Key Points on Alcohol Withdrawal

  • Alcohol Withdrawal Syndrome (AWS) is the body’s reaction to reduced or stopped alcohol intake in people who are alcohol-dependent.
  • Mild to severe symptoms include hand tremors, sweating, insomnia, hallucinations, and seizures.
  • Delirium Tremens (DTs) is a serious life-threatening form of withdrawal that requires immediate medical intervention.
  • Diagnosis often involves assessing your health history, symptom severity, and laboratory tests to rule out other conditions.
  • Treatment may include medications like benzodiazepines, psychosocial support, and medical supervision to ensure a safe detox.
  • Why Alcohol Withdrawal Occurs

    Alcohol acts as a central nervous system depressant, slowing down brain activity by enhancing the inhibitory effects of the neurotransmitter gamma-aminobutyric acid (GABA) and suppressing excitatory pathways. When someone drinks heavily over a long period, the brain adapts by changing how it responds to these chemical signals.

    Once alcohol intake is suddenly cut off, the brain can become hyperactive, leading to Alcohol Withdrawal Syndrome (AWS). The more a person drinks on a regular basis, and the longer they’ve been drinking, the greater the risk of developing withdrawal symptoms when they stop drinking.

    Your body, accustomed to regular alcohol intake, will experience a range of symptoms as it adjusts to the absence of alcohol. These can vary widely in severity and often include both physical and psychological effects.

    Withdrawal symptoms typically begin 8 to 24 hours after the last drink. For some people, these symptoms remain mild, but for others, withdrawal can quickly escalate. Recognising the early warning signs and seeking professional help can be lifesaving.

     

    Typical Alcohol Withdrawal Symptoms

    There are many different types of withdrawal symptoms and they can start as early as six hours after stopping drinking.

    • Nausea
    • Vomiting
    • Anxiety
    • Shaky hands
    • Sweating
    • Insomnia
    • Headache
    • Hallucinations
    • Seizures

    2-5 days after drinking, you may experience the following withdrawal symptoms:

    • Delirium tremens and shaking
    • Dehydration
    • Rapid heartbeat
    • High blood pressure
    • Confusion
    • Loss of consciousness
    • Angry or nervous behaviour
    • Sweating
    • Lack of sleep

    alcohol withdrawal symptoms
    Around 5 days after your last drink, your withdrawal symptoms are likely to start easing off. However, a small number of people will continue to experience withdrawal symptoms for several weeks, and some severe withdrawal symptoms may be life-threatening.

     

    Severe Symptoms & Delirium Tremens (DTs)

    For some people, withdrawal may progress into severe or life-threatening forms:

  • Hallucinations: Visual, auditory, or even olfactory hallucinations can appear a day or two after the last drink.
  • Seizures: Alcohol-related seizures typically occur between 12 and 48 hours after the final drink and can be a precursor to DTs.
  • Delirium Tremens (DTs): Usually emerging 2 to 3 days into withdrawal, DTs include severe tremors, hallucinations, confusion, agitation, and critical changes in vital signs (like tachycardia and hypertension). Early detection and treatment are crucial, as DTs carry a significant risk of morbidity and even death.
  • alchol withdrawal timeline
     

    Diagnosis of Alcohol Withdrawal

    Diagnosing Alcohol Withdrawal Syndrome involves assessing a person’s overall health, history of alcohol use, and whether they’ve had withdrawal episodes before. While there isn’t a single test for AWS, doctors may order blood work or heart tests to rule out other issues.

    Medical professionals also refer to the DSM-5 criteria for diagnosing withdrawal, which include:

  • A reduction or cessation of heavy, prolonged alcohol use.
  • A set of withdrawal symptoms not explained by another medical or mental health disorder.
  • Understanding these factors helps in creating an appropriate treatment plan and ensuring that any other complications are properly managed.

     

    Who Is at Risk of Severe Withdrawal?

    While anyone who drinks heavily over time can develop withdrawal symptoms, certain factors increase vulnerability:

  • Heavy, Prolonged Use: The larger the daily intake and the longer the duration, the higher the dependency risk.
  • Previous Withdrawals: A history of severe withdrawal or delirium tremens (DTs) indicates a higher risk for future severe episodes.
  • Concurrent Health Issues: Co-occurring medical or mental health conditions can exacerbate withdrawal severity.
  • According to some estimates, around 5-6% of hospitalised patients with Alcohol Use Disorder (AUD) experience AWS, underscoring the seriousness of the condition.
    precursor to aws
     

    Standard Treatments for Alcohol Withdrawal

    The severity of withdrawal determines the level of care required. Mild to moderate cases may be managed on an outpatient basis with close monitoring, while severe cases require hospitalisation or a specialised detox facility. Common treatments include:

  • Benzodiazepines (e.g., chlordiazepoxide, diazepam, lorazepam): These medications mimic alcohol’s effects on the brain, reducing the risk of seizures and easing anxiety and insomnia.
  • Gabapentin: Can improve sleep, stabilise mood, and decrease cravings.
  • Supportive Care: Monitoring hydration, electrolytes, and vital signs is essential, especially for patients at risk of complications.
  • Gamma-hydroxybutyric acid (GHB) and Sodium oxybate (SMO): Sometimes used in severe AWS cases or within specialised settings.
  •  

    Mild Alcohol Withdrawal

    If you detox at home without medical supervision some basic steps can help:

    • Soft lighting
    • Healthy foods
    • Plenty of fluids
    • Quiet surroundings
    • A positive, supportive atmosphere

    If you start to experience severe withdrawal symptoms such as a rise in your body temperature, pulse or blood pressure, or if you start experiencing hallucinations and seizures, you should seek medical care immediately.

     

    Medically Assisted Withdrawal (MAW)

    Also known as a planned detoxification under medical supervision, MAW often combines medication with psychosocial support. Clinicians may adopt symptom-triggered approaches using scales like the Glasgow Modified Alcohol Withdrawal Scale or the Minnesota Detoxification Scale (MINDS) to tailor care.

  • Medication: Dosages are adjusted based on withdrawal severity.
  • Counselling and Therapy: Helps patients address the psychological aspects of addiction.
  • Risk-Benefit Assessment: The advantages of controlled detox must be weighed against potential risks, ensuring the safest path for each person.
  •  

    Potential Complications of Alcohol Withdrawal

    When untreated or poorly managed, alcohol withdrawal can result in complications such as:

  • Seizures and other neurological issues.
  • Wernicke’s Encephalopathy: A serious condition linked to thiamine deficiency, presenting with confusion, ataxia, and eye movement abnormalities.
  • Alcohol Withdrawal Psychosis: Characterised by delirium, paranoia, or a disconnect from reality.
  • Neuropsychological Impairment: Repeated withdrawals can damage cognitive function over time, affecting memory and decision-making.
  • Gastrointestinal Issues: Chronic alcohol use can harm the GI tract, sometimes causing diarrhoea or malabsorption.
  • Ruling out any co-occurring withdrawals (e.g., from drugs) or other medical problems is critical to providing effective treatment.

     

    Seeking Help and Support

    If you or a loved one may be dependent on alcohol, early intervention is crucial. The following resources can help:

  • GP or Local Alcohol Services: A primary care doctor can guide you to detox programmes and specialised services.
  • Frank (0300 123 6600): Offers advice on substance use, including alcohol.
  • Charities and Private Organisations: Provide additional treatment options, often with shorter wait times.
  • Support Groups: Organisations such as Alcoholics Anonymous (AA), We Are With You, Drinkline, and Drinkchat offer ongoing peer and professional support.
  •  

    A well-structured plan that combines medical supervision, counselling, and long-term support can greatly increase the likelihood of successful, sustained recovery.

    Get Help Today

    Alcohol withdrawal can be challenging and, in severe cases, life-threatening. Recognizing the symptoms early, seeking professional guidance, and following a structured detox plan can significantly reduce the risks and improve overall outcomes. Here at Asana Lodge we provide full medically assisted detoxification and alcohol rehabilitation programmes for clients wishing to overcome their alcohol addiction.

    Frequently Asked Questions

    What is alcohol withdrawal syndrome (AWS) and who is at risk?

    AWS refers to the set of physical and psychological symptoms that appear when someone who is dependent on alcohol suddenly stops or reduces their alcohol intake. Heavy drinkers are most at risk, with an estimated 8% of hospitalised individuals with Alcohol Use Disorder (AUD) experiencing AWS.

    What are the common symptoms of alcohol withdrawal?

    Symptoms can range from mild (hand tremors, sweating, restlessness, insomnia) to severe (hallucinations, seizures, delirium tremens). Mild symptoms often start 8–24 hours after the last drink, while severe symptoms, like DTs, can develop around 2–3 days later.

    What is delirium tremens (DTs) and why is it dangerous?

    DTs is a life-threatening form of withdrawal marked by severe tremors, hallucinations, and confusion. It typically emerges 2–3 days into withdrawal. DTs can lead to serious complications, including cardiovascular instability and even death, making early detection and immediate medical care essential.

    What is medically assisted alcohol withdrawal (MAW) and what does it involve?

    MAW is a planned detox process performed under medical supervision, often in specialist treatment settings. It may use symptom-triggered medication protocols (like the Glasgow Modified Alcohol Withdrawal Scale). Psychosocial support is generally included, ensuring both the physical and emotional aspects of withdrawal are addressed.


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    John Gillen - Author - Last Updated: 16 February 2022

    John has travelled extensively around the world, culminating in 19 years’ experience looking at different models. He is the European pioneer of Nad+ (Nicotinamide Adenine Dinucleotide) treatment to Europe in 2010; and recently back from the USA bringing state of the art Virtual Reality Relapse Prevention and stress reduction therapy. his passion extends to other metabolic disturbances and neurodegenerative diseases.

    The journey continues, in recent times john has travelled to Russia to study and research into a new therapy photobiomudulation or systemic laser therapy working with Nad+ scientists and the very best of the medical profession in the UK and the USA, together with Nadcell, Bionad Clinics own select Doctors, nurses, dieticians and therapists, Johns’ passion continues to endeavour to bring to the UK and Europe new developments with Nad+ therapy in preventive and restorative medicine and Wellness. In 2017 John Gillen was made a visiting Professor at the John Naisbitt university in Belgrade Serbia.

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    Dr. Olalekan Otulana (Advanced Practitioner)

    Dr. Olalekan Otulana (Advanced Practitioner) - Clinical Reviewer - Last Reviewed: 28/11/2023 11:00 am

    Dr. Otulana is a highly skilled General Practitioner and Addiction Specialist. He possesses extensive expertise in the field of Substance Misuse Management and boasts a diverse background in evaluating, overseeing (including detox procedures), and overseeing the residential recovery of individuals grappling with various drug and substance addiction issues. His primary goal is to conduct thorough assessments of patients dealing with addiction issues and determine their medical detoxification and psychological treatment requirements. Dr. Otulana is well-versed in caring for patients who need dual drug and alcohol detoxification therapies.

    In addition to his medical qualifications, Dr. Otulana is a proficient healthcare professional who holds a Master of Business Administration (M.B.A.) degree from the prestigious Cambridge University Judge Business School.