Alcohol Withdrawal: Symptoms, Causes, Diagnosis, and Treatment

Alcohol withdrawal refers to a set of symptoms that may happen if you stop or significantly reduce alcohol intake after a prolonged period of heavy drinking.

• Five or more drinks within two hours for men
• Four or more drinks within two hours for women

• At least 5 drinks on any day or 15 drinks a week for men
• At least 4 drinks on any day or 8 drinks a week for women

Heavy and prolonged drinking increases alcohol tolerance. As a result, your body can become dependent on alcohol to function. This physiological dependence triggers withdrawal symptoms if you suddenly stop drinking or significantly reduce alcohol consumption.

• Headache
• Anxiety
• Mood changes
• Excessive sweating
• Insomnia (trouble sleeping)
• Heart palpitations (fast or irregular heartbeat)
• Increased heart rate or blood pressure
• Tremors (shakiness) of the hands or body
• Upset stomach and other gastrointestinal issues
• Hyperthermia (high body temperature)
• Hallucinations (seeing or hearing things that aren’t there)
• Seizures

Timeline of Alcohol Withdrawal Symptoms

• 6–12 hours after you stop drinking: Mild symptoms begin. These symptoms may include headache, small tremors, mild anxiety, insomnia, or upset stomach.
• 12–48 hours after you stop drinking: Symptoms may worsen and could include hallucinations or seizures in severe cases. During a hallucination, you may see, hear, smell, taste, or touch things that aren’t present. Seizure risk is highest 24 to 48 hours after your last drink.
• 48–72 hours after you stop drinking: Most symptoms peak and start to resolve, but some may continue for a few weeks or longer. Alcohol withdrawal delirium, or delirium tremens, is a severe condition that may occur during this time. Symptoms can include fever, agitation, confusion, fast heart rate, hallucinations, disorientation, and high blood pressure. If you think you may be experiencing delirium tremens, seek immediate emergency medical care.

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  Although rare, delirium tremens can be life-threatening and requires hospitalization. It has a mortality rate of up to 37 percent if untreated. With immediate and proper treatment, delirium tremens can last up to five days.

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If you are concerned about any lingering withdrawal symptoms after 72 hours, reach out to your doctor for help.

• Discontinuation or reduction of alcohol use that’s been heavy and prolonged
• Two or more withdrawal symptoms that develop hours or days after alcohol intake lessens or stops. Possible symptoms include sweating, increased heart rate, tremors, insomnia, nausea or vomiting, hallucinations, agitation, anxiety, or seizures.
• Symptoms cause significant distress or impairment
• Symptoms are not due to another medical condition and not better explained by another mental health issue, such as intoxication or withdrawal from a different substance.

Alcohol withdrawal treatment is often based on your drinking history, the severity of your symptoms, and the kinds of support that are available to you.

• Supplements and Fluids These can help replenish electrolytes and nutrients, such as thiamine and folate. People with alcohol withdrawal often have vitamin deficiencies, so replacing these is crucial in preventing certain complications. Supplements can be administered through IV or intramuscular injection. If you’re detoxing at home, your doctor may recommend oral supplementation.
• Benzodiazepines These medications can make your brain less active and can help prevent or lessen withdrawal symptoms. It’s important to only take these medications under the direction and monitoring of your doctor, as they come with risks, including the risk of overdose if combined with drinking.
• Antiseizure Medications These can help prevent or treat seizures.
• Antipsychotic Medications These medications help manage hallucinations.

Once the acute symptoms of alcohol withdrawal resolve, the next step is to address and treat the drinking patterns that led to withdrawal symptoms, such as alcohol use disorder or binge drinking. With professional support, you can overcome alcohol use disorder and avoid future episodes of alcohol withdrawal.

Alcohol withdrawal can happen when someone suddenly stops or significantly decreases heavy drinking. Symptoms can be mild, severe, or even life-threatening, requiring immediate treatment. If you’re experiencing withdrawal symptoms of any severity, seek professional help. Recovery is possible.