Alcohol Withdrawal

Alcohol withdrawal occurs when a person who drinks heavily stops. This occurs during detox and is the most difficult portion of rehab for many people. In severe cases, medical supervision is necessary.
Evidence Based
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Alcohol Withdrawal Syndrome (AWS)

Alcohol withdrawal occurs when a person who drinks heavily stops drinking. It is the period before their bodies are “clean,” but they are not consuming any more alcohol. The body tends to crave alcohol during this time, which makes it difficult to resist the urge to drink.

This phase of recovery is one of the most difficult and there is a high risk for relapse. Other health risks also occur during this time.

Alcohol withdrawal syndrome (AWS), on the other hand, is the medical term for the symptoms that occur when a heavy drinker stops drinking. Withdrawal symptoms occur when alcohol intake is suddenly stopped or reduced. Symptoms are both physical and emotional and can be severe.

In some cases, AWS is life-threatening.

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Causes of AWS

Excessive drinking affects the nervous system. Long-term excessive drinkers can develop a physical dependence on alcohol, which damages the nervous system. It expects alcohol and has trouble functioning without it. Symptoms of AWS occur when the nervous system fails to get what it “thinks” it needs. Your body works hard to keep your brain in a more awake state and to keep your nerves talking to one another. When the alcohol level suddenly drops, your brain stays in this keyed up state. That’s what causes withdrawal.

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Symptoms of AWS

Heavy drinkers who suddenly stop or reduce alcohol intake are likely to experience mild symptoms of AWS within six hours of their last drink. Symptoms can continue for up to seven days.

Symptoms can be severe in the first few hours of withdrawal. They gradually become milder in the days and weeks that follow. Although, they tend to be the most intense after first waking.

Symptoms might include any combination of the following:

  • Tremors
  • Anxiety
  • Nausea and vomiting
  • Headache
  • Elevated heart rate and/or blood pressure
  • Sweating
  • Irritability and confusion
  • Insomnia and nightmares
  • Hallucinations that can be tactile, auditory, or visual

Delirium tremens (DT) might be a symptom in severe cases. DTs usually start 48 to 72 hours after a person’s last drink. Its symptoms include:

  • Extreme confusion or agitation
  • Fever
  • Seizures
  • Hallucinations, including tactile, auditory, or visual
  • Racing heart
  • High blood pressure
  • Heavy sweating

If you or a loved one experiences any of these symptoms, it is necessary to seek medical attention immediately.

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Alcohol Withdrawal Timeline

Alcohol withdrawal occurs in phases.

During the first phase, which occurs approximately six hours after the last drink, a person might experience anxiety, nausea, abdominal pain, and insomnia.

During the second phase, there is an increase in blood pressure and body temperature, and heart rate might be unstable. There might also be confusion during this stage. This phase occurs approximately 24 to 72 hours after the last drink.

The final phase, which tends to only occur in severe situations, includes hallucinations, agitation, seizures, and fever. It takes place approximately two to four days after the last drink.

Symptoms of alcohol withdrawal tend to peak about 24 to 72 hours after a person’s last drink.

Typically, symptoms fade and are gone within a week.

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What are Alcohol Withdrawal Seizures? 

Abruptly reducing or stopping alcohol intake after extended heavy drinking might trigger alcohol seizures. Generalized tonic-clonic (formerly known as Grand Mal) seizures are the most dangerous component of alcohol withdrawal syndrome.

Tonic-clonic seizures include both tonic and clonic activity:

  • Tonic activity includes loss of consciousness, strong muscle spasms, the potential for impaired breathing, gasping and gurgling sounds, and saliva or foam from the mouth.
  • Clonic activity includes intense and rapid jerking movements of the face, arms, and legs that eventually relax as seizure activity concludes.

People often remain unconscious for several minutes following the seizure as the brain recovers.

Neuronal networks in the brainstem trigger tonic-clonic withdrawal seizures. Long-term heavy drinkers experience more intense withdrawal symptoms, and over time, multiple detoxification episodes increase their risk for seizures. Researchers postulate that alcohol withdrawal permanently alters the brain in a way that heightens seizure risk.

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Treatment for Alcohol Withdrawal 

Doctors treat alcohol withdrawal based on the severity of a person’s symptoms. Severe cases often require hospitalization and temporary round-the-clock monitoring.

The initial step in treatment is to keep the patient safe and comfortable by managing the most severe symptoms. In some severe cases, treatment of symptoms of AWS include benzodiazepines such as Ativan, Klonopin, Xanax, and Valium.

Treatment includes detoxification from alcohol and then counseling. The goal is to help the person stop drinking as quickly and safely as possible.

At-home treatment is possible in less severe cases of AWS. This requires monitoring symptoms to ensure they don’t worsen and follow-up efforts for counseling and medical evaluations. Heavy drinking can cause long-term health problems. In many cases, it’s necessary to treat these issues before or concurrently with treating alcohol addiction.

Alcohol withdrawal syndrome and the associated symptoms are avoidable if you do not drink. If you’ve already developed a dependence on alcohol, seek ongoing counseling and medical care to manage your addiction and avoid relapse. Avoiding alcohol, either immediately or through a gradual reduction in consumption is the only way to avoid alcohol withdrawal symptoms.


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Resources

Rogawski, Michael A. “Update on the Neurobiology of Alcohol Withdrawal Seizures.” Epilepsy Currents, vol. 5, no. 6, Nov. 2005, pp. 225–230, www.ncbi.nlm.nih.gov/pmc/articles/PMC1312739/, 10.1111/j.1535-7511.2005.00071.x.

“Tonic-Clonic (Grand Mal) Seizures.” Johns Hopkins Medicine, 2020, www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/tonic-clonic-grand-mal-seizures.

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Updated on: September 23, 2020
Author
Michael Bayba
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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