Alcohol withdrawal syndrome, commonly abbreviated to AWS [1], refers to the adverse withdrawal symptoms a heavy drinker experiences when they moderate or discontinue alcohol consumption. The effects of alcohol withdrawal can be both physical and emotional, similar to cocaine withdrawal.

Research shows that 50% of those with alcohol use disorder will experience manifestations of alcohol withdrawal during the detoxification phase of rehab [2]. While detox is only one phase of the recovery process, it is vital to your overall success.

Learn about alcohol withdrawal causes, discover the most common symptoms of alcohol withdrawal, and find out how to connect with science-backed treatment.

What are Alcohol Withdrawal Symptoms?

Drinking excessive amounts of alcohol long-term can trigger significant changes to your CNS (central nervous system) [3]. Alcohol induces a sedating effect on the brain. Drinking heavily and/or long-term means that your brain is continuously exposed to the depressant effects of alcohol. In response, the brain produces chemicals to address this imbalance and to counteract the sluggish feeling heavy drinking can induce.

When you drink alcohol regularly, the brain increases the production of serotonin and norepinephrine – chemical messengers or neurotransmitters. When you significantly reduce alcohol intake after chronic alcohol use, your brain suddenly becomes overstimulated. With your brain running at full speed and your CNS finding the absence of alcohol challenging, alcohol withdrawal symptoms manifest as your brain’s response.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), when heavy drinkers stop or reduce alcohol, withdrawal symptoms such as shakiness, sweating, tremors, headaches, anxiety, irritability, and insomnia may occur due to the nervous system’s adjustment to the absence of alcohol [4].

Craving alcohol, having a tolerance to the effects of alcohol, and experiencing withdrawal symptoms when you try to stop drinking are some of the criteria that point toward having an Alcohol use disorder (AUD).

Early Withdrawal Symptoms

The early withdrawal symptoms of alcohol typically present from 6 to 12 hours after the last alcohol intake and mild symptoms appear which usually include:

• Insomnia

• Mild anxiety

• Headaches

• Tremors

• Upset stomach

Alcohol withdrawal symptoms peak within the first 3 days of detox. Alcohol withdrawal delirium, known as DTs (delirium tremens), is the most severe form of alcohol withdrawal, and may manifest within 48 hours of the last alcoholic drink. Symptoms of DTs may be life-threatening and include:

• Severe confusion

• Severe shaking

• High blood pressure

• Hallucinations

Common Symptoms of Alcohol Withdrawal

The most common alcohol withdrawal symptoms can be grouped as follows:

6 to 12 hours after the last alcoholic drink

• Nausea

• Vomiting

• Anxiety

• Agitation

• Shaking

• Headaches

12 to 24 hours after the last alcoholic drink

• Hand tremors

• Disorientation

• Alcohol withdrawal seizures

48 hours after the last alcoholic drink

• Insomnia

• High blood pressure

• High fever

• Excessive sweating

• Visual or auditory hallucinations

• Seizures

• Delirium tremens

In most cases, symptoms of alcohol withdrawal start to improve within 5 days, although a minority of those detoxing from alcohol may encounter prolonged withdrawal symptoms.

The duration and intensity of alcohol withdrawal is impacted by factors such as:

• Frequency of alcohol consumption

• Amount of alcohol consumed

• Duration of alcohol abuse

• Medical history

• Co-occurring mental health conditions

You are more likely to experience more severe withdrawal symptoms or life threatening complications if you have been abusing alcohol in combination with other addictive substances.

Alcohol Withdrawal Stages

Alcohol withdrawal symptoms will differ according to the severity of AWS. Symptoms unfold over the following stages [5]:

• Stage 1: Mild alcohol withdrawal syndrome

• Stage 2: Moderate alcohol withdrawal syndrome

• Stage 3: Severe alcohol withdrawal syndrome (delirium tremens)

Stage 1: Mild alcohol withdrawal syndrome

The mild withdrawal symptoms are correspondingly benign. These include:

• Anxiety

• Depression

• Tremors

• Headaches

• Insomnia

• Abdominal pain

• Gastrointestinal issues

• Vomiting

• Appetite loss

Stage 2: Moderate alcohol withdrawal syndrome

Moderate withdrawal symptoms include all of the above symptoms in addition to the following:

• Rapid heartbeat

• Raised body temperature

• Shallow breathing

• Heavy sweating

• Increased systolic blood pressure levels

• Seizures

As well as these physical symptoms, moderate AWS often triggers a sense of overall confusion, as well as irritability and pronounced mood changes. If you experience seizures during alcohol withdrawal, you should seek immediate medical intervention.

Stage 3: Severe alcohol withdrawal syndrome (delirium tremens)

Alcohol withdrawal occurs in varying degrees of severity. Around 5% of people detoxing from alcohol experience the most severe form of alcohol withdrawal in the form of delirium tremens (DTs) [6]. The mortality rate for untreated delirium tremens can be as high as 15% [7]. It is advisable to withdraw from alcohol in a medical detox center or inpatient treatment center if you are at risk of manifesting severe symptoms of AWS.

Many factors impact the extent and severity of withdrawal symptoms, including:

• How long you have been drinking and drinking history

• How much you have been drinking

• Relevant medical history

• Co-occurring mental health disorders

• Stress levels

• Family history of alcoholism

Not everyone experiences all of the above symptoms, and all situations are different. That said, alcohol withdrawal is the safest and most comfortable when undertaken in a clinical setting like a rehab center or licensed medical detox center.

What to Expect From Your Body When You Stop Drinking

While alcohol withdrawal may be intensely uncomfortable, it is also a relatively rapid process. Once your system is purged of toxins, there are many short-term and long-term benefits when you stop drinking alcohol. Here is what to expect from your body after alcohol detox is complete:

• No more hangovers: You will no longer be plagued by the tiredness, headaches, and nausea associated with alcohol hangover. Instead, you may notice an improvement in your body and overall productivity.

• Reduced stress and anxiety: Sustained alcohol abuse interferes with brain chemicals that are essential for sound mental health [8]. When you stop drinking, you may notice a reduction in stress, depression, and anxiety.

• Improved sleep: Regular consumption of alcohol disrupts the sleep cycle, leaving you feeling sluggish and tired the day after drinking [9]. Although alcohol may help you to fall asleep, this comes at the cost of a reduced quality of sleep with less sleep in the REM (rapid eye movement) stage of the sleep cycle.

• Better skin: Drinking alcohol can negatively impact your skin as the substance dehydrates your body. When you quit drinking, you should notice your skin becoming softer and more supple.

• Weight loss: Alcohol contains lots of empty calories that can cause weight gain without delivering nutritional benefits. When you quit drinking, you may find that you lose weight and find it easier to maintain a healthy weight [10].

• Reduced chances of developing alcohol-related diseases: Alcohol is associated with an increased risk of certain cancers [11], including liver, breast, bowel, and mouth cancer. Quitting drinking will reduce your risk of developing these cancers, as well as minimize the chances of liver disease developing [12]. If you stop drinking, you will also be at decreased risk of heart disease, high blood pressure, gastrointestinal issues [13], sexual dysfunction [14], and stroke [15].

Alcohol Withdrawal Treatment

It is advisable to begin treating alcohol withdrawal by engaging with a supervised medical detox program for professional diagnosis and clinical management.

The withdrawal process is typically followed using the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar).

During detoxification, you will be continuously monitored, minimizing the chance of complications. The treatment team may prescribe medications to reduce the severity of cravings and acute alcohol withdrawal symptoms. These may include:

• Benzodiazepines

• Anti-convulsants

• Antidepressants

• Naltrexone

• Acamprosate

Benzodiazepines are often the first treatment that doctors suggest for alcohol withdrawal. Benzodiazepines can help rebalance brain chemicals during alcohol withdrawal. Thiamine is routinely recommended during alcohol withdrawal treatment to prevent complications. Gabapentin may be used to help reduce cravings and improve sleep during alcohol withdrawal. Antipsychotics may be used to control severe symptoms such as hallucinations during alcohol withdrawal.

Detox addresses alcohol dependence and prepares you for ongoing treatment for alcohol use disorder in an inpatient or outpatient setting. We can help you with all this and more here at California Detox.

Withdraw From Alcohol in a Safe Environment at California Detox

If you have been struggling with alcohol use disorder, we can help you kickstart your sustained recovery at California Detox in Laguna Beach.

Access our supervised medical detox program and streamline the intensity of the alcohol withdrawal process while conquering the issue of physical dependence. After a week or so, you can transition into ongoing treatment. We offer inpatient and intensive outpatient treatment programs for alcohol addiction at our luxury facility in Laguna Beach, CA.

All alcohol addiction and substance abuse treatment programs at California Detox combine evidence-based interventions [16] and holistic treatments that may include:

• Psychotherapy

• Medication-assisted treatment

• Individual counseling

• Group therapy

• Family therapy

• Holistic therapies

• Aftercare

Call 888-995-4208 for a supervised medical detox from alcohol followed by evidence-based treatment.

Sources

[1] https://medlineplus.gov/ency/article/000764.htm

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/

[3] https://pubmed.ncbi.nlm.nih.gov/23713737/

[4] https://www.samhsa.gov/substance-use/learn/alcohol?utm_

[5] https://medlineplus.gov/ency/article/000764.htm

[6] https://www.nejm.org/doi/full/10.1056/NEJMra1407298

[7] https://www.ncbi.nlm.nih.gov/books/NBK441882/

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272862/

[9] https://www.sciencedirect.com/science/article/pii/S2352250X18302719?via%3Dihub

[10] https://pubmed.ncbi.nlm.nih.gov/30630543/

[11] https://pubmed.ncbi.nlm.nih.gov/34321471/

[12] https://onlinelibrary.wiley.com/doi/10.1111/add.15204

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513683/

[14] https://academic.oup.com/jsm/article-abstract/15/4/458/6980312?redirectedFrom=fulltext&login=false

[15] https://pubmed.ncbi.nlm.nih.gov/24820756/

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678283/