Alcohol withdrawal symptoms usually begin 6 to 48 hours after the last drink.
Alcohol withdrawal — symptoms that develop when a person suddenly stops drinking alcohol after prolonged, heavy drinking — is a common feature of alcohol dependence, or alcoholism.
Alcohol is a central nervous system depressant. In response to alcohol, the brain tries to maintain balance by using several mechanisms to increase the excitability of neurons.
But when alcohol use abruptly stops, the brain temporarily remains in this state of excessive excitability, resulting in alcohol withdrawal symptoms.
Alcohol Withdrawal Symptoms
Withdrawal symptoms vary widely among people and typically begin 6 to 48 hours after the cessation of drinking, according to the National Institute of Alcohol Abuse and Alcoholism (NIAAA).
Common initial symptoms may include:
- Agitation or irritability
- Sleep disturbances
- Nausea and vomiting
- Heightened sensitivity to light and sound
- Difficulty concentrating or thinking clearly
- Loss of appetite
- Rapid heart rate
In serious cases of alcohol withdrawal, some people experience vivid hallucinations.
About 25 percent of all withdrawal episodes also involve withdrawal-associated seizures, which may happen once or several times over a short period.
These symptoms typically intensify and then resolve within about four days, but some people suffer from alcohol withdrawal for weeks, according to the U.S. National Institutes of Health.
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Delirium tremens (DT) is the most serious syndrome (group of related symptoms) of alcohol withdrawal.
DT generally occurs in people who have been drinking excessively for years, and begins two to four days after the last drink. It's estimated to affect about 5 percent of people who go through alcohol withdrawal, according to the NIAAA.
Symptoms of DT include:
- Severe agitation
- Delirium, a condition characterized by confusion with a fluctuating level of consciousness and inattention
- Persistent hallucinations
- Spikes in heart rate (arrhythmia), breathing rate, pulse, and blood pressure
- Profuse sweating
These symptoms may persist for up to a week, according to UpToDate.
Up to 5 percent of people with DT die while experiencing it, usually due to arrhythmia, pneumonia, or other complicating illnesses — or because of other (undetected) health issues that preceded the cessation of alcohol use, such as pancreatitis, hepatitis, an infection, or injury to the central nervous system.
Alcohol Withdrawal Treatment
The goals of alcohol withdrawal treatment are to reduce symptoms, prevent complications, and help maintain abstinence from alcohol.
Treatment typically begins with a physical examination to detect any coexisting conditions, such as arrhythmia, alcoholic hepatitis, infectious diseases, or pancreatic diseases (including alcoholic pancreatitis), among other conditions.
Supportive care — either in a hospital or clinic, or in an outpatient setting with a caregiver watching over you — is standard in alcohol withdrawal treatment after other conditions have been ruled out or adequately treated.
If you have only mild or moderate symptoms from alcohol withdrawal, you may be able to detoxify successfully in an outpatient setting with supportive friends and family to help you.
But you may require in-patient detoxification if you're pregnant, or if you have:
- Severe symptoms
- Previous seizures or DT
- Certain medical conditions or severe psychiatric disorders
- Multiple past detoxifications
- No reliable support network
During outpatient supportive care, your caregiver will make sure you have a comfortable environment (quiet and with low lighting), limited interactions with people, proper nutrition and fluids, and copious reassurance and positive encouragement.
Your caregiver may also administer benzodiazepine sedative drugs, such as Valium (diazepam), Ativan (lorazepam), Librium (chlordiazepoxide), or Serax (oxazepam).
If you're receiving in-patient care, your doctor will also continuously monitor various vital signs (blood pressure, temperature, pulse, and breathing rate) and blood chemistry levels (electrolytes and vitamins), keep an eye out for serious symptoms (such as DT), and possibly provide you with fluids with electrolytes and essential vitamins and minerals, and medications intravenously (by IV).
Your doctor may also prescribe drugs that target specific symptoms, such as anticonvulsants for seizures, and beta blockers or other medications for heart rate and blood pressure issues.