Withdrawal from Alcohol
Alcohol withdrawal is different for everyone and heavily dependent on genetics, type of alcohol consumption, and how long you’ve been dependent on the substance.Last updated: December 17, 2018
Alcoholics who drink heavily and often are more likely to develop a dependency on the substance. As a result, it is possible to go through alcohol withdrawal when the person suddenly stops. The severity of the symptoms will be very different depending on how much the person was drinking, how often the person was drinking, how long the person has been drinking for, and if they’re genetically predisposed to alcohol.
For people dependent on alcohol, most will start to experience withdrawal symptoms 24 hours after their last drink, but some people have been known to experience symptoms as early as six hours after their last drink. Typically alcohol withdrawal lasts no more than two weeks.
Why People Experience Alcohol Withdrawal
Unlike commonly abused stimulant drugs, alcohol is a depressant. It slows down brain function and, consequentally, all bodily functions. This makes it harder for alcoholics to stay focused on a task, takes them longer to react, and even stay awake. People suffering from Alcohol Use Disorder (AUD) tend to experience alcohol withdrawal because their central nervous system (CNS) has grown used to working twice as hard to keep the brain and body functioning. When alcohol is removed from their system, their CNS remains in this state (the new normal) which is effectively what causes the withdrawal symptoms.
Alcohol withdrawal has three stages of side effects:
Stage 1 Symptoms
The stage 1 symptoms are mild and usually occur within the first 24 hours since your last drink.
- Abdominal pain
- Loss of appetite
- Difficulty thinking/problem solving
- Heart palpitations
It’s important to note that while these are common stage one symptoms for someone going through alcohol withdrawal, it is possible for someone to suffer from the moderate and severe symptoms as well. Although rare, some people have started to experience alcohol withdrawal, six hours after their last drink, and because of that some people actually start to experience seizures and even hallucinations within 24 hours. This is one (of many) reasons why it’s important to either detox in a treatment center or communicate with someone you love and trust to watch over you during this tumultuous time.
Stage 2 Symptoms
The stage 2 symptoms are more moderate, typically occurring on the first full day abstinent and lasting up to three days.
- Irregular heart rate
- Mental confusion
- Regular sweating
- Mood swings
- Increased blood pressure
- Heightened body temperature
- Rapid or irregular respiration
Stage 3 Symptoms
Stage 3 symptoms start around day four and continue through day seven. Although for many people these symptoms continue for several weeks afterwards. This is when the symptoms of alcohol withdrawal are most severe.
- Severe confusion
- Dehydration (sweating)
- Agitation and heightened irritability
In addition to all these symptoms however, 3-5% of people going through alcohol withdrawal will experience delirium tremens (DT) which can be fatal if gone untreated.
DTs can start in the moderate stage and worsen over the course of the withdrawal period. DTs occur because the central nervous system has been suppressed by alcohol for a long time. Alcohol enhances inhibitions and diminishes excitatory neurotransmitters. Long time alcohol use however causes the brain to work harder to compensate for the increase / decrease. When alcohol is removed, a rebalancing of chemicals needs to occur which is what results in a plethora of severe psychological symptoms (such as hallucinations), vivid nightmares and seizures.
This is one of the many reasons, people suffering from AUD should not try to ‘white knuckle’ their way through alcohol withdrawal.
Alcohol Withdrawal Treatment
As any alcoholic can tell you, the initial withdrawal – while taxing – is not biggest challenge. The biggest challenge is the day-to-day mental challenge that follows.
In regards to treatment, most medical facilities provide medications to control the physical symptoms. This way, nausea, dehydration, and insomnia can be dealt with without suffering or relapsing. In addition, many medical centers prescribe benzodiazepines in an effort to avoid DT. Again, the reason is, DT is caused by the overactivity of the CNS, so the benzodiazepines is used to lessen that sudden stimulation and help the body achieve a better balance.
Medical facilities also use medication to curb other potentially dangerous symptoms such as the irregular heartbeats, rapid respiration, and high blood pressure. Plus, many alcoholics suffer from malnutrition due to their addiction, so supplements are provided. In short, medical supervision is highly recommended to avoid relapsing or prolonged suffering. It’s meant to rebalance your body without the whiplash of withdrawal.
From there, the mental symptoms of withdrawal need to be dealt with. Some medical offices will prescribe medication to help with the initial symptoms of depression and anxiety, but others will not. The medications that are approved for dealing with alcohol use disorder are naltrexone, acamprosate and disulfiram. Naltrexone helps recovering alcoholics by blocking opioid receptors in the brain. Opioid receptors are a contributing factor to “instant gratification”, so this reduces the “reward” or “immediate” part of the brain and subsequently the cravings for the substance as well. Meanwhile acamprosate seems to have a long-lasting impact on treating AUD withdrawal symptoms and disulfiram is supposed to make people sick if they drink alcohol, thereby making the thought of drinking undesirable – more of a short term fix.
There is a fourth drug (topiramate) that is undergoing tests and seems to change the way alcohol rewards drinkers – namely, by not – but it is not yet FDA approved.
Not all medical facilities will offer prescription drugs, but almost all will prescribe some counseling treatment and/or therapy sessions as part of the recovery process. This can be a 12-step program or one-on-one counseling. This is instrumental in long-term care, continued abstinence, and ongoing support.