Substance Use

Alcohol Withdrawal

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Alcohol Withdrawal Symptoms, Timeline & Detox Treatment Options

According to the National Institute on Alcohol Abuse and Alcoholism, in 2019, nearly 15 million people ages 12 and older had alcohol use disorder. 

Alcohol addiction is a common issue in the United States, with many experiencing an unhealthy relationship with the substance from a young age.

If you or your loved one struggles with alcohol, the withdrawal  process can be daunting. However, not seeking the treatment you need could be dangerous. Approximately 18.5% of emergency department visits are related to alcohol, making alcohol the third-leading preventable cause of death in the United States.

Learn more about alcohol withdrawal syndrome and how to seek help for yourself or a loved one.

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The Stages of Alcohol Withdrawal

If you would like help to overcome your struggles with alcohol use disorder, alcohol withdrawal and detox is the first step. Following a period of excessive alcohol use, users often experience alcohol withdrawal syndrome (AWS). 

  • Stage 1: Mild Symptoms (Lasts 6 hours to 7 days)
    • Nausea, anxiety, insomnia 
  • Stage 2: Serious Adverse Effects (Lasts 1 to 3 days)
    •  Seizures, tremors 
  • Stage 3: Delirium (Lasts 2 to 7 days)
    •  Fever, hallucinations, extreme confusion 
  • Stage 4: Post-Acute Withdrawal (Lasts 6 months to 2 years)
    • Insomnia, mood changes, irritability, sluggish cognitive performance, depression, anxiety 

This process can be uncomfortable, present severe symptoms, and even cause potentially life-threatening complications. That’s why individuals are not recommended to go through the alcohol withdrawal process without medical supervision.

Management of alcohol withdrawal symptoms by a trained provider is critical to the success of overcoming unhealthy alcohol intake, as well as, protecting the individual’s well-being.

What Are the Symptoms of Alcohol Withdrawal?

Alcohol withdrawal symptoms were studied as early as 400 B.C. Hippocrates recorded the first known clinical picture of alcohol withdrawal. He wrote that if a patient is “in the prime of life and if from drinking he has trembling hands,” it may well be the case that the patient is showing severe withdrawal symptoms.

Although the symptoms are well-established, alcohol withdrawal remains underrecognized and undertreated to this day. 

It has become normalized to drink heavily on a regular basis for many, and the quitting process and related symptoms fly under the radar. Symptoms can begin even if an individual still has significant blood alcohol concentrations. 

Level of Blood Alcohol Concentration & Related Effects

Alcohol withdrawal symptoms are uncomfortable. High intoxication levels increase your risk of early death, which is a daily occurrence for many.

Dealing with alcohol withdrawal syndrome is a safer and better long-term option as opposed to living with the severe complications of alcohol dependence.

These are the symptoms of intoxication that develop based on blood alcohol concentrations, although this can vary greatly depending on tolerance level, age, sex, weight, and other factors. 

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that blood alcohol concentrations correspond with clinical signs. 

  • 20-100 mg – Reduced coordination, mood changes, impairment
  • 101-200 mg – Speech impairment, reduced coordination, impaired thinking 
  • 201-300 mg – Memory blackouts, vomiting, impaired thinking and memory, reduced alertness 
  • 301-400 mg – Excessive sleepiness, amnesia, worsening of symptoms above 
  • 401-800 mg – Dangerous decreases in temperature, blood pressure, and pulse, increasing the risk of death or coma

The Dangers of Alcohol Withdrawal

The symptoms of alcohol withdrawal can cause the following:

  • Significant illness and death
  • Delirium tremens (DTs)
  • Seizures

The entire cluster of severe symptoms is known as acute alcohol withdrawal (AW). Although some individuals experience mild symptoms, the events and disease processes that accompany AW can be life-threatening. 

The symptoms associated with alcohol withdrawal can begin as early as six hours following the initial decline from peak intoxication.

The initial symptoms include:

  • Tremors 
  • Insomnia 
  • Anxiety 
  • Nausea 
  • Restlessness

Approximately 10% of patients will experience serious symptoms, including:

  • Rapid breathing 
  • Fever 
  • Severe tremors
  • Profuse sweating
  • Withdrawal seizures in approximately 5% of untreated individuals 
  • Delirium tremens, characterized by confusion, disorientation, and hallucinations

More on Seizures and Delirium Tremens

For those who experience alcohol-related seizures, over 90% occur within 48 hours after the individual stops drinking. The likelihood of these seizures and their severity increase with the number of past withdrawals based on cumulative long-term changes in brain excitability.

Medications can be given in a medical detoxification setting to target this dangerous symptom

Delirium tremens typically develop 1 to 4 days after the onset of alcohol withdrawal. These symptoms develop among those who have been drinking excessively for years. Warning signs include hallucinations and extreme hyperactivity.

Sadly, the mortality rate among those suffering from delirium tremens is around 5%, but it may be as high as 25%. However, this risk drops significantly when the individual receives medical support. 

Research shows that approximately 50% of patients who experience a withdrawal seizure will progress to have delirium tremens. 

What Causes Alcohol Withdrawal?

Alcohol withdrawal is a clinical syndrome that has serious potential consequences both physically, mentally, and emotionally. 

This syndrome is caused by prolonged, excessive alcohol use, which leads to tolerance and physical dependence. Following long-term exposure, if a person discontinues alcohol use, the central nervous system becomes hyper-excitable.

Without alcohol, there is a lack of the sedative effect your brain is used to, which causes the alcohol-related physical complications discussed above. 

There are some predictors concerning alcohol withdrawal including:

  • Men who consume more than eight standard drinks daily and women who have more than six standard drinks daily 
  • Individuals who drink daily, at this level, for at least two weeks (withdrawal is unlikely among binge drinkers)
  • If a person’s last drink was consumed in the past six to 24 hours 
  • If a person has experienced a withdrawal syndrome in the past 
  • If the person has their first drink in the morning 

To better understand alcohol withdrawal, you must consider this substance’s mechanism of action. 

Alcohol Consumption & Effects on the Body

Alcohol is a central nervous system depressant. When you consume alcohol, it affects your brain and body in several ways. Within the brain, it targets specific neurochemicals. For example, it inhibits glutamate while enhancing GABA. Normally, these two chemicals are balanced. 

Since GABA increases, alcohol reduces feelings of fear and anxiety. It has a calming effect. However, when individuals drink alcohol regularly long-term and then suddenly stop, the central nervous system experiences an excitement overload. 

Long-term, alcohol decreases the number of GABA receptors, which means users have to drink larger doses of alcohol to achieve the same effect. This effect is known as tolerance and acts as the first major stepping stone toward dependence.

When you’re physically dependent on alcohol, discontinuing use means withdrawal syndrome will surface and the related severe symptoms will take place.

With chronic alcohol use, users experience increases in glutamate to maintain balance with increasing GABA levels. When alcohol use is stopped, this results in high levels of glutamate, resulting in tremors, sweating, neuropsychiatric complications, seizures, etc. 

This complex process involves several brain regions and other brain chemicals, including dopamine.

How Long Does Alcohol Withdrawal Take?

Alcohol withdrawal happens in several stages. How these stages unravel depends on variables such as the level of dependence, your environment, and your overall health status. You may only experience stage one, whereas someone else will experience all stages. 

Overall, this timeline will vary. However, most people will experience stage one symptoms 6-12 hours after their last drink. At this point, symptoms are mild and, although uncomfortable, they’re manageable. 

Within 24 hours, symptoms are significant enough to impair function and may be severe enough to require medical attention. Most symptoms will peak within 24 hours.

For the next 48 hours, symptoms will slowly level off, but this time frame is not easy. As discussed above, many people experience seizures within the first 48 hours. 

The key is to seek professional assistance. When symptoms are properly managed under clinical supervision, the vast majority of people fully recover. At this point, they can begin their journey toward long-term sobriety, which will require an individualized treatment plan.

Safely Treating Alcohol Withdrawal

The alcohol detoxification process should not be attempted without medical supervision. Alcohol use disorders can be multilayered and complex in nature.

For an individual who has a long-term dependence on the substance, and wishes to quit, a healing plan is a necessary first step. A clinical institute withdrawal assessment will help a medical professional understand the best course of action to safely treat alcohol withdrawal.

Alcohol is one of the most dangerous substances to withdraw from because of the way it influences the central nervous system. 

Appropriate alcohol withdrawal treatment can effectively relieve your discomfort, keep you safe, and help reduce the risk of cumulative effects that may worsen in the future. Although many individuals experiencing mild symptoms can be treated via outpatient services, the safest setting is a medical detox facility. 

Withdrawal Symptoms Impacting Other Health Conditions

One of the primary concerns of alcohol detox is the medical disorders that often co-occur with alcoholism. These disorders can exacerbate symptoms.

For example, patients may have an irregular heartbeat or inadequate heart function, liver disease, infectious diseases, gastrointestinal bleeding, or nervous system impairment. These disorders need to be considered when monitoring vital signs and administering medications. 

Alcohol Withdrawal & Mental Health

Co-occurring mental health conditions are also a cause for concern. However, these disorders are addressed in more detail following the detoxification period.

There is a strong relationship between mental health conditions and substance use disorders. In many cases, mental health symptoms lead to excessive drinking or drug use to help mask what the individual is feeling. It is a form of self-medication that creates a dangerous cycle. 

Data shows that one in four adults living with a serious mental health condition also has a substance abuse problem.

Common co-occurring conditions include:

  • Anxiety disorders
  • Schizophrenia
  • Depression
  • Personality disorders

To ensure long-term success, this will be addressed within your personalized treatment plan. Therapy will be recommended as well as other holistic, evidence-based approaches. However, to get to this point, you must first successfully detox.

The setting in which you withdraw from alcohol will make a significant difference. For example, you should seek a low-lighting room with minimal stimulation. 

This can be challenging, as there is nothing to distract you. To help you through the most uncomfortable symptoms, medications may be required. 

Prescribed Medication For Alcohol Withdrawal

Several types of medications may be administered throughout the detoxification period, depending on your symptoms and any pre-existing medical conditions. These medications will often target specific symptoms, helping individuals remain as comfortable and safe as possible. 

For example, individuals at risk of seizures may be given lorazepam. To prevent Werknicke’s encephalopathy (WE), induced by a vitamin B1 deficiency, supplementation may be required. 

Today, benzodiazepines are commonly administered to help prevent alcohol withdrawal symptoms such as seizures.  

For mild cases, medications may not be required. Sometimes, individuals simply need a quiet, supportive environment that is calm and understanding. The key is to be in a place where you’re monitored so that further action can be taken if need be.

Can You Withdraw From Alcohol Without Medications?

People do successfully detox from alcohol without the use of medication. However, the management of alcohol withdrawal without medication can be dangerous.

There are currently no screening techniques to predict with confidence that someone will not experience life-threatening complications during this process. The risk of a seizure is fairly high, especially among those with a history of alcohol withdrawal seizures. 

As discussed, individuals with mild symptoms do not typically require medication-assisted treatment. When symptoms are moderate to severe, however, a higher level of care is highly recommended.

Some options for those who do not receive medication include:

  • Adequate fluids
  • Adequate sleep
  • Maintenance of an alcohol-free environment
  • Ongoing interpersonal support

When to Contact a Medical Professional Regarding Alcohol Withdrawal

There is no need to fear alcohol withdrawal when you have the support of a professional clinical team. Not taking this critical step can increase your risk of the dangerous, potentially deadly complications that come with alcoholism.

You can overcome your alcohol addiction and then address any underlying conditions that trigger your urge to drink. Building a life that’s fulfilling and free from the grip of alcohol is possible — but first, you’ll need to complete the alcohol withdrawal process. 

Support is available to help you do just that. With professional care, you’ll remain safe and comfortable. Take back control of your health, life, and future. Reach out to our free alcohol addiction hotline today at (855) 430-9439.

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