Approximately 16 million people in the United States have an alcohol use disorder, defined by the National Institutes of Alcohol Abuse and Alcoholism as “compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.” Withdrawing from alcohol is one of the most dangerous and life-threatening side effects associated with alcohol abuse. Physicians state that alcohol is often the most dangerous substance for the body to withdraw from, especially when attempted without medical supervision. Symptoms of alcohol withdrawal usually begin 6 hours after the last drink and can last up to 4 days. The most critical period is 24-72 hours after the last sip as this is the timeframe where delirium tremors can occur.

Alcohol withdrawal symptoms

Mild symptoms (six-eight hours after the last drink): depression, anxiety, insomnia, nausea, headache, vomiting, mood swings; also known as the hangover phase

Moderate symptoms (12-48 hours after the last drink): high blood pressure, fever, irregular heartbeat, confusion, sweating.

Severe symptoms (48-72 hours after last drink): hallucinations, fever, seizures, confusion, and agitation.

Delirium tremors: The most severe form of alcohol withdrawal manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse. Altered mental state presents as delusions, confusion, anxiety, hallucinations, nightmares, restlessness, and agitation. Sympathetic overdrive includes chest pain, excessive sweating, excitement, fever, uncontrolled muscle spasms, seizures, increased heart rate, sensitivity to light and sounds, increased startle reflex, and stomach pain.

Medical Detoxification

Medical detoxification is necessary for severe withdrawal symptoms, and as a result, it is strongly advised that any individual experiencing the first signs of alcohol withdrawal seeks medical help immediately to prevent hallucinations, seizures, and cardiovascular collapse, which can lead to death. For those individuals experiencing the most severe symptom of alcohol withdrawal, shaking, shivering, sweating and delirium tremens, the death rate has been estimated as high as four percent, or one in 25. The Centers for Disease Control and Prevention counted 831 deaths in 2016 that could be characterized as related to alcohol withdrawal.

Alcohol withdrawal treatment

Individuals who are at risk of alcohol withdrawal should be monitored in a medical setting in case they require medications or medical intervention. A slowly tapered dose of benzodiazepines is usually administered to individuals to prevent severe withdrawal effects. Benzodiazepines work on the same receptors in the brain as alcohol and therefore can alleviate any of the physical withdrawal side effects since this class of medication is considered to be structurally and chemically similar to alcohol. Over time the individuals are weaned off of this benzodiazepine taper until they are no longer at risk of physical alcohol withdrawal symptoms. Individuals may still experience alcohol cravings and the desire to drink, and therefore, these individuals should undergo long-term alcohol treatment where they can develop coping skills to understand their triggers and control their cravings.

Are you at risk of alcohol withdrawal?

The following are common questions to ask yourself if you think you have an alcohol addiction that can result in withdrawal:

  • Have you ever tried to stop drinking for a week or longer but only lasted a couple of days?
  • Has your drinking ever caused you trouble at home?
  • Has your drinking ever caused you pain with your job?
  • Have you ever felt the need to have a drink in the morning to curb shakiness?
  • Do you have “blackouts”? A blackout occurs when you have been drinking for, and you cannot recall any events.
  • Do you drink when you are stressed out, disappointed, or are in a fight with someone?
  • Have you ever had withdrawal symptoms from alcohol? These can include a racing heart, nausea, vomiting, tremors, or seizures.
  • Have you ever operated a motor vehicle while under the influence?
  • Have you ever tried to hide your drinking habits from your friends or family?
  • Has anyone close to you expressed concern about your drinking?
  • Do you often find yourself in a hurry to have your first drink of the day?
  • Do you ever feel disappointed or uncomfortable if alcohol is not available in a social setting?