Effects of Alcohol Withdrawal, Causes, Timeline, Detox, Diagnosis & Treatment
Alcohol Abuse & Misuse
Misuse of alcohol, often called ‘alcohol abuse,’ refers to excessive alcohol use or any other way that can place you at risk for experiencing physical, mental health, and social problems.
Having more than 1 drink daily for women (7 per week) or 2 drinks for men (14 per week) is generally considered alcohol misuse. Binge drinking, a form of alcohol misuse, is when a man has 5 or more drinks or a woman has 4 or more drinks within a short period of time.
Binge drinking or alcohol misuse can increase someone’s risk of developing alcohol use disorder, more commonly known as ‘alcoholism’ or having an alcohol addiction. AUD is a disease characterized by the inability to control alcohol use despite negative, harmful consequences.
Craving alcohol, having a tolerance to the effects of alcohol and experiencing withdrawal symptoms when you try to stop drinking are but some of the criteria that point toward having AUD. When a person has a physiological dependence on alcohol, the withdrawal symptoms that are experienced after they significantly reduce or stop drinking can be extremely distressing and uncomfortable, and people commonly return to drinking alcohol as a way of relieving their discomfort.
What is Alcohol Withdrawal Syndrome (AWS)?
The effects of alcohol withdrawal syndrome are a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking or drastically reduces their alcohol intake.
Effects of Alcohol Withdrawal
Signs and symptoms of the various stages of alcohol withdrawal may include:
- Mood changes
- Gastrointestinal disturbances
- Heart palpitations
- Increased blood pressure or heart rate
- Rapid abnormal breathing
What Causes the Effects of Alcohol Withdrawal?
Alcohol withdrawal is thought to arise as a function of various changes in brain activity caused by prolonged and excessive alcohol use. Though the neurochemical details of alcohol withdrawal syndrome are somewhat complicated, its associated symptoms reflect compensation for previous disruptions in both excitatory and inhibitory neurotransmitter activity—the balance between the two having been upended, to begin with as a result of prolonged alcohol use.
The effects alcohol has on the body are complex, but two particular neurochemicals contribute to both short-term effects of drinking as well as the development of alcohol withdrawal syndrome when someone stops drinking: the brain’s main inhibitory chemical, gamma-aminobutyric acid (GABA), and the brain’s main excitatory chemical, glutamate.
When a person drinks alcohol it changes the functioning of GABA receptors as well as certain glutamate receptors, resulting in a slowdown of brain functioning that a person typically experiences as decreased anxiety and sedation. The brain reacts by decreasing the amount of GABA being released and increasing glutamate signaling to compensate for how alcohol alters these levels. This adaptation functions as long as you continue to drink alcohol—this is known as “tolerance.”
If you stop or significantly reduce alcohol intake, it disrupts your brain activity, causing a hyper-aroused state which leads to a range of effects of alcohol withdrawal that can appear within hours after your last drink. The withdrawal symptoms a person experiences, as well as their severity, may vary greatly from one person to the next, and it has been estimated that more than 80% of those with an alcohol use disorder may experience withdrawal symptoms.
Alcohol Withdrawal Timeline and Detox
What happens to your body when you give up alcohol may hinge on a variety of factors. Depending on the level of physiological alcohol dependence, the severity of acute alcohol withdrawal will vary for different individuals. The American Academy of Family Physicians outlines 3 potential stages that a person in withdrawal may experience. These include:
- Stage 1 (mild): Symptoms may include headache, insomnia, anxiety, hand tremor, gastrointestinal disturbances, and heart palpitations.
- Stage 2 (moderate): Symptoms my include Stage 1 mild symptoms in addition to increased blood pressure or heart rate, confusion, mild hyperthermia, and rapid abnormal breathing.
- Stage 3 (severe): Symptoms include Stage 2 moderate symptoms in addition visual or auditory hallucinations, seizures, disorientation, and impaired attention.
Without treatment by a healthcare professional, some people can progress from Stage 2 to Stage 3 rapidly.
While a precise timeline for alcohol withdrawal will vary from person to person based on several factors (average quantity and duration of heavy drinking behavior, the concurrent presence of physical and mental health issues, etc.), a general symptom timeline for alcohol detox may look like something like:
- 6-12 hours after the last drink: The relatively mild symptoms of early withdrawal may begin to be felt, including some headache, mild anxiety, insomnia, small tremors, and stomach upset.
- By 24 hours: Some people may have begun to experience visual, auditory, or tactile hallucinations.
- Within 24-72 hours: Various symptoms may have peaked and begun to level off or resolve (though some more protracted symptoms may stick around for weeks or longer). Seizure risks may be highest from 24-48 hours after the last drink, requiring close monitoring and seizure prophylaxis. Withdrawal delirium (i.e., DTs) may appear from 48-72 hours after drinking has stopped.
More rarely, some people experience more persistent withdrawal-related symptoms—such as sleep disturbances, fatigue, and mood changes—that last for months. It is important to note, however, that most people recover fully with proper medical detox and withdrawal management services.
Can Alcohol Withdrawal Be Fatal?
The effects of alcohol withdrawal syndrome vary significantly among alcoholics in both its clinical manifestations and its severity. These manifestations can range from mild insomnia to severe consequences, such as delirium tremens (DT’s) and even death. Substantial variability also exists in the incidence with which symptoms occur in various drinkers.
Some people who regularly consume alcohol never experience any withdrawal symptoms. Conversely, in some alcoholics withdrawal symptoms can occur at blood alcohol concentrations (BACs) that would be intoxicating in non-alcohol-dependent people but which for the dependent patients represent a decline from their usual BACs.
Diagnosing Alcohol Withdrawal
The symptoms of withdrawal are not specific and easily can be confused with other medical conditions. Consequently, the clinician’s initial assessment also serves to exclude other conditions with symptoms similar to those effects of alcohol withdrawal. Examples of such conditions include subdural hematoma (i.e., the collection of blood in the space between the membranes surrounding the CNS), pneumonia, meningitis, and other infections.
Similarly, seizures and delirium tremens (DTs) may be confused with other conditions that should be excluded during the initial assessment. For example, DTs, which represent an acute confusional state, can mimic delirium from other medical causes, such as encephalitis, meningitis, adverse effects of some medications, or Wernicke’s encephalopathy. Likewise, the effects of alcohol withdrawal seizures must be distinguished from seizures resulting from other causes, such as mineral or electrolyte abnormalities, strokes, brain tumors, epilepsy, or subdural hematoma.
Thus, a diagnosis of DT’s and AW seizures should be made only after other reasonable causes for these complications have been excluded. A thorough assessment also should anticipate health problems that frequently occur in patients withdrawing from alcohol. These complications may include the following:
- Gastritis (i.e., an inflammation of the stomach lining, which often is associated with bleeding)
- Gastrointestinal bleeding (e.g., from the esophagus, stomach, or intestines)
- Alcohol-Induced Liver disease
- Cardiomyopathy (i.e., any disorder of the heart muscle)
- Pancreatitis (i.e., an inflammation of the pancreas)
- Disturbances in the electrolyte balance (e.g., alcohol ketoacidosis—a metabolic derangement that results in too much acid in the bloodstream—and abnormally low levels of magnesium in the blood)
- Deficiency of the vitamin folate, which can cause lower-than-normal numbers of blood cells
- Deficiency of the vitamin thiamine, which can lead to serious neurological problems, such as Wernicke’s encephalopathy (accordingly, thiamine should be administered to all patients undergoing effects of alcohol withdrawal to prevent the development of this syndrome).
Once a diagnosis of the effects of alcohol withdrawal has been made, the clinician must assess the severity of withdrawal and the risk for associated complications.
Treatment for the Effects of Alcohol Withdrawal, Coping & Prevention
Detox is often considered the first stage of treatment. It will help you navigate the difficult process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.
- Inpatient or residential treatment involves living at a facility for the duration of treatment while you receive around-the-clock support and intensive therapy in group and individual sessions.
- Outpatient treatment involves living at home and attending group and individual therapy sessions at regularly scheduled appointments. This allows you to practice what you learn in treatment in real-world situations while managing stressors.
In general, the course of alcohol withdrawal is highly variable and somewhat unpredictable. Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms. Those experiencing mild alcohol withdrawal symptoms or who are concerned about experiencing withdrawal symptoms will benefit from the advice of a physician or clinician trained to assess and treat patients in alcohol withdrawal.
Those experiencing moderate to severe effects of alcohol withdrawal, or those who are at risk of experiencing moderate to severe symptoms (i.e., if you’ve had severe alcohol withdrawal symptoms in the past) typically require inpatient monitoring and treatment of withdrawal symptoms at an acute care hospital or detox-equipped facility. Outpatient treatment may be available for mild-to-moderate symptoms of alcohol withdrawal, however, should symptoms become severe, inpatient care may be required.
Other post-detox resources include:
- Therapies such as family therapy and cognitive behavioral therapy (CBT).
- 12-step meetings, such as AA.
- Participation with other mutual support groups such as Smart Recovery.
- AAC’s free online virtual support meetings.
Medications for the Effects of Alcohol Withdrawal
To prevent or lessen withdrawal symptoms or medical complications that can occur with severe alcohol withdrawal, doctors may prescribe benzodiazepines. These drugs can stop certain withdrawal reactions from proceeding to serious consequences.
Other medications may also be used to stabilize patients or for supportive care (e.g., anticonvulsants, antipsychotics, beta-blockers, and alpha-adrenergic agonists.) Patients who are dehydrated or malnourished may be given fluids or certain vitamins. Medications that may be used in the treatment of AUDs may include:
- Acamprosate: Helps avoid alcohol use after recovery
- Disulfiram: Causes unpleasant symptoms if alcohol is consumed
- Naltrexone: Helps to block the rewarding or reinforcing effects of alcohol
Some of these medications may be prescribed after abstinence or detox.
Dangers of Alcohol Withdrawal
Moderate-to-severe alcohol withdrawal can be extremely dangerous and sometimes life-threatening. The most severe form of alcohol withdrawal, delirium tremens, has a mortality rate of 1-4%.
Experiencing severe alcohol withdrawal symptoms is somewhat rare, however, it can be difficult to predict those who will experience them and those who will only experience mild withdrawal symptoms. Despite this, studies have identified some predictors of severe alcohol withdrawal (e.g., withdrawal seizures or DTs). These include:
- Heavy daily alcohol use
- Being of older age
- History of DTs or alcohol withdrawal seizures
- Comorbid illnesses
- Electrolyte disturbances
- Brain lesions
- Abnormal liver function
Reclaim Your Life From The Effects Of Alcohol Withdrawal
Alcoholism is a serious disease that can cause severe repercussions, such as the effects of alcohol withdrawal, that should not be taken lightly. We Level Up Washington center can provide you, or someone you love, the tools to treat alcoholism professionally and safely. Feel free to call us to speak with one of our counselors, we can inform you about this condition and give you clarity about issues like the alcohol withdrawal timeline, our specialists know what you are going through. Have in mind that each call is private and confidential.
 Centers for Disease Control and Prevention. (2020). Dietary Guidelines.
 Centers for Disease Control and Prevention. (2018). Alcohol and substance misuse.
 Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
 Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.