What Is Alcohol Withdrawal?
After many years of drinking alcohol, it can be quite difficult to stop. As a mind-altering drug, alcohol is not only addictive, but also causes withdrawal symptoms. Alcohol withdrawal is a potentially life-threatening consequence of alcohol abuse. Tragically, many people who want to become sober repeatedly fall back into drinking because withdrawal is distressing and painful. However, with medical care and professional support, people can weather the experience of withdrawal and adjust to living life without alcohol.
Alcohol withdrawal encompasses a variety of symptoms that arise when a person who regularly drinks alcohol suddenly stops drinking altogether or begins to drink less. Adults who binge drink or suffer from alcohol addiction are most likely to suffer withdrawal. The symptoms of withdrawal will vary in severity from person to person, with the most severe symptoms afflicting those who drink the heaviest.
The Difference Between Withdrawal and a Hangover
Some people mistake alcohol withdrawal for a hangover, but they are different conditions. Alcohol withdrawal is the body’s reaction to an absence of alcohol, while a hangover is the body’s reaction to excessive alcohol. The most common symptoms of a hangover are headaches, confusion, fatigue, and nausea.
Anyone can have a hangover if they drink too much alcohol, but not everyone will experience withdrawal when they stop drinking. Unlike withdrawal, a hangover is primarily the result of dehydration and stomach inflammation. By contrast, alcohol withdrawal is an ailment of the brain and central nervous system.
What Causes Alcohol Withdrawal?
All forms of withdrawal occur because the brain is an adaptable organ. It changes itself when exposed to a stimulus, and it will require time to return to its normal state when the stimulus disappears.
Alcohol is a central nervous system depressant, a substance that sedates and relaxes the brain. By altering a person’s brain chemistry, alcohol affects a person’s perception and behavior. When alcohol reaches the brain through the bloodstream, it amplifies the effects of GABA (gamma-Aminobutyric acid), a neurotransmitter which inhibits connectivity among neurons. Alcohol simultaneously reduces the brain’s production of glutamate, an excitatory neurotransmitter which facilities neural activity, the opposite effect of GABA.
In general, alcohol depresses the functioning of the brain. As a result, a person who drinks alcohol in small quantities will feel relaxed and perhaps euphoric, while a person who drinks larger quantities of alcohol will struggle with coordination, judgment, and memory.
To adjust to the effects of alcohol, the brain will overcharge its production of other neurotransmitters, especially serotonin and norepinephrine, to keep itself stimulated. These chemical changes are temporary for someone who drinks alcohol occasionally and moderately. However, a person who frequently drinks alcohol in large amounts will force their brain to consistently adapt to alcohol.
Eventually, the brain will become accustomed to alcohol and require more of it to yield the same chemical changes. This is the phenomenon of tolerance. Tolerance causes people to drink more alcohol to feel drunk, and it reinforces the brain’s alcohol habituation. Consequently, when a heavy drinker puts alcohol away, the absence of alcohol shocks their brain and nervous system and provokes adverse physical and psychological symptoms.
As long as the person survives withdrawal, their brain will eventually return to its pre-alcohol chemical structure. Until then, the entire nervous system will operate with chemical imbalances, causing pain and discomfort. Once withdrawal is finished, the neurological anchor of alcohol dependence is lifted, and long-term recovery from alcohol addiction becomes possible.
The Symptoms of Alcohol Withdrawal
When someone suffers withdrawal, they may experience different symptoms than someone else. The more common and less severe alcohol withdrawal symptoms are:
- Dilated pupils
- Heart palpitations
- Increased blood pressure
- Loss of appetite
- Shaking and tremors
Delirium Tremens: A Severe Case of Withdrawal
Sometimes alcohol withdrawal can become a medical emergency or even turn fatal. In fact, about 1 out of every 20 people who suffer alcohol withdrawal will also suffer delirium tremens, a set of withdrawal symptoms which arise from dangerous fluctuations in a person’s heart rate and body temperature. Delirium tremens usually begins two to three days after someone stops drinking alcohol, and it reaches its greatest intensity within four to five days.
Delirium tremens can be fatal when the condition causes seizures, which can damage the brain. Seizures present the greatest risk of severe injury or death from delirium tremens. It is important to get help immediately if you or someone you know exhibits the symptoms of delirium tremens, which include:
- Hypersensitivity to sound, light, and touch
- Intense sweating
- Loss of consciousness
How Long Does Alcohol Withdrawal Last?
The symptoms of alcohol withdrawal typically begin within six to eight hours after a person stops drinking. However, withdrawal can sometimes begin several days later. In most cases, the withdrawal process lasts for about one week, with symptoms reaching peak intensity during the second or third day.
Within the first 12 hours of withdrawal, the symptoms of sweating, nausea, irritability, insomnia, and tremors typically begin. During this phase of withdrawal, a person’s heartbeat will accelerate and their blood pressure will rise. As symptoms begin to worsen after 48 hours, the hallucinations and seizures of delirium tremens are most likely to occur.
Withdrawal symptoms often continue in full force for up to five days of withdrawal. After the fifth day, withdrawal symptoms generally begin to subside, although psychological distress may persist. In particular, people who undergo alcohol withdrawal may experience anxiety, irritability, depression, and sleeplessness for many weeks. In some cases, symptoms may persist for up to 18 months. Any withdrawal symptoms that last for more than two weeks are considered Post-Acute Withdrawal Symptoms (PAWS).
Diagnosing Alcohol Withdrawal
If you suspect that you are experiencing alcohol withdrawal, a doctor can easily diagnose the condition with a physical exam. The exam may involve a toxicology screening for alcohol and a blood test. A doctor will also look for withdrawal symptoms, including signs of delirium tremens. Since many people who experience alcohol withdrawal have a history of alcohol abuse, it is important to be honest with your doctor about your alcohol consumption to ensure an accurate diagnosis.
Treatment for Alcohol Withdrawal
Since alcohol withdrawal poses potentially fatal health risks, no one should attempt to wean themselves off alcohol alone or go “cold turkey.” It is necessary to undergo withdrawal to overcome alcoholism, but it is best to undergo it in a detox program at a hospital or professional rehab center.
Medically-supervised detox makes the ordeal of withdrawal safer and more bearable. During detox, healthcare providers use medications and nutrition to alleviate a person’s pain and discomfort and keep them healthy. Additionally, therapists and counselors who work at rehab centers can help alcohol withdrawal patients manage their emotions as they progress through detox.
In cases of severe withdrawal, some people may require full hospitalization. This may be necessary for people at risk for delirium tremens, which requires medical attention.
I Went Through Alcohol Withdrawal. Now What?
If you have gone through withdrawal, your brain is ready for a fresh start. The best way to avoid the cycle of alcohol withdrawal and relapse is to start treatment for alcoholism. At a rehab center, people can make a full recovery from alcohol addiction and achieve life-long sobriety. There are thousands of treatment centers across the United States and throughout the world that provide inpatient and outpatient treatment, therapy, and access to support groups for recovering alcoholics who want to start a new life.
Alcoholism may be the past and present, but it does not have to be the future. If you or your loved one is struggling with alcohol addiction, please contact a dedicated treatment provider today to learn more about your rehab options.
Author: Nathaniel Yerby | Last Edited: March 31, 2021
Medical Reviewer: Theresa Parisi