Alcohol Withdrawal

What is alcohol withdrawal?

Alcohol withdrawal (alcohol withdrawal syndrome) is a range of symptoms that can happen if you stop or significantly reduce alcohol intake after long-term use. It typically affects people with alcohol use disorder (AUD).

Alcohol withdrawal can range from very mild symptoms to a severe form, known as delirium tremens.

How common is alcohol withdrawal?

Alcohol withdrawal is relatively common. It affects about 50% of people with alcohol use disorder who stop or significantly decrease their alcohol intake. AUD is the most common substance use disorder in the U.S., affecting 28.8 million adults.

What are the symptoms of alcohol withdrawal?

Withdrawal symptoms typically begin within six to 24 hours of stopping or significantly decreasing heavy, long-term alcohol use. Symptoms — ordered from mild to severe — include:

• Headache.
• Anxiety, nervousness or irritability.
• Insomnia.
• Excessive sweating.
• Upset stomach.
• Heart palpitations.
• Increased blood pressure.
• Increased heart rate.
• Hyperthermia (high body temperature).
• Tremor (shakiness) of hands or other body parts.
• Confusion.
• Hallucinations.
• Seizures.
• Delirium.

Each of these symptoms can increase in intensity depending on the severity of the withdrawal.

Go to the nearest emergency room or call 911 (or your local emergency service number) if you or a loved one has any concerning symptoms of alcohol withdrawal.

Alcohol withdrawal symptom timeline

The severity and length of alcohol withdrawal varies based on many factors. But a general timeline includes:

• From six to 12 hours after your last alcohol-containing drink: Mild symptoms appear, like headache, mild anxiety and insomnia.
• Within 24 hours of your last drink: You may experience hallucinations, depending on the severity of withdrawal.
• Between 24 to 72 hours of your last drink: For most people with mild to moderate withdrawal, the symptoms typically peak (reach their worst) and begin to resolve in this timeframe. If you have severe or complicated withdrawal, your seizure risk is highest 24 to 48 hours after your last drink. Delirium tremens may appear from 48 to 72 hours after your last drink.

Some people experience prolonged withdrawal symptoms, like insomnia and mood changes, that can last for weeks or months.

How long does alcohol withdrawal last?

Symptoms of alcohol withdrawal tend to peak 24 to 72 hours after your last drink. But you may experience some symptoms for weeks.

What causes alcohol withdrawal?

Alcohol withdrawal can develop if you stop using or significantly reduce the amount of alcohol you use after more than two weeks of heavy use. The U.S. National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines heavy drinking as:

• For adults assigned male at birth (AMAB), consuming five or more drinks containing alcohol on any day or 15 or more per week.
• For adults assigned female at birth (AFAB), consuming four or more drinks containing alcohol on any day or 8 or more drinks per week.

Alcohol (ethanol) depresses (slows down) your central nervous system (CNS). If you consistently consume significant amounts of alcohol, your CNS gets used to this effect. Your CNS must work harder to overcome the depressant effects of alcohol to keep your body functioning.

When you stop consuming alcohol after prolonged, heavy use, your CNS can’t respond or regulate itself fast enough. It becomes overexcited because there’s no more alcohol to slow it down. This overload of activity results in withdrawal symptoms.

What are the risk factors for alcohol withdrawal?

It’s difficult to predict who will and who won’t experience alcohol withdrawal — and how severe it will be.

The NIAAA’s definitions of heavy drinking are just general guidelines. Whether you develop alcohol withdrawal symptoms depends on several other factors, like:

• Your body chemistry.
• Your age.
• If you have coexisting physical or mental health conditions.
• The medications you take.
• If you use other substances.

But studies have identified some factors that increase your risk of severe alcohol withdrawal. They include:

• Heavy daily alcohol use.
• Age greater than 65.
• A history of delirium tremens or alcohol withdrawal seizures.
• Coexisting health conditions.
• Dehydration.
• Electrolyte imbalances.
• Brain lesions.
• Abnormal liver function.

How is alcohol withdrawal diagnosed?

Healthcare providers make a diagnosis of alcohol withdrawal syndrome based on:

• A physical exam.
• Your symptoms.
• Your alcohol use history.
• Your medical history.

It’s important to be honest about your alcohol use — and any other substance use — so your provider can give you the best care.

Your provider may recommend other tests — like blood tests and an EKG (electrocardiogram) — to check your overall health, especially since alcohol use disorder can cause health complications. They may assess you for conditions like:

• Dehydration and electrolyte imbalances.
• Injuries.
• Infection.
• Liver function issues.
• Heart issues.
• Gastrointestinal (GI) bleeding.

What is the treatment for alcohol withdrawal?

The goals of alcohol withdrawal treatment are to:

• Reduce withdrawal symptoms.
• Prevent complications, like seizures.
• Provide treatment options for alcohol use disorder.

But treatment varies based on the severity of alcohol withdrawal and the likelihood that it could progress to severe or complicated withdrawal.

Mild to moderate alcohol withdrawal treatment

Healthcare providers typically prescribe short-term medications to relieve the symptoms of mild to moderate alcohol withdrawal.

For mild alcohol withdrawal that’s not at risk of worsening, your provider may prescribe carbamazepine or gabapentin to help with symptoms.

For moderate alcohol withdrawal, benzodiazepines or barbiturates are the first-line therapy to reduce your risk of seizures and the development of delirium tremens. These medications may include:

• Chlordiazepoxide.
• Diazepam.
• Lorazepam.
• Phenobarbital.

If you continue to have symptoms despite taking one of the medications listed above, your provider may prescribe:

• Beta-blockers or clonidine for persistent high blood pressure and fast heart rate.
• Carbamazepine or gabapentin to reduce cravings.

You may also receive other medications or treatments for related health issues, like IV fluids for dehydration and electrolyte imbalances or antinausea medicines if you experience vomiting.

Severe or complicated alcohol withdrawal treatment

Severe and complicated alcohol withdrawal requires treatment in a hospital — sometimes in the ICU. While receiving treatment, healthcare providers will want to monitor you continuously to make sure you don’t develop life-threatening complications.

The main management for severe symptoms is long-acting benzodiazepines — typically IV diazepam or IV lorazepam.

You’ll likely need other treatments for related health issues.

Treatment for alcohol use disorder

Your healthcare provider will recommend and encourage treatment for alcohol use disorder.

There are several types of treatment programs for AUD. Many involve a combination of group psychotherapy (talk therapy) and medications. Your provider will provide resources for various programs.

Can I prevent alcohol withdrawal?

The main ways to prevent alcohol withdrawal are to avoid alcohol altogether or to get professional help as soon as possible if you think you’re developing alcohol use disorder. The sooner you get treatment, the better.

What is the prognosis for someone with alcohol withdrawal?

The prognosis (outlook) for someone with alcohol withdrawal depends greatly on its severity.

Most people with mild to moderate alcohol withdrawal don’t need treatment in a hospital. But severe or complicated alcohol withdrawal can result in lengthy hospital stays and even time in the intensive care unit (ICU).

It’s also important to note that delirium tremens can be life-threatening. About 5% to 10% of people with this complication die from it.