The Most Commonly Asked Questions About Alcohol Withdrawal Syndrome
What's In This Article?
The following are some of the most frequently asked questions about alcohol withdrawal along with answers and more information.
What Is Alcohol Withdrawal Syndrome?
Alcohol withdrawal syndrome or AWS is the name of the symptoms that happen when someone who abused alcohol or was a heavy drinker with an alcohol addiction either stops drinking or reduces how much alcohol they consume.
Alcohol withdrawal syndrome can include a combination of mental and physical symptoms. Symptoms can be mild and include anxiety, nausea and fatigue. Symptoms can also be much more severe, and in some cases, alcohol withdrawal syndrome can be deadly if it’s not properly monitored and treated by a medical professional.
People may experience alcohol withdrawal syndrome because their central nervous system and body have become used to the presence and effects of alcohol over time. Alcohol, particularly alcohol abuse, can change how the brain functions and it can impact neurotransmitters, which are naturally occurring brain chemicals. Your brain over time will try to compensate for the effects of alcohol.
Your brain will overproduce certain chemicals, and if you stop drinking your brain is still producing an excess of those chemicals. As the brain tries to adjust the removal of the alcohol, withdrawal symptoms can occur.
Not all people who drink or even drink heavily experience withdrawal symptoms, but it is fairly common for heavy drinkers who stop or cut back to experience some level of alcohol withdrawal syndrome.
What Are the Symptoms of Alcohol Withdrawal?
The symptoms of alcohol withdrawal can appear anywhere from six hours to a few days after someone takes their last drink. Some of the most common symptoms of alcohol withdrawal include:
- Tremors
- Anxiety
- Nausea
- Vomiting
- Headache
- Increased heart rate
- Increased or high blood pressure
- Irritability
- Sweating
- Confusion
- Insomnia
- Nightmares
The symptoms of alcohol withdrawal may get worse for anywhere from two to three days after someone has their last drink. Milder symptoms may be ongoing for weeks, and often the symptoms of alcohol withdrawal are more noticeable in the morning when someone first wakes up, and they gradually dissipate throughout the day.
Severe symptoms of alcohol withdrawal can occur as well when someone decides to suddenly stop drinking. Delirium tremens is one of the most severe symptoms of alcohol withdrawal. Signs and symptoms delirium tremens (DT) can include:
- Extreme confusion
- Extreme agitation
- Fever
- Seizures
- Tactile hallucinations (feeling sensations such as itching or burning that aren’t occurring)
- Auditory hallucinations
- Visual hallucinations
If someone experiences DTs or severe symptoms of alcohol withdrawal syndrome, it’s a medical emergency, and they need care right away.
What Are the Signs of Alcohol Withdrawal?
If you go to a doctor about your drinking or your desire to stop drinking, they can assess you for the potential that you will experience alcohol withdrawal syndrome. If you are already potentially experiencing alcohol withdrawal syndrome, some of the signs the doctor will look for include hand tremors and an irregular heart rate. A doctor might also look for dehydration and fever and may perform a toxicology screen.
There is something called the Clinical Institute Withdrawal Assessment of Alcohol (CIWA-AR) which is a set of questions used to diagnose and measure alcohol withdrawal syndrome. The scale looks at these ten signs of alcohol withdrawal:
- Agitation
- Anxiety
- Auditory disturbances
- Problems thinking clearly or clouded thinking
- Headache
- Nausea and vomiting
- Seating
- Tactile disturbances
- Tremors
- Visual disturbances
When Does Alcohol Withdrawal Peak?
The peak of alcohol withdrawal symptoms is when symptoms are at their worst. For most people who through alcohol withdrawal syndrome, once they reach the peak of the symptoms, the severity will start to decline.
While everyone’s withdrawal timeline can vary, on average most people experience peak symptoms within 24 to 48 hours after they have they last drink alcohol. Peak withdrawal symptoms can include changes in blood pressure, rapid heartbeat, tremors, fever, sweating and insomnia.
Delirium tremens can occur within 48 hours after someone has their last drink.
How Long Does It Take For Alcohol Withdrawal To Start?
The timeline for withdrawal from alcohol can vary depending on the person and their health, individual factors, and a person’s history with alcohol. Usually, within eight hours after someone who is dependent on alcohol has their last drink, they will start experiencing the initial symptoms of withdrawal.
Some of the first symptoms of withdrawal tend to include anxiety, insomnia, and nausea.
For some people, the symptoms of withdrawal can start within six hours after the last drink, or it could take several days to notice signs of withdrawal.
What Is Alcohol Withdrawal Like?
People often ask the question “what is alcohol withdrawal like,” and there’s not one easy answer for that. If you’re going through mild withdrawal from alcohol, you may feel like you’re sick with something like the flu. You might also feel more anxious or agitated.
For people with severe alcohol withdrawal, it can be a much worse experience. Alcohol withdrawal can lead to intense vomiting to the point that a person becomes dehydrated. Often people going through severe withdrawal will feel like they’re panicking, they will be drenched in sweat, and they may hallucinate.
Some people will describe going through severe alcohol withdrawal as bringing with it a sense of impending doom. The overwhelming panic is sometimes one of the most difficult symptoms for people to deal with if they’re going through withdrawal from alcohol.
The issue with alcohol withdrawal is that it’s nearly impossible to predict how severe it will be. The best thing to do is to seek medical treatment before you stop drinking. Then, your doctor or health care providers can advise you on the best steps to take and can give you any necessary medications before you get to a severe point or a life-threatening point.
How Long Do Alcohol Withdrawal Symptoms Last?
The symptoms of alcohol withdrawal will usually peak anywhere from 24 to 48 hours after someone has their last drink, but it’s necessary to go through detox if your long-term goal is to stay sober. The symptoms can persist for around a week, but for some people, they can last for several weeks. This is particularly true of the psychological withdrawal symptoms like anxiety and insomnia.
Factors that play a role in how long alcohol withdrawal symptoms last include how severe someone’s alcohol abuse was, and how long they were a heavy drinker.
There’s also something called protracted withdrawal syndrome. If someone has this, they will experience mild symptoms of withdrawal for months after they detox from alcohol. Some of the persistent symptoms of protracted withdrawal include:
- Irregular blood pressure and breathing
- Anxiety
- Insomnia
- Depression
- Alcohol cravings
- Irritability
How to Ease Alcohol Withdrawal
If someone is going to withdrawal from alcohol at home, they should only do so under the supervision and instruction of a health care professional. If someone does choose to detox at home, they should give themselves the necessary time and clear their schedule.
It’s very helpful to have a support system and maybe even participate in support groups as you go through it. You may also need someone to make sure you’re safe, and you can get access to emergency medical care if necessary.
The following are ways how to ease alcohol withdrawal:
- Make sure that you’re staying hydrated. Alcohol withdrawal can cause nausea and vomiting, even when it’s mild. It’s essential to stay hydrated and make that a priority throughout the process. If it’s difficult to drink or eat, try things like ice pops and gelatin which may be easier.
- Having a balanced diet is important both as you’re detoxing from alcohol and as you’re recovering from alcohol abuse.
- Some of the most important vitamins and minerals to get if you are withdrawing from alcohol include B vitamins, vitamin E, vitamin C, calcium, magnesium, and
There are prescription medications that your doctor may be able to give you if you’re detoxing that can reduce the symptoms and the risks.
Some of the medications that may be used in the treatment of alcohol withdrawal are:
- Antabuse (disulfiram) which is used to help people avoid relapse. When someone takes Antabuse, and then they drink, they can become very ill. This is a type of aversion therapy, but Antabuse doesn’t directly treat symptoms of alcohol withdrawal.
- Campral (acamprosate) is a prescription medication that might inhibit certain actions in the central nervous system, and it can help reduce cravings or urges to drink, but again, it doesn’t affect the actual symptoms of alcohol withdrawal syndrome.
- Librium is one of the most commonly used medicines for alcohol withdrawal. Librium is a benzodiazepine, and it can help treat anxiety and other withdrawal symptoms related to alcohol.
- Gabapentin is a medicine used to treat epilepsy. It’s classified as an anticonvulsant, and it affects the nerves and the chemicals in the brain and body that can lead to seizures.
- Diazepam is the generic name of Valium, and it’s a benzodiazepine. Along with treating anxiety disorders, diazepam is frequently used as a medicinal treatment for alcohol withdrawal.
- Clonidine is a medicine that is primarily used to lower blood pressure because it reduces the levels of chemicals in the blood that promote blood vessels relaxing. Off-Label use of Clonidine is for the treatment of withdrawal symptoms related not only to alcohol but other substances as well.
How Long Does It Take To Recover From Alcohol Withdrawal?
How long does it take to detox from alcohol? It depends on the individual, but alcohol withdrawal syndrome can last for a week up to several weeks. Some of the factors that play a role in how long alcohol detox last include:
- How long someone has abused alcohol
- How much someone drinks and how frequently
- The type of alcohol consumed
- Other physical health issues and medical history
- Whether or not there are other co-occurring substance use disorders
- Other mental health disorders
For many people, alcohol withdrawal will last for around a week, and then symptoms will start to subside.
Why Does Alcohol Withdrawal Cause Seizures?
Why does alcohol detox cause seizures in some people? Withdrawal seizures can occur a few hours after someone takes their last drink up to 72 hours after someone last has alcohol. The reason alcohol withdrawal can cause seizures has to do with the effects of alcohol dependence on the brain.
When you drink heavily for long periods of time, your brains chemicals and neurotransmitters adjust to the presence of the alcohol. The brain starts to function differently as a result of alcohol exposure.
If you stop drinking, especially suddenly, the brain will start trying to overcompensate for the lack of alcohol and will start producing high levels of certain chemicals and neurotransmitters again. This causes excitatory neurotransmitter activity in the brain, which is what can lead to seizures from alcohol withdrawal. Sometimes even when people are still drinking, they may have seizures.
If someone has a history of seizures for any reason, they’re more likely to have seizures related to alcohol abuse and alcohol withdrawal. If someone has a seizure from alcohol withdrawal, they’re also more likely to have delirium tremens or DTs, which are the most severe and deadly symptom of detoxing from alcohol.
How to Help Alcohol Withdrawal Naturally?
Before ever considering going through alcohol withdrawal naturally, due to the life-threatening nature of alcohol detox you should always consult with a health care professional first. If you aren’t an extremely heavy drinker or your health care provider says it’s okay, the following are some of the things that help alcohol withdrawal naturally:
- Acupuncture which requires needle therapy may help with certain symptoms of alcohol detox and withdrawal including anxiety, depression and perhaps alcohol cravings. One study conducted in 2002 looking at 34 alcoholics found that with two weeks of acupuncture treatments paired with a medication called carbamazepine, helped decreased symptoms of withdrawal.
- Milk thistle is an herbal remedy for alcohol withdrawal that comes from a plant in the daisy family. One component in milk thistle called silymarin may help promote liver health and may protect against liver damage from alcohol.
- A few research studies have indicated kudzu may help with alcohol dependence. In particular, an animal study from 2003 showed the use of kudzu extract helped reduce alcohol dependence. A separate study showed supplementing with kudzu helped reduce human alcohol intake.
As well as herbal supplements and acupuncture, different people may have varying levels of benefit from natural remedies for alcohol withdrawal including yoga and meditation.
How to Taper Off Alcohol to Avoid Withdrawal
There are two general options that someone can follow if they want to detox from alcohol. One is stopping cold turkey, and one is tapering off alcohol. Cold turkey means stopping suddenly, while tapering off refers to gradually reducing how much alcohol you drink slow, to reduce symptoms of alcohol withdrawal syndrome.
Currently, there’s no evidence suggesting any real value to the idea of tapering off alcohol to reduce symptoms of withdrawal.
Tapering off drugs such as antidepressants and opioids is something doctors often recommend, but it may be less beneficial with alcohol.
With that being said, if tapering off alcohol slowly is recommended by a doctor or might make someone feel less uncomfortable about the idea of detoxing, it’s probably okay. Along with reducing alcohol withdrawal symptoms, tapering down how much alcohol is consumed gradually can be more manageable and attainable than stopping suddenly.
How Do You Die from Alcohol Withdrawal?
How do you die from alcohol withdrawal and can you die from alcohol withdrawal are two questions people often have. It is possible to die from alcohol withdrawal, although it’s relatively uncommon.
If someone has been a drinker for many years and drank heavily during that time, they could have seizures. Seizures could cause aspiration, which is where a person vomits and then swallows and chokes on their vomit. This is one way you can die from alcohol.
It’s also possible that if a person is experiencing seizures as they go through detox from alcohol, they could hit their head or get into another kind of accident.
Delirium tremens or DTs are one of the most dangerous possible effects of alcohol withdrawal. DTs usually affect only the most severe alcohol. Even a functioning alcohol isn’t very likely to have this symptom of withdrawal. Only an estimated five percent of alcoholics have alcohol withdrawal syndrome so severe that DTs are a possibility.
Delirium tremens can be deadly.
One reason it’s possible to die from delirium tremens is that the brain’s ability to send signals to the rest of the body can become so out-of-balance that the heart can’t pump blood properly and the lungs can’t take in enough air, leading to cardiovascular problems that can be deadly. The brain can be deprived of oxygen and blood during this time.
While delirium tremens can be one of the most severe symptoms of alcohol withdrawal, they are treatable. The potential for this side effect of alcohol withdrawal syndrome is one of the reasons why people go through alcohol detox in a professional facility. In an alcohol detox facility, patients are monitored, and symptoms are proactively treated before they become larger and more severe complications.
Alcohol withdrawal can lead to severe nausea and vomiting as well, so dehydration can be one of the life-threatening risks of detoxing.
What Are DTs In Alcohol Withdrawal
Delirium tremens or DTs are one of the most serious and severe symptoms of alcohol withdrawal. Delirium tremens is part of what’s known as alcohol withdrawal delirium or AWD. Of the people who experience withdrawal symptoms from stopping drinking, around 3 to 5 percent may have AWD symptoms, which can also include grand mal seizures and confusion.
Delirium tremens may occur anywhere from 48 to 96 hours after someone has their last drink most commonly, but it may take as long as ten days after the last drink for DTs to occur. Symptoms of delirium tremens include:
- Delirium which is sudden, severe confusion
- Body tremors
- Changes in cognition and mental functionality
- Extreme agitation and irritability
- Deep sleep for a day or more
- Stupor
- Hallucinations
- Fear or excitement
- Sudden bursts of energy
- Rapid mood changes
- Excitement
- Fatigue
- Sensitivity to stimuli including sound, light, and touch
Seizures can occur with delirium tremens, and they can occur with or without the symptoms above. Seizures with delirium tremens most often occur in people who have previously had complications resulting from alcohol withdrawal, and they’re most likely to occur within the first 12 to 48 hours after someone has their last drink.
DTs are different from the shakes from alcohol withdrawal, but the two can seem similar because the shakes can be a symptom of delirium tremens, although it doesn’t have to be. It’s very common to shake from alcohol withdrawal, however. Even people not dependent on alcohol may have the shakes if they’re hungover from drinking too much.
How to Help Someone Going Through Alcohol Withdrawal
How do you help someone who is going through alcohol withdrawal? For people who don’t require hospitalization or inpatient treatment, it may be possible to detox at home. However it’s still challenging.
When someone is going through alcohol withdrawal syndrome, having someone nearby can be very helpful, for support and also for safety.
A few things to keep in mind if you want to help someone going through alcohol withdrawal:
- You might want to speak to a doctor or counselor to see how you can be most helpful to the person, and so you can be aware of any precautions that you should take.
- Learn more about the signs and symptoms of alcohol withdrawal so you can know what to expect, and also what to look for in case of an emergency.
- If the person is taking any medications under the instruction of a doctor, create a list of what these are and when they should be taken so you can help them remember.
- Help the person going through alcohol withdrawal syndrome stay hydrated by reminding them to regularly have juice or water, and encourage them to eat a healthy, nutrient-rich diet. Some of the vitamins that are most important when going through alcohol withdrawal include vitamins A, B vitamins and vitamin E. Some of the herbs that can help with alcohol detox include milk thistle, magnesium, glutamine and primrose oil.
- Don’t take things personally as someone is going through alcohol withdrawal. A person going through a detox from alcohol is likely to go through many emotions including anxiety, depression, irritability, and rapid mood changes. These are part of the process, so prepare yourself to know this and know that it’s not a personal attack on you.
- Take care of yourself as well. For you to be an effective caretaker and support system, you need to make sure that you’re coping and that you’re practicing self-care.
How Bad Will My Alcohol Withdrawal Be?
Alcohol withdrawal syndrome and symptoms can range from mild and moderate to severe. Severe withdrawal is rare but serious and potentially deadly. Alcohol withdrawal symptoms can also get worse over time. The most intense symptoms of alcohol withdrawal tend to occur anywhere from two to five days after someone stops drinking.
While it’s difficult to answer “how bad will my alcohol withdrawal be” for a specific person, the following are some things that may help you get a better idea of the answer to this questions.
- According to the Centers for Disease Control and Prevention (CDC), moderate drinking is defined as having up to one drink a day for women and up to two drinks a day for men. That is usually considered a fairly safe level of drinking.
- Excessive drinking can include heavy drinking or binge drinking. For women, binge drinking is four or more drinks, and it’s five or more for men.
- Heavy drinking is characterized as a woman who has eight or more drinks a week, and men who have 15 or more drinks a week.
- Around 50 percent of people who drink heavily experience alcohol withdrawal syndrome. Of those, only 3 to 5 percent experience delirium tremens.
- Verywell Mind put together a quiz that might be useful called “Are You Experiencing Alcohol Withdrawal?”
How Dangerous Is Alcohol Withdrawal?
Alcohol withdrawal itself isn’t necessarily that dangerous or deadly. Instead, it’s the complications from alcohol withdrawal that’s dangerous. Typically, casual drinkers and even high-functional alcoholics won’t experience the most dangerous symptoms of alcohol withdrawal syndrome. For someone to experience the most severe aspect of withdrawal—delirium tremens—they would have been a very heavy drinker for a period of at least several years.
According to the Bulletin of the American College of Surgeons, in 2013 around ten people died of delirium tremens, and around 300 people were hospitalized for the condition.
Even though severe alcohol withdrawal symptoms are fairly rare, it’s more likely a person will die from alcohol detox than withdrawal from any other types of drugs or substances.
When delirium tremens is untreated, anywhere from 15 to 40 percent of cases may lead to death. For treated cases of DTs, the death rate goes down to 1 to 5 percent.
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