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Alcohol withdrawal happens when your body is dependent on alcohol and you either stop drinking or greatly reduce your alcohol intake.

Alcohol withdrawal can be mild in some cases. In others, it can be severe and even life-threatening.

Alcohol is a depressant of the central nervous system (CNS). This means it has a slowing effect on the brain.

With continued exposure, the body adapts to alcohol’s depressant effect. When you reduce or stop drinking alcohol, the CNS becomes overexcited. This can lead to the symptoms of withdrawal.

Continue reading as we explore these symptoms and how they’re treated.

The symptoms of alcohol withdrawal can range from mild to severe. Typically, symptoms are more serious in people who’ve been drinking heavily for a long period of time.

Overall, symptoms often improve after about a week. However, for some people, these symptoms may last longer.

Initial symptoms

Initial symptoms can happen as early as several hours after your last drink. They can include things like:

  • tremors
  • trouble sleeping (insomnia)
  • nausea or vomiting
  • feeling on edge or restless
  • anxiety
  • headache
  • sweating

In people with milder levels of alcohol dependence, these may be the only symptoms they experience.

Typically, initial symptoms get worse after they first appear. They usually reduce over the next day or two.

More serious symptoms

People with more severe levels of alcohol dependence may experience more serious symptoms.

Hallucinations

Hallucinations can be:

They often appear within 24 hours of having your last drink.

Withdrawal seizures

These seizures are generalized in nature. Like hallucinations, they often appear within 24 hours after your last drink.

Status epilepticus

Of those who develop seizures, about 3 percent may have a more serious type of seizure called status epilepticus. This is medical emergency that can lead to disability or death.

Delirium tremens

Delirium tremens is the most serious symptom of alcohol withdrawal and can lead to death. It often occurs two to three days after your last drink. Symptoms can include:

With early treatment and prevention, the chance of death from delirium tremens is rare.

risk for delirium tremens

Some people have a higher risk for developing delirium tremens. This includes older people and those who have:

  • a history of daily, heavy alcohol use
  • another acute illness at the same time
  • a history of withdrawal seizures or delirium tremens
  • liver disease or abnormal liver function

There aren’t any specific tests for alcohol withdrawal. Instead, your doctor will use a detailed medical history and physical examination to help diagnose and determine the severity of withdrawal.

When taking your medical history, they may ask you about the following things:

  • how long you’ve been using alcohol
  • your level of alcohol intake
  • how long it’s been since you last had alcohol
  • if you’ve experienced alcohol withdrawal in the past
  • whether you have any other underlying medical or psychiatric conditions

Due to its stigma, talking about heavy alcohol use can be difficult, but it’s important to be open and honest with your doctor.

Knowing all the facts helps them to both evaluate your condition and determine an appropriate treatment. This only helps you in the long run.

Heavy or prolonged alcohol use can have a negative effect on many parts of your body, including the heart, liver, and nervous system. Your doctor may also perform blood tests to check for any alcohol-related damage to these areas.

How is alcohol use disorder diagnosed?

There are several steps your doctor can take to diagnose alcohol use disorder. They can include:

  • Medical and personal history. Your doctor will ask you for a thorough evaluation of your drinking habits.
  • Physical exam. This can include laboratory tests to assess your overall health and look for markers of prolonged or heavy alcohol use.
  • Psychological exam. This evaluation can give further insight into your thoughts and behaviors. Your doctor may use the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help them make a diagnosis.

The treatment for alcohol withdrawal involves supportive care and medications.

Supportive care

Supportive care can include:

Medications

The Food and Drug Administration (FDA) has approved three medications to treat alcohol dependence.

They’re not addictive and won’t replace alcohol use. Rather, they’re designed in much the same way as any medication to treat a long-term medical condition.

Here’s a quick rundown:

  • Acamprosate helps reduce or prevent symptoms caused when you stop drinking alcohol.
  • Disulfiram causes unpleasant symptoms, such as nausea, when you drink alcohol.
  • Naltrexone helps stop cravings for alcohol by blocking certain receptors in the brain.

For many years, the primary drugs used to treat alcohol withdrawal have been benzodiazepines. These are sedative drugs. They’re useful for easing withdrawal symptoms as well as preventing seizures and delirium tremens. Examples include:

  • diazepam (Valium)
  • lorazepam (Ativan)
  • chlordiazepoxide (Librium)

Although benzodiazepines are the primary drug treatment for alcohol withdrawal, your doctor may also use other drugs alongside them. This can include drugs like clonidine (Catapres) and haloperidol (Haldol).

The importance of a safe withdrawal

Depending on your level of alcohol dependency, the symptoms of alcohol withdrawal can become very serious and even life-threatening. That’s why it’s very important to manage your withdrawal safely.

Supervised alcohol withdrawal is safest. Mild to moderate alcohol withdrawal can be done in an outpatient setting, often requiring daily check-ins. Individuals with more serious symptoms should be treated in an inpatient setting, where their condition can be more closely monitored.

If you or someone you know is misusing alcohol, contact a doctor before stopping use. They can assess your condition and advise you on whether you should complete your withdrawal in an inpatient or outpatient setting.

Your doctor can also discuss the symptoms you may experience and the medications they may prescribe to ease them. Following withdrawal, your doctor can also provide resources and tools to help you stay alcohol-free.

If your body is dependent on alcohol, it’s likely that you’ll experience some form of withdrawal symptoms when you stop drinking.

If you misuse alcohol but don’t have a dependency on it, consider using alcohol in moderation on your way to completely quitting it. Here are some tips to help you do this:

  • Set personal goals. These can be things like defining the number of days a week you drink or the amount of drinks you can have in a week.
  • Keep a record of how much you drink. Having a written reminder can keep you aware of what you’ve consumed and help you slow down.
  • Measure how much you drink. Either estimate according to standard drink sizes or use a measuring cup to determine the exact amount you’re drinking.
  • Change your activities. Find alternatives to activities that involve a lot of social drinking.
  • Ask for help. Let those close to you know you’re aiming to cut back. Don’t be afraid to say “No thank you” if someone offers you a drink.
Finding help

If you or a loved one is misusing alcohol or other substances, here are some resources to help you get support today:

  • Call the Substance Abuse and Mental Health Services Administration’s National Helpline at 800-662-4357 for free, confidential information and treatment referrals.
  • Check out the National Institute on Alcohol Abuse and Alcoholism’s Treatment Navigator for information about treatment options and how to find them.
  • Visit an Alcoholics Anonymous (AA) meeting for mutual support from others who get it.
  • Visit an Al-Anon meeting. This support group is for the family, friends, and loved ones of people with alcohol use disorder and other substance use disorders.

Alcohol withdrawal happens when people who have an alcohol dependency either stop drinking or significantly curb their drinking. Symptoms may be mild in some people. Others may experience severe or even life-threatening symptoms.

Supportive care and medications can treat alcohol withdrawal. Experts recommend people going through alcohol withdrawal get monitored. Outpatient plans with check-ins can treat milder cases of withdrawal. Inpatient plans are needed for severe cases.

If you or a loved one is misusing alcohol, speak with a healthcare provider first. They can work with you to help manage your withdrawal in a safe and effective manner.