Alcohol Withdrawal Syndrome: Symptoms, Causes, Treatment, and More

The signs and symptoms of AWS may appear anywhere from 6 hours to a few days after your last drink. These usually include at least two of the following:

• tremors
• anxiety
• nausea
• vomiting
• headache
• an increased heart rate
• sweating
• irritability
• confusion
• insomnia
• nightmares
• high blood pressure

The symptoms may worsen over 2 to 3 days, and some milder symptoms may persist for weeks in some people. They may be more noticeable when you wake up with less alcohol in your blood.

The most severe type of withdrawal syndrome is known as delirium tremens (DT). Its signs and symptoms include:

• extreme confusion
• extreme agitation
• a fever
• seizures
• tactile hallucinations, such as having a sense of itching, burning, or numbness that isn’t actually occurring
• auditory hallucinations, or hearing sounds that don’t exist
• visual hallucinations, or seeing images that don’t exist
• excessive sweating
• increased heart rate
• high blood pressure
• fast respirations

If you have severe AWS symptoms, it’s a medical emergency. Call for help or go to the emergency room. A high fever, hallucinations, and heart disturbances are all reasons to seek immediate help.

Excessive drinking excites and irritates the nervous system. If you drink daily, your body becomes dependent on alcohol over time. When this happens, your central nervous system can no longer adapt easily to the lack of alcohol. If you suddenly stop drinking or significantly reduce the amount of alcohol you drink, it can cause AWS.

People who have an addiction to alcohol or who drink heavily on a regular basis and are not able to gradually cut down are at high risk of AWS.

AWS is more common in adults, but children and teenagers who drink excessively may also experience the symptoms. You’re also at risk for AWS if you’ve previously had withdrawal symptoms or needed medical detox for a drinking problem.

The Centers for Disease Control and Prevention define heavy drinking as more than eight drinks per week for women and more than 15 drinks per week for men. The following are the equivalent of one drink:

• 1.5 ounces of distilled spirits or liquor, including gin, rum, vodka, and whiskey
• 5 ounces of wine
• 8 ounces of malt liquor
• 12 ounces of beer

Binge drinking is the most common form of heavy drinking. For women, it’s defined as four or more drinks in one sitting. For men, it’s defined as five or more drinks in one sitting.

Your doctor will review your medical history, ask about your symptoms, and conduct a physical exam. Some signs your doctor will look for include:

• hand tremors
• an irregular heart rate
• dehydration
• a fever

Your doctor may also perform a toxicology screen, which tests how much alcohol is in your body.

The Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) is a series of questions used to measure AWS. Healthcare professionals may use this test to diagnose AWS. It can also be used to determine the severity of your symptoms. The scale measures the following 10 symptoms:

• agitation
• anxiety
• auditory disturbances
• clouding of sensorium, or the inability to think clearly
• headache
• nausea and vomiting
• paroxysmal sweats, or sudden, uncontrollable sweating
• tactile disturbances
• tremor
• visual disturbances

It’s important to note that the Clinical Assessment mentioned above may be unreliable because it is subjective in nature. According to a 2017 study, the use of the Objective Alcohol Withdrawal Scale (OAWS) was more useful for treatment because it can be used as a framework and tailored to individual cases.

Questions a medical professional may ask include:

• Who am I?
• What day is this?
• Does it feel like there is a band around your head?
• Do you feel sick to your stomach?
• Do you feel bugs crawling under your skin?

If you need help finding a primary care doctor, then check out our FindCare tool here.

Treatment for AWS depends on how severe your symptoms are. Some people can be treated at home, but others may need supervised care in a hospital setting to avoid potentially dangerous complications such as seizures.

The first goal of treatment is to keep you comfortable by managing your symptoms. Alcohol counseling is another important treatment goal. Your doctor’s treatment goal is helping you stop drinking as quickly and safely as possible.

Home care

Mild symptoms of AWS can often be treated at home. A relative or friend must stay with you to monitor your condition. Their job is to make sure that if you develop any worsening of symptoms, they get you to a hospital or call 911 immediately.

They should also make sure you attend your counseling appointments and visit the doctor regularly for any routine blood tests that may be ordered. You may also need tests for alcohol-related medical problems.

If your home environment is not supportive for staying sober, talk with your doctor. Your doctor may be able to connect you with shelter programs for people recovering from alcohol addiction.

Hospitalization

If your symptoms are more severe, you may need to stay in the hospital. This is so your doctor can monitor your condition and manage any complications. You may need to get fluids intravenously, or through your veins, to prevent dehydration and medications to help ease your symptoms.

Medications

Symptoms of AWS are often treated with sedatives called benzodiazepines. The most prescribed benzodiazepine is chlordiazepoxide, which is only available as a generic in the United States.

Other benzodiazepines that might be prescribed are:

• lorazepam (Ativan)
• alprazolam (Xanax)

Benzodiazepines carry a Food and Drug Administration boxed warning because there is a risk of dependence. If you’re prescribed a medication from this class of drugs talk with your doctor about the risks before taking them and always follow the doctor’s instructions.

In addition, vitamin supplements may be given to replace essential vitamins that are depleted by alcohol use. Once withdrawal is complete, additional medications and supplements may be needed to address complications and nutritional deficiencies that occur because of chronic alcohol use.

Most people with AWS fully recover. If you’re otherwise healthy and can stop drinking and get treatment, the outlook is usually good. However, sleep disturbances, irritability, and fatigue may continue for months.

If AWS has advanced to delirium tremens, it can be fatal. If you begin experiencing severe symptoms of AWS, it’s important to seek immediate medical attention. The sooner you begin treatment, the better your chances are of preventing life threatening complications.

The best way to prevent AWS is to avoid regular heavy drinking. If you already have alcohol use disorder, it’s important to seek counseling and medical care as soon as possible. The goal is to safely and gradually decrease your dependence on alcohol so that you can resume your daily life.