Alcohol Withdrawal in Theory and Practice

People who abuse alcohol, then stop can struggle with problems related to alcohol withdrawal.

Without assistance from a health care provider, alcohol withdrawal and the accompanying symptoms can be deadly.


What Causes Alcohol Withdrawal

Heavy drinking can cause alcohol independence, so stopping causes the body to react to the lack of alcohol (1).

When you drink, your brain responds by producing more of a neurotransmitter that makes you feel calm and joyful (2). It also reduces the neurotransmitter that creates a feeling of excitement.

When you stop drinking, those neurotransmitters respond in the opposite way to create balance.

Eventually, your brain cannot make up for the changes. The body responds with tremors and anxiety. The physical reaction depends on several factors: how much you drink, for how long, when you stop, and pre-existing conditions.


Symptoms of Alcohol Withdrawal

Alcohol withdrawal involves a combination of symptoms with a range of severity.

Some people have severe, life-threatening symptoms like:

  • Mood changes
  • Sleep disruptions
  • Headaches
  • Upset stomach
  • Fatigue
  • Fever and sweating
  • Loss of appetite
  • Seizures
  • Hallucinations

Anyone suffering from any combination of these symptoms should see a health care provider immediately.


Diagnosing Alcohol Withdrawal

Medical professionals, usually in a hospital or rehab center, diagnose alcohol withdrawal based on the symptoms the patient presents.

Health care providers use a professional tool called the Clinical Institute Withdrawal Assessment of Alcohol Scale that assess the type and severity of symptoms.

The diagnosis usually includes a physical exam, so the provider can check the patient’s heart rate, hydration, body temperature, and blood pressure.


Timeline for Withdrawal

Generally, alcoholics need at least a week to recover from withdrawal symptoms.

Most people go through a three-step withdrawal process.


Stage One

The first stage starts within a few hours of not drinking and can last up to a week.

This stage includes mild symptoms that can include blood pressure changes, nausea, shakes, and anxiety.


Stage Two

The second stage usually starts within two days of stopping drinking, and can last a week.

During the second stage, people might have more serious symptoms like seizures. If people don’t have seizures within 48 hours of the last drink, they probably won’t have them.

Then, they probably won’t move into the third stage.


Stage Three

The third stage starts within 48 hours and lasts about 48 hours.

If you have had seizures, you might end up with delirium tremens, usually between 48 and 72 hours after the last drink.

It is vital that people experiencing seizures and/or delirium tremens see a health care provider immediately.

Delirium tremens have several symptoms that can include hallucinations, confusion, mood changes, bursts of energy with sweating, fever, grand mal seizures, and sleepiness.


Stage Four

A fourth stage exists, and the symptoms can happen within a week or months after the last drink.

It can last between six months and two years. The post-acute withdrawal stage can include mood disorders and sleep problems.


Detoxing on Your Own

The best way to detox is to work with a healthcare provider.

When you detox in a facility, you will be kept safe and comfortable.