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Updated on September 26, 2022

Alcohol Withdrawal

Alcohol Withdrawal Syndrome (AWS)

Alcohol withdrawal syndrome (AWS) is the medical term for the symptoms that occur when a heavy drinker stops drinking.

Withdrawal symptoms develop when alcohol intake is suddenly stopped or reduced. Symptoms are both physical and emotional and can be severe.

This phase of recovery is one of the most difficult, with a high chance of relapse and other health concerns. People with alcohol use disorder (AUD) are at high risk for AWS. In some cases, it can be life-threatening.

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What Causes Alcohol Withdrawal Syndrome (AWS)?

When you drink alcohol, it depresses your central nervous system (CNS).

The CNS consists of your brain and spinal cord. It regulates your body temperature, physical coordination and reflexes, and cognition.

When you drink heavily, your CNS becomes physically dependent on alcohol.

This is why withdrawal symptoms can include things like sweating, shaking, and confusion. Your CNS expects alcohol and has trouble functioning without it.

Another symptom of AWS is agitation. Your body works hard to keep your brain in a more awake state and your nerves talking to one another. When the alcohol level drops suddenly, your brain stays in this keyed-up state.

Symptoms of Alcohol Withdrawal Syndrome (AWS)

Heavy drinkers who suddenly stop or reduce alcohol intake are likely to experience mild symptoms of AWS within 6 hours of their last drink. Symptoms can continue for up to 7 days.

Symptoms can be severe in the first few hours of withdrawal. They gradually become milder in the days and weeks that follow.

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.

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's necessary to seek medical attention immediately.

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Alcohol Withdrawal Timeline

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.

Alcohol withdrawal occurs in three phases:

Alcohol Withdrawal Timeline

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 theorize that alcohol withdrawal permanently alters the brain in a way that heightens seizure risk.

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Treatment for Alcohol Withdrawal 

Those who suffer from alcohol dependence should seek medical attention. The first step is a physical exam by a health professional.

The professional may also perform a series of imaging tests. By showing alcohol-related organ damage, these tests provide evidence of alcohol use disorder.

The tests are also used to get an accurate diagnosis for AWS and allow a rehab center to develop a comprehensive treatment plan.

After this, addiction treatment can be pursued. 

Treatment begins with detoxification (or ‘detox’ for short). Severe symptoms should be treated at an inpatient clinic, where the person's symptoms can be monitored and treated.

Drugs can be provided that will reduce symptoms. These include:

  • Naltrexone
  • Disulfiram
  • Topiramate
  • Baclofen

Benzodiazepines can also be used to treat severe AWS symptoms. These include:

  • Ativan
  • Klonopin
  • Xanax
  • Valium

Symptoms that are more mild be able to be treated at home.

If other drugs besides alcohol are being abused are involved that will complicate treatment. Drugs and alcohol interact with each other in ways that make the effects stronger and reinforce dependence.

This is known as polysubstance abuse disorder and it requires around the clock monitoring at an inpatient clinic.

Oftentimes, addiction is accompanied by mental illness. In this case dual diagnosis treatment may be necessary. After treatment, the person can proceed to counseling and therapy.

Alcohol withdrawal syndrome and the associated symptoms are avoidable if you don't 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 tapering in consumption, is the only way to avoid alcohol withdrawal symptoms.

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