What is Alcohol Withdrawal?
Author: Thomas Roth
Last Updated: 2/07/2022
Alcohol withdrawal occurs when an alcoholic goes for an extended period without drinking. Symptoms of withdrawal vary from person to person, including how intense the symptoms are. The factors that influence this variation are the amount of time someone has been a chronic drinker, how long it has been since the last drink, other health complications, and if they have a mental illness.
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What are the Causes of Alcohol Withdrawal
Alcohol withdrawal is caused by changes in brain activity within people who have consumed/abused alcohol over long periods. While the science is still complicated and requires more research, the consensus is that withdrawal is the result of excitatory and inhibitory neurotransmitter activity.
These neurotransmitters get disrupted when someone consumes alcohol over long periods. The balance between them is held together by alcohol instead, which causes dependence. Once someone stops consuming alcohol, the brain needs to obtain balance again. The balancing process is what causes the withdrawal symptoms and it explains why the duration and intensity vary based on how long someone has been an alcoholic.
To take this further, gamma-aminobutyric acid (GABA) and glutamate are the two primary chemicals that lead to alcohol withdrawal symptoms. GABA is the brain’s inhibitory chemical, while glutamate is the brain’s excitatory chemical. When a person consumes alcohol the brain reduces the amount of GABA and increases the amount of glutamate, which causes the imbalance. As this process continues over years, a tolerance is built up. This tolerance can be used as an indicator for withdrawal.
Timeline of Alcohol Withdrawal Symptoms
Once an alcoholic stops drinking alcohol a timeline for withdrawal begins. This process can begin as soon as 4 hours after drinking and lasts until the next drink. When alcoholics stop drinking, GABA and glutamate chemicals fight for balance and this causes withdrawal. 80% of people who suffer from alcohol abuse disorder will experience some type of withdrawal when they stop drinking.
We’re going to take you through the symptoms and effects of alcohol withdrawal on the body over different lengths of time.
1. What Happens 6 Hours After You Stop Drinking?
We’ll begin with what happens 6 hours after you start drinking. After 6 hours, sometimes as soon as 4 hours, your body will start to show noticeable symptoms.
You’ll start to experience:
- Shaking (tremors)
- Blood pressure imbalances
- Nausea and vomiting
- Trouble breathing
- Heart rate inconsistencies
These symptoms begin because brain chemistry is working hard to maintain a balance between GABA and glutamate chemicals –this will be a common battle that continues for the duration of withdrawal.
2. What Happens 12-48 Hours After You Stop Drinking?
Once you reach the 12-48 period after you stop drinking, symptoms begin to peak. During this time you’ll experience similar symptoms from the 6-12-hour period but they’ll be more intense.
You might experience:
- Violent tremors
- Irregular heartbeat
- Changes in blood pressure
- Vomiting and irritated stomach
Unfortunately, these symptoms can last for more than 2 or 3 days depending on how long you consumed alcohol. The good news is that things get better for most people after this period. This is because chemicals in the brain (GABA and glutamate) begin to balance.
3. What Happens 48-72 Hours After You Stop Drinking?
Once you reach the 48-72-hour mark, symptoms will typically start to improve. This depends on how long you’ve been drinking for but for most recovering alcoholics this is where things start to get better. While you’ll experience similar symptoms they’ll be reduced and less noticeable.
That said, severe cases of withdrawal are different. In severe cases, delirium tremens will occur. This tends to occur after 3 days to one week and these symptoms are severe and require intensive care.
People with delirium tremens can suffer from:
- Rapid heartbeat
- Loss of consciousness
- Nervous behavior
The good news is that delirium tremens only occurs in about 5% of people who recover from alcoholism –according to Harvard Medical School. That said, it’s the cause of 1/20 alcohol withdrawal-related deaths.
How to Diagnose Alcohol Withdrawal
Alcohol withdrawal can be self-diagnosed but we always recommend consulting with a licensed mental health professional. For medical professionals to diagnose alcohol withdrawal there tends to be a short questionnaire and blood tests if necessary. In most cases, the questionnaire is enough to get the answers that doctors need to make a diagnosis.
Doctors will also look for some of the common withdrawal symptoms, depending on how long it has been since the patient’s last drink. Therefore, medical professionals will look for:
- Blood pressure irregularities
- High cholesterol
- Labored breathing
- Mental health disorders
Diagnosing alcohol withdrawal is challenging but working with licensed medical professionals is the best method.
How to Safely Treat Alcohol Withdrawal Symptoms
While alcohol withdrawal is dangerous, there are five methods professionals use to treat the condition. These methods are inpatient care, outpatient care, medication-assisted therapy, individual counseling, and support groups.
1). Inpatient Treatment
Inpatient treatment is one of the most common methods for alcoholism treatment. Inpatient treatment gives patients plenty of time to recover because they typically last for between 3-12 months. In fact, some extended programs follow patients past the 12-month mark.
Inpatient treatment is beneficial because patients are monitored 24/7. This is important for severe cases of withdrawal because patients can get necessary medical care if it’s needed. Inpatient treatment centers also provide patients with amenities and give people a safe, trigger-free environment to recover in. Some inpatient treatment centers also have extended programs.
2. Outpatient Treatment
Outpatient treatment is similar to inpatient treatment but doesn’t require patients to remain at the clinic. Instead, outpatient programs typically have schedules for patients to follow. These schedules have weekly meetings, drug tests, appointment times, and health monitoring sessions. While it’s less of a time commitment than inpatient treatment, outpatient treatment is effective and more flexible.
Outpatient treatment also has many modalities. Patients can become partially hospitalized, in severe cases of withdrawal, and treated until withdrawal subsides. Outpatient treatment can also offer patients prescriptions for medications that will help the symptoms of withdrawal. That said, the most common method of treatment for outpatient programs includes behavioral therapy, which gives patients a mental toolbox to combat withdrawal and addiction triggers.
3. Medication-Assisted Therapy
Medication-assisted therapy is designed to help patients with severe cases of withdrawal. These clinics are known as detox centers and will monitor patients as their body removes the alcohol from their body and returns to balance. MAT treatments vary depending on the needs of each patient but some programs can last for weeks or months.
MAT is beneficial for severe cases because it prevents discomfort, death, and relapse. For example, medications like Diazepam, which reduce anxiety and prevent muscle spasms or seizures. Some medications make drinking undesirable. A great example of this is Disulfiram, which has been in use since 1951. There are also more medication-assisted treatments (MAT) for alcohol use disorder that work for co-occurring disorders.
4. Individual Counseling
Another treatment method is individual counseling. This can be done through any mental health professional but we recommend working with outpatient clinics that have addiction specialists. We make this recommendation because they’re better qualified to diagnose, treat, and prevent addiction.
Individual counseling is beneficial because it treats alcohol abuse disorder in many ways. Counseling can attack co-occurring disorders to target the root cause of addiction and use methods like cognitive behavioral therapy to give patients the tools to fight addiction on their own. With individual Counseling, the options are limitless and depend on the needs of each individual.
5. Support Groups
One of the most common methods for alcoholism is a support group. These groups give people the ability to recover at their own pace with a sponsor or accountability partner. Support groups are recommended for people who have already experienced the worst symptoms of withdrawal and people who have already completed treatment. Some common support groups for alcoholism include Alcoholics Anonymous and several online sobriety groups.
What are the Medications Used to Treat Alcohol Withdrawal
There are many medications used to treat alcohol withdrawal –each has unique benefits. The type of alcohol used depends on the needs of each individual and in some cases, a combination of medications will be used. Medication type is also dependent on how severe the symptoms of withdrawal are and how long a person has been drinking.
Some common medications used to treat alcoholism withdrawal are:
- Diazepam: Treats anxiety and muscle spasms
- Lorazepam: Treats seizures
- Oxazepam: Manages depression and other withdrawal symptoms
- Chlordiazepoxide: Tremors, alcohol withdrawal, anxiety
- Disulfiram: Makes drinking miserable
- Thiamine (Vitamin B-1): Helps with thiamine deficiency
These are a handful of medications that treat alcohol withdrawal but medical professionals come up with new treatments each year.
What is Alcohol Withdrawal Seizure
Alcohol Withdrawal seizures are serious complications that occur in 5% of people going through withdrawal. These seizures can be life-threatening and tend to begin after 3-5 days of being sober. The condition covering these seizures is called delirium tremens.
Delirium tremens is a serious seizure that occurs because chemicals in the brain have trouble functioning properly without alcohol. The symptoms include:
- High blood pressure
- Uncontrollable tremors
- Sudden mental health issues like depression or anxiety
- Nervous system changes
Delirium tremens are a severe symptom of withdrawal. If you or a loved one is experiencing these symptoms it’s important to seek medical care immediately.
What Should Be Done During an Alcohol Withdrawal Seizure
During alcohol withdrawal symptoms you need to act fast. There are many things you can do and proper home care can even save someone’s life.
Here are some treatment methods you can try:
- Call 9/11
- Clear sharp objects away from the person
- Do not try and hold them
- Time the length of the seizure and relay that information to medical professionals
- Avoid putting things in their mouth
- Place them on their side if they’re on their back
- Clear the area of others
These are the only things you can do at home. While it doesn’t seem like much, what you do in the event of a seizure can give medical professionals enough time to arrive and help.
How Long Does it Take to Detox from Alcohol?
Detoxing from alcohol takes time and varies depending on the person. Factors that contribute to recovery time are based on how long someone has been drinking, how much they consume, and their age. That said, alcohol detox can take between 72 hours and 3 weeks.
The process starts off slow. During the first few hours, people will start to feel mild symptoms. These include:
- General discomfort
These symptoms can last for up to 48 hours. Still, more severe cases cause more intense symptoms to occur after long periods of not drinking. These symptoms include:
- Irregular heartbeat
- Irregular blood pressure
- Rapid breathing
- Difficulty breathing
These symptoms tend to last for 12-48 hours and represent the peak of alcohol withdrawal for most people.
Unfortunately, the most severe cases can cause worse symptoms that can last for up to three weeks. These symptoms include:
- Agitation, aggression, and other extreme moods
This process is known as delirium tremens and occurs in about 5% of cases and accounts for 1/20 alcohol withdrawal deaths.
Can You Die From Alcohol Withdrawal?
Alcohol Withdrawal, when serious enough, can kill you. While most cases (95%) don’t result in severe withdrawal symptoms, the most severe cases are more dangerous than withdrawal symptoms from some of the hardest drugs like opiates. This is because the brain’s dependence on alcohol takes time to fix and sometimes it struggles to regain chemical balance between GABA and glutamate neurotransmitters.
When cases are severe, death results because of seizures, irregular heartbeat, and elevated risks of heart attacks. The common cause of death is delirium tremens, which can cause seizures, comas, and even death. For this reason, you should always consult with a medical professional during alcohol withdrawal.
How Long Does it Take to Feel the Symptoms of Withdrawal?
After you stop drinking the symptoms of withdrawal occur faster than most people think. In fact, depending on how severe the case is, symptoms can occur within 4 hours of not drinking. That said, most symptoms of withdrawal will begin after 6-12 hours.
During this period you can expect to feel fatigued, irritability, sweating, discomfort, and other mild symptoms.
How Quickly Do Withdrawal Signs Start?
Alcohol withdrawal signs start after about 8 hours. These signs show up as early withdrawal symptoms and might go unnoticed by people who chronically abuse alcohol. This is because the signs of alcohol withdrawal are similar to the symptoms of a hangover.
Still, symptoms continue to get worse and reach their peak after about 24 hours. This is when the signs of alcohol withdrawal become noticeably different from a hangover. People will begin to experience nausea, tremors, confusion, blood pressure changes, heart rate changes, and more.
For How Long Should Withdrawal Symptoms Last?
Withdrawal symptoms can last between 3 days and 3 weeks. This depends on the person and how severe the case of alcohol abuse disorder was. In fact, some cravings can last after three weeks and take months to subside. Unfortunately, this makes alcoholism one of the hardest addictions to recover from, especially because it can be found almost everywhere.
Addiction symptoms will start to occur between 6-12 hours. These are mild symptoms but after 48 hours withdrawal symptoms begin to peak. Then, from 48 hours to 72 hours, the symptoms slowly begin to subside. In severe cases, delirium tremens can occur after 3-5 days and can last for up to 3 weeks.
Which Alcohol Type has the Most Severe Withdrawal Symptoms?
Alcohol withdrawal does not vary based on the type of alcohol. While frequent tequila use may cause a different response because it’s an “upper,” most alcohol types will have the same withdrawal symptoms. This is not to be confused with hangovers, which can vary based on the other ingredients present within the alcohol.
The primary cause for variation in withdrawal symptoms depends on the person. Factors that contribute are the amount of alcohol consumed, the type of drinking habit, and the length of the alcohol addiction.
What are the Post-Withdrawal Effects on the Body?
Most symptoms of alcohol withdrawal will dissipate after days to weeks. While most people will recover from alcoholism and feel fine over the next few months, this isn’t true for everyone. There is a condition known as post-acute withdrawal syndrome (PAWS).
PAWS is a condition that impacts people who have consumed large quantities of the substance over long periods. After the traditional withdrawal period concludes, these individuals can suffer from many issues but most of them are mental. For example, people can experience prolonged periods of depression, mood swings, and irritability. In some cases, individuals can also suffer from physical aches and pain.
The good news is that even PAWS comes to an end and is not chronic. After months or years, your body will recover. Moreover, many positive things happen after alcohol withdrawal. Some examples include better liver health, improved heart function, and more.