Alcohol Withdrawal: Causes, Symptoms, Timeline and Treatment Options

Emesis is common alcoholism treatment with moderate to severe intoxication; because emesis usually occurs with obtundation, aspiration is a significant risk. Tolerance to alcohol develops rapidly; similar amounts cause less intoxication. Tolerance is caused by adaptational changes of central nervous system cells (cellular, or pharmacodynamic, tolerance) and by induction of metabolic enzymes. People who develop tolerance may reach an incredibly high blood alcohol content (BAC). However, ethanol tolerance is incomplete, and considerable intoxication and impairment occur with a large enough amount. But even people who have developed tolerance may die of respiratory depression secondary to alcohol overdose.

The severity and presence of withdrawal depend on several factors, including the duration and amount of alcohol consumption, individual health conditions, and previous history of withdrawal. While most cases are mild,  if you experience severe or acute withdrawal, seek immediate medical attention, as symptoms can be life-threatening if left alone. Alcohol withdrawal symptoms can develop once a person with alcohol use disorder stops drinking alcohol. More mild alcohol withdrawal symptoms include tremors, weakness, sweating, gastrointestinal symptoms, fast heart rate, headache, and elevated blood pressure.

When to contact a doctor

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The likelihood of developing alcohol withdrawal increases with the amount and frequency of your alcohol intake. Still, people experiencing these withdrawal symptoms are generally fully conscious and can think clearly. In some cases, AWS can be a medical emergency and — if complications arise — potentially life threatening. Alcohol withdrawal is a natural physical response your body goes through when trying to break an alcohol dependence. Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa.

Alcohol Withdrawal Syndrome: Symptoms, Emergency Care, and Advanced Therapies 2025

• That way, they can help you manage the discomfort and respond quickly in case of a medical emergency.
• But severe or complicated alcohol withdrawal can result in lengthy hospital stays and even time in the intensive care unit (ICU).
• If intravenous fluids are administered, thiamine (100 mg intravenously) should be given before glucose is administered, to prevent precipitation of Wernicke’s encephalopathy.
• Your doctor may also use a questionnaire like the Clinical Institute for Withdrawal Assessment for alcohol revised scale (CIWA-Ar) to determine the severity of your withdrawal symptoms.

Interestingly, previous withdrawal experiences can actually “prime” your brain to expect more severe symptoms in the future. The history and physical examination establish the diagnosis and severity of alcohol withdrawal. Basic laboratory investigations include a complete blood count, liver function tests, a urine drug screen, and determination of blood alcohol and electrolyte levels. Symptoms of insomnia, anxiety, and mild tremors can occur while there is still a detectable alcohol level in the patient’s blood work. Alcoholic hallucinosis is characterized by visual and tactile hallucinations, with an otherwise clear sensorium, and one can understand that the hallucinations are not real. Due to the kindling effect of alcohol withdrawal, more severe and progressive symptoms occur with subsequent withdrawal episodes.

Symptoms of alcohol withdrawal can range from mild to serious and can sometimes be life-threatening. If you drink only once in a while, you’re unlikely to have withdrawal symptoms. But if you’ve gone through alcohol withdrawal once, you’re more likely to go through it again. People with alcohol use disorder should be monitored by a medical professional when withdrawing from alcohol. Moderate to heavy drinkers can also benefit from medical supervision in the acute withdrawal stage.

Prescription Drugs Treatment

During alcohol withdrawal, you’ll likely experience nausea within 6-8 hours after your last drink, affecting nearly 24% of individuals going through withdrawal. Your digestive discomfort may intensify over the first hours, accompanied by symptoms like clammy skin and poor appetite. To manage stomach pain safely, you should maintain hydration, consider doctor-prescribed anti-nausea medications, and watch for signs of severe symptoms that require immediate medical attention.

Alcohol Misuse and Binge Drinking

It also includes binge drinking — a pattern of drinking where a male has five or more drinks within two hours or a female has at least four drinks within two hours. Both opioid and alpha-adrenergic receptors have the same effect on the potassium channel in the locus ceruleus. The medication clonidine has similar clinical findings in withdrawal, and this cross-tolerance explains why this medication can be used for the treatment of opioid withdrawal. This may include medications, therapy, or both and can be offered in a variety of settings, both inpatient, outpatient, or a hybrid model.

What is PAWS?

• Three distinct phases characterize alcohol withdrawal tremors, beginning with hand tremors that typically emerge 6-10 hours after your last drink.
• Besides a psychiatrist, other healthcare professionals that should be involved include the internist, neurologist, pain specialist, intensivist, mental health nurse, pharmacist, and sometimes a cardiologist.
• Delirium tremens (DTs) is the most severe form, characterized by confusion, agitation, fever, hallucinations, and life-threatening autonomic instability.
• It slows down your brain function and changes the way your nerves send messages back and forth.
• There are many resources available to help, including peer support groups, counseling, therapy, and inpatient rehabilitation.

Once you identify them, you can develop healthier ways to navigate around them. This could involve mindfulness techniques, exercise, or pursuing hobbies you enjoy. This is why continued support and realistic expectations are so vital. Even after the initial planting, the garden requires consistent care and attention to thrive.

Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal should be treated as outpatients when possible. Ambulatory withdrawal treatment should include supportive care and pharmacotherapy as appropriate. Benzodiazepines are first-line therapy for moderate to severe symptoms, with carbamazepine and gabapentin as potential adjunctive or alternative therapies.

Mood swings, anxiety, depression, fatigue, and cravings can lead individuals to seek relief through substance use. Stress and emotional instability make it harder to cope with daily challenges, increasing vulnerability Sobriety to relapse. Since PAWS symptoms come in waves, unexpected setbacks can trigger frustration and self-doubt. Without proper support and coping strategies, maintaining sobriety becomes more difficult. Engaging in therapy, building a strong support system, practicing stress management, and following a healthy lifestyle can help reduce relapse risk and support long-term recovery. Alcohol withdrawal syndrome can range from mild to severe, depending on the person’s mental health, physical health, and the severity of the addiction.

Furthermore, factors like age, past instances of Delirium Tremens (DTs), and liver health can influence the likelihood and severity of withdrawal symptoms. You might experience fluctuating energy levels, feeling exhausted one moment and then inexplicably wired the next. These shifts occur as your metabolism readjusts to functioning without the presence of alcohol. This phase, while generally less intense than the initial days of withdrawal, can be surprisingly challenging due to these lingering effects. It’s common to feel frustrated by the nonlinear nature of healing or to become concerned by unexpected symptom flare-ups.

Continued alcohol consumption causes changes in the central nervous system and neurotransmitter production in the brain. When the supply of alcohol suddenly stops or decreases, withdrawal symptoms can develop. In extreme cases, the brain can have problems regulating breathing and circulation. Drastic changes in blood pressure and heart rate can also develop, which may lead to a stroke or heart attack.