What is Alcohol Withdrawal?

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Alcohol withdrawal occurs when a person ceases alcohol consumption after a prolonged period of heavy usage. This is caused by the brain remaining in a more stimulated state initially brought on by the constant exposure to alcohol.

Since this substance slows brain function and how nerves communicate, the central nervous system (CNS) adjusts to this by keeping the brain in an awakened state to allow nerve messaging to function. 

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When alcohol is suddenly removed from the system, the brain stays stimulated without the depressive effects of withdrawal. This is the cause of alcohol withdrawal, which is also referred to as alcohol withdrawal syndrome.

Symptoms of Alcohol Withdrawal 

Alcohol withdrawal can produce severe symptoms that can be life-threatening. They can range from moderate to severe, usually depending on other health conditions, and present both mental and physical symptoms. They can occur as soon as two hours after the last drink or as late as four days after stopping alcohol use. 

These symptoms may include:

  • Headache
  • Nausea
  • Vomiting
  • Loss of appetite
  • Tremors (shakes)
  • Sweating
  • High blood pressure
  • Anxiety
  • Nervousness
  • Agitation
  • Irritability
  • Restlessness
  • Mood swings
  • Hallucinations
  • Seizures
  • Elevated heart rate
  • Disorientation
  • Insomnia

Alcohol withdrawal is a very serious condition that often requires professional treatment to manage correctly. It can lead to coma or death if not appropriately treated.

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What are Delirium Tremens & How Do They Occur?

Delirium tremens (DTs) is also known as alcohol withdrawal delirium (AWD). This is a form of severe withdrawal that usually begins two or three days after someone suffering from alcohol abuse quits drinking.

Delirium tremens usually lasts for only a couple of days, but lingering symptoms may be present for up to a week or more. If left untreated, this can lead to cardiac arrest or death.

Delirium tremens most commonly affects:

  • Adult men
  • Those with a history of seizures
  • People that have previously experienced alcohol withdrawal
  • Heavy drinkers
  • Those suffering from long-term substance abuse 

How Long Can Alcohol Withdrawal Symptoms Last?

Alcohol withdrawal symptoms typically last at least 72 hours and can persist for months if not treated properly.

The worst or most intense symptoms generally occur within the first week, while someone who has remained alcohol-free beyond this time can begin to experience the benefits of going sober at this time if done in the right way. 

While this is a generally applicable timeframe, the effects of alcohol withdrawal are different for everybody. The amount of time that symptoms last is based at least in part on the severity and length of time a person has been drinking, as well as a variety of other pre-existing health factors. 

Stages of Alcohol Withdrawal

There are three stages of alcohol withdrawal that are experienced by most people. These stages are:

Stage 1

Typically occurring within the first couple of days, this stage commonly brings headaches, trouble sleeping, anxiety, shaking, stomach pains, and heart palpitations.

Stage 2

The second stage includes many of the same mild symptoms as the first, in addition to elevated blood pressure, elevated heart rate, elevated body temperature, disorientation, and rapid breathing.

Stage 3

The third and final stage is the most severe, with lingering moderate symptoms from the second stage and the introduction of auditory and visual hallucinations, seizures, and impaired attention.

These stages occur over various intervals, which vary from person to person based on drinking behavior and concurrent mental health or physical issues.

Below is a general timeline for when alcohol withdrawal symptoms tend to occur on average:

6 to 12 hours

As soon as six hours after the last drink, relatively mild early withdrawal symptoms can begin to set in. This typically includes the symptoms from stage 1, such as headache, anxiety, shaking, upset stomach, and trouble sleeping.

12 to 24 hours

After 12 hours, an acute rise in blood pressure typically occurs along with an increased body temperature. Sometimes, hallucinations can begin to emerge, though these often set in later for most people.

24 to 48 hours

After the first full day without alcohol, serious complications can occur. Seizure risks are typically highest during this time, which requires close monitoring to treat appropriately. 

48 to 72 hours

Withdrawal delirium typically sets in during this period. If left untreated, this can lead to heart attack, stroke, or death. It is crucial to be under medical supervision while experiencing withdrawal symptoms to make sure seizures and delirium are properly managed. 

72+ hours

On top of all other symptoms, without proper treatment, sleep disturbances, fatigue, and mood changes can persist after 72 hours and potentially last for months. 

What Happens After Two Weeks of No Alcohol?

After getting past the initial danger and unpleasantness of withdrawal, those who quit drinking will begin to experience the benefits of better sleep and adequate hydration. In general, people tend to start feeling happier, with fewer mood swings and a better overall mood. 

Concentration tends to improve drastically, and blood pressure begins to normalize. This, in turn, helps to lessen the risk of associated health problems with the heart and liver.

Can Alcohol Permanently Damage Your Brain?

Alcohol damages the brain by directly affecting the neurons. Since it is a toxic substance, it can damage or kill neurons, which are responsible for normal brain function.

Some long-term drinkers can also develop nutritional deficiencies that lead to brain function damage, and prolonged alcohol use has been shown to cause brain shrinkage. 

While there are no cures for brain damage caused by drinking alcohol, early diagnosis and lifestyle changes will stop further damage and reverse deterioration.

Recent research has also found that new brain cells can be produced within a year after abstaining from drinking.

Alcohol Addiction: Treatment & How to Detox Properly

Alcohol addiction requires proper treatment and detoxification measures to overcome successfully, especially for the management of withdrawal symptoms. 

While alcohol detox by itself is not a form of treatment, it is an important first step on the path to recovery. Detox should be completed at an inpatient or outpatient treatment center with medical supervision.

Without medical professionals overseeing detox and managing withdrawal symptoms, patients could face further negative effects ranging from prolonged physiological damage to death. 

If you or a loved one is in need of medical advice for alcohol addiction treatment programs, contact a local healthcare provider or medical professional.

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Resources +

Myrick, H., & Anton, R. F. (1998). Treatment of alcohol withdrawal. Alcohol health and research world, 22(1), 38–43., https://pubmed.ncbi.nlm.nih.gov/15706731/

Richard Saitz, M.D., M.P.H. Introduction to Alcohol Withdrawal. NIAAA. https://pubs.niaaa.nih.gov/publications/arh22-1/05-12.pdf

Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial psychiatry journal, 22(2), 100–108. https://doi.org/10.4103/0972-6748.132914

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