Alcohol Withdrawal Symptoms

Withdrawal occurs when the body and brain are no longer getting something they are addicted to or dependent on. A typical example of withdrawal is getting a headache if you don’t drink your morning coffee.

Alcohol withdrawal results from the body and brain reacting negatively to alcohol leaving the system after a period of alcohol abuse.  It commonly occurs in people who quit drinking as part of their recovery from alcohol addiction.

What Is Alcohol Withdrawal?

Alcohol withdrawal is a sign of alcohol use disorder. It occurs when someone who has been drinking alcohol for a long time suddenly stops drinking. Alcohol withdrawal is the body’s natural reaction to cutting off alcohol consumption after it has grown accustomed to and dependent on it.

The physical dependence on alcohol causes withdrawal syndrome, which can be dangerous and potentially life-threatening.

Doctors should medically supervise withdrawal from alcohol to ensure a person’s safety. If you suspect someone is withdrawing from alcohol, seek medical care immediately.

What Causes Alcohol Withdrawal?

When you stop drinking alcohol after your body has become dependent on it, you may experience withdrawal symptoms. Alcohol withdrawal occurs because of the way alcohol interacts with the brain.

Alcohol is a central nervous system depressant with sedation effects. It causes the brain to produce more gamma-aminobutyric acid (GABA) and less glutamate.

GABA is the neurotransmitter (brain messaging chemical) that makes you feel calm and euphoric, while glutamate is what makes you feel excited.

Because the effects of alcohol create this chemical imbalance, the brain starts producing less GABA and more glutamate to try to balance itself.

When you suddenly stop drinking, your brain can’t reverse this imbalance, which leads to alcohol withdrawal symptoms.

Timeline of Alcohol Withdrawal Symptoms

The symptoms associated with alcohol withdrawal can range from mild to potentially life-threatening, depending on the severity of a person’s alcohol dependency or addiction.

Below is a timeline of alcohol withdrawal symptoms you can expect during the withdrawal process.

First Six Hours After the Last Drink

You may experience common withdrawal symptoms as soon as six hours after your last drink of alcohol.

Mild symptoms during the first six hours typically include:

  • Nausea
  • Vomiting
  • Sweating
  • Hand tremors
  • Headache
  • Anxiety
  • Insomnia

Depending on the severity of the addiction, these alcohol withdrawal symptoms can last up to seven days.

Medical professionals may prescribe medications to alleviate some of these symptoms if you are going through withdrawal at a treatment center or detox facility.

12-48 Hours After the Last Drink

The second phase of alcohol withdrawal can begin as early as the 12-hour mark after stopping drinking. The symptoms associated with this stage are significantly more severe.

At this point, you may even experience hallucinations and confusion.

Other alcohol withdrawal symptoms during the second phase include:

  • Increased blood pressure
  • Increased heart rate
  • Rapid breathing
  • Mild hypothermia
  • Seizures

48-72 Hours After the Last Drink

People battling severe withdrawal symptoms may experience delirium tremens (DTs) by the third phase of alcohol withdrawal, or about 48 to 72 hours after quitting drinking alcohol.

Symptoms of DTs affect both physical and mental health and include:

  • Vivid visual or auditory hallucinations
  • Delusions
  • Disorientation
  • Rapid mood changes
  • Fever and/or hypothermia
  • Agitation
  • Sleepiness or fatigue
  • Energy bursts
  • Fever
  • Sweating
  • Racing heart
  • High blood pressure
  • Confusion
  • Seizures

If someone is undergoing DTs due to alcohol withdrawal, they should receive treatment under medical supervision before starting alcohol addiction treatment.

Delirium tremens is a dangerous part of the withdrawal process. Don’t risk your or your loved one’s health by attempting at-home detox.

How Do You Know If You’re Experiencing Alcohol Withdrawal?

If you’re wondering if you or a family member need help with alcohol withdrawal, you may need to perform a quick alcohol use self-assessment to see if you should seek care.

Ask yourself the following questions:

  • Are you feeling ill when you don’t drink alcohol (i.e., nausea, getting headaches)?
  • Do you feel anxious when you can’t drink?
  • Are you experiencing unusual symptoms when it’s been a while since you had a drink (i.e., confusion, agitation)?
  • Do your hands start to shake in the morning or after a period of not drinking?
  • Are you having trouble sleeping if you don’t drink first?
  • Do you experience rapid breathing or a racing heart when you can’t get a drink?

This is not medical advice, but if you answered ‘yes’ to these questions, and your alcohol use has become a big part of your life (for instance, you drink every day), you may be experiencing withdrawal symptoms.

How Do Doctors Diagnose Alcohol Withdrawal Syndrome?

The University of Maryland Medical School created the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) to help treatment professionals identify if someone is undergoing Alcohol Withdrawal Syndrome (AWS). The CIWA-Ar can also help determine the severity of a person’s withdrawal symptoms.

The CIWA-Ar measures the severity of the following ten withdrawal symptoms:

  • Nausea and vomiting
  • Tactile disturbances
  • Tremors
  • Auditory disturbances
  • Paroxysmal sweating
  • Visual disturbances
  • Anxiety
  • Headaches
  • Agitation
  • Cloudiness or the inability to think clearly

Healthcare providers can use the results of this assessment to help identify your condition and suggest the appropriate level of detoxification care and follow-up alcohol treatment program.

What Treatment Options Are There for Alcohol Withdrawal?

Treatment of alcohol withdrawal begins with an alcohol detox program. There are different levels of detox based on the severity of the withdrawal symptoms.

Before beginning treatment, it’s critical to consult a medical professional to determine the best and safest option for managing alcohol withdrawal.

Alcohol Detox Programs

The safest way to withdraw from alcohol is with medical detox. A medical detox program provides the care and supervision of trained medical professionals.

Also called medically supervised detox, this type of program offers 24-hour medical care to address withdrawal symptoms.

During alcohol detox, you might be prescribed medications to help cut down on cravings and alleviate some of the withdrawal symptoms, including withdrawal seizures.

Medications approved by the Food & Drug Administration for medical detox include:

  • Benzodiazepines such as Xanax (alprazolam), Valium (diazepam), or Ativan (lorazepam)
  • Vivitrol (naltrexone)
  • Antabuse (disulfiram)
  • Campral (acamprosate)

Doctors may also prescribe medications to restore your overall health, such as rebalanced electrolytes, psychiatry medications for mental disorders, and treatments for people battling symptoms of alcohol-related liver disease.

Alcohol Rehab Programs

Once you have completed detox, your doctor will likely recommend that you enter an inpatient or outpatient treatment program to continue treating your alcohol addiction.

During alcohol addiction treatment, you will participate in a variety of therapy sessions to help better understand what led to your addiction.

These therapy sessions will also offer ways to help you better manage triggers and cravings in the future without turning to alcohol again.

The best alcohol rehab centers also help set you up for a sober life after treatment. They may provide employment support, specialized job training, and sober housing connections.

Alcohol Recovery Support Groups

Support group meetings are a powerful resource during substance abuse treatment and in long-term recovery.

Support groups such as Alcoholics Anonymous (AA) provide safe, supportive environments to share what you are going through and hear from others with similar experiences.

People you meet in support groups may become your recovery peers, supporting your recovery journey. They may even help you find new, non-alcohol-related activities.

You can find AA meetings in your local area by visiting the Alcoholics Anonymous website and using their meeting finder tool.

Get Help for Yourself or a Loved One Facing Alcohol Withdrawal

When not treated properly, alcohol withdrawal symptoms can be dangerous and, in some cases, even life-threatening.

Call the SAMHSA helpline at 1-800-662-4357 or visit their online program locator to find alcohol addiction treatment options in your area.

Do you still have questions about the alcohol withdrawal process? Find answers to commonly asked questions here.

Alcohol Withdrawal FAQs

What does your body do when you stop drinking alcohol?

Alcohol withdrawal happens when you stop alcohol intake after you have formed a physical alcohol dependence.

This is your body’s reaction to removing a substance it has come to rely on to function normally.

What are the most serious withdrawal symptoms associated with alcoholism?

Some of the most severe symptoms of alcohol withdrawal occur in people with alcoholism or alcohol use disorder.

These include fever, seizures, confusion, hallucinations, and delusions and may result from delirium tremens, a severe form of alcohol withdrawal syndrome.

How quickly do alcohol withdrawal symptoms start?

The onset of alcohol withdrawal symptoms depends on the severity of a person’s alcohol use disorder, when they last drank alcohol, how often they typically drink, and the amount of alcohol they drink.

People who engage in heavy drinking regularly may see symptoms begin 6 to 8 hours after their last drink.

Is alcohol withdrawal treatable?

Alcohol withdrawal is treatable. The safest treatment options include medical supervision, such as medical detox programs, due to the risks associated with alcohol withdrawal.

Kent S. Hoffman, D.O. is a founder of Addiction GuideReviewed by:Kent S. Hoffman, D.O.

Chief Medical Officer

  • Fact-Checked
  • Editor

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the quality of our website’s content and messaging.

Jessica Miller is the Content Manager of Addiction GuideWritten by:

Content Manager

Jessica Miller is a USF graduate with a Bachelor’s Degree in English. She has written professionally for over a decade, from HR scripts and employee training to business marketing and company branding. In addition to writing, Jessica spent time in the healthcare sector (HR) and as a high school teacher. She has personally experienced the pitfalls of addiction and is delighted to bring her knowledge and writing skills together to support our mission. Jessica lives in St. Petersburg, FL with her husband and two dogs.

5 references
  1. American Society of Addiction Medicine (ASAM) (2022). “Alcohol Withdrawal Management Guidelines.” Retrieved December 14, 2022 from https://www.asam.org/quality-care/clinical-guidelines/alcohol-withdrawal-management-guideline.

  2. Harvard Health Publishing (2019, April 22). “Alcohol Withdrawal.” Retrieved December 14, 2022 from https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z.

  3. Mayo Clinic (2022). “Alcohol use disorder.” Retrieved December 14, 2022 from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243.

  4. National Institute on Alcohol Abuse and Alcoholism (2022). “Understanding Alcohol Use Disorder.” Retrieved December 14, 2022 from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder.

  5. StatPearls (2022). “Alcohol withdrawal.” Retrieved December 14, 2022 from https://www.statpearls.com/ArticleLibrary/viewarticle/17335.

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