• Appetite loss
• Enlarged pupils
• Headaches
• Jumpiness
• Irritability

In most cases it is obvious when a person is struggling with alcohol withdrawal. It is generally a self-diagnosable condition, but the DSM-5, the guidebook used by mental health professionals to diagnose conditions, does set out certain criteria that must be met to make a diagnosis of alcohol withdrawal:

• Two or more of the characteristic symptoms of alcohol withdrawal
• Symptoms that occur between several hours and a few days of stopping drinking
• Significant impairment in normal activities or significant distress caused by the symptoms
• Symptoms that cannot be found to have been caused by anything other than cessation of drinking, such as another substance or another medical condition

A severe form of alcohol withdrawal is called delirium tremens. It occurs in people with the most severe forms of alcohol use disorder and those who drink very heavily, frequently, and over a long period of time. It is also more common in people who have experienced alcohol withdrawal in the past. Delirium tremens can be triggered by stopping drinking but also by a head injury or infection in heavy drinkers.

A heavy drinker or a person with a severe alcohol use disorder in this context means someone who has been drinking the equivalent of seven to eight pints of beer, four to five pints of wine, or one pint of hard liquor every day for months or someone who has struggled with an alcohol use disorder for 10 years or more. Symptoms of delirium tremens include:

• Delirium, or profound confusion
• Tremors throughout the body
• Mental deterioration
• Sleeping deeply for a day or more
• Agitation and irritability
• Hallucinations
• Irrational fear
• Mood swings
• Sudden bursts of energy
• Sensitivity to light, touch, or sound
• Fatigue or stupor

Seizures may also occur with delirium tremens. They are most common during the 12-to-48 hours following a final drink and are typically generalized tonic-clonic seizures. Formerly known as grand mal seizures, tonic-clonic seizures are characterized by rigid muscles, contractions, and convulsions throughout the body. A person going through delirium tremens may also experience any of the other signs of alcohol withdrawal.

Delirium tremens can be life-threatening. It should be treated immediately and as a medical emergency. Treatment is focused on keeping the individual alive through life support and medications, fluids, electrolytes, and psychiatric care to relieve symptoms and keep the person calm as they recover.

If the symptoms of alcohol withdrawal persist beyond when they would be expected to stop, a person may be diagnosed with protracted withdrawal syndrome. This is not common, but some people experience symptoms for up to a year. The most common symptoms in these cases are tremors, insomnia, depression, anxiety, elevated heart rate and breathing, fatigue, and decreased metabolism, the latter of which can lead to weight gain. This condition is important to recognize and manage, because the ongoing symptoms are not just uncomfortable—they can also lead to relapse.

In addition to the uncomfortable symptoms that alcohol withdrawal causes, there are also many potential complications. Some of these may be short-lived and temporary, while others are long-lasting or even permanent. For instance, mental illnesses may be triggered during withdrawal and can persist for a long time after, requiring treatment. Most common are anxiety disorders and depression.

Many of the symptoms of alcohol withdrawal can cause physical injuries as complications: tremors, hallucinations, seizures, and an inability to sleep and resulting tiredness. Mood swings and irritability can cause a person to lash out and get hurt or hurt someone else. Alcohol withdrawal may cause temporary or permanent memory issues. And, of course most serious of all, withdrawal can lead to death.

Detoxing from alcohol should never be done alone, and ideally it is done with medical supervision. This is a type of withdrawal that can actually be fatal. The immediate goals of treatment are to keep a person safe and to prevent them from dying. This may be done in a hospital, depending on the severity of the illness and symptoms, but it can also be done in a detox facility with medical staff. Initial treatments include monitoring vital signs, administering fluids and medications, and sometimes sedating the patient. Medications that may be used to treat alcohol withdrawal include anti-anxiety medications and antipsychotics.

Emergency and immediate treatment for alcohol withdrawal may save a patient’s life, but it is not enough to help over the long-term. There are other medical and psychiatric issues to treat that are caused by heavy drinking and withdrawal. These may include nutritional deficiencies, organ damage, or mental illnesses like depression.

Patients who have gone through withdrawal also need ongoing care for alcohol use disorder to prevent relapse and to encourage a healthier lifestyle in recovery. This may be given in outpatient or residential care and generally includes various types of behavioral therapies and counseling, medications, support groups, family therapy and education, and ongoing treatment for mental illness and physical health issues.

The outlook for someone who has gone through alcohol withdrawal varies depending on the severity of the symptoms and the damage that drinking has caused to the body and brain. Even when treatment saves a life, there can be ongoing complications and symptoms as well as a serious risk of drinking again. The best prognoses are for those people who manage to abstain, keep up with ongoing alcohol use disorder treatment, and who make healthy lifestyle changes and rely on friends and family for positive support.