Alcohol Withdrawal Syndrome | Symptoms, Timeline & Treatment

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Someone who has an alcohol use disorder (AUD) will eventually experience alcohol withdrawal symptoms if they go long enough without having a drink. Even someone who only drinks casually can experience some mild symptoms the next morning; however, alcohol withdrawal symptoms get worse the more someone drinks and the longer someone has been drinking.

If someone has substance use disorder to the point where they have become fully dependent on that substance, the withdrawal symptoms can be severe. In the case of alcohol, the symptoms could become life-threatening if the situation is not overseen by a trained healthcare professional.

That is where medical detox and therapeutic support can be beneficial. The first step in recovery from alcohol addiction is to fully detox and remove all traces of alcohol from the body. This means going through alcohol withdrawal syndrome. It is critical for everyone to understand what alcohol withdrawal looks like, what alcohol withdrawal symptoms are, and what the treatment process is. 

What Is Alcohol Withdrawal?

If someone who has become dependent on alcohol goes for a while without having an alcoholic beverage, they will eventually experience alcohol withdrawal. Alcohol withdrawal is an important part of the journey someone has to complete to remove all traces of alcohol from the body.

When someone drinks continuously for a long amount of time, the brain becomes used to having alcohol around. When alcohol is no longer around, the brain and the body can get confused, and the symptoms of alcohol withdrawal start to appear.

The Science Behind Alcohol Withdrawal

Some might be interested in the biochemistry behind alcohol withdrawal. When someone drinks for a long time, the chemistry of the brain changes. The brain uses neurotransmitters (such as GABA) to send signals throughout the central nervous system. The balance of the neurotransmitters will change when someone drinks for a long amount of time because the brain becomes imbalanced. The brain changes levels of neurotransmitters in an effort to counteract the impacts of alcohol on the body.

As someone continues to drink, the body builds up a tolerance to alcohol. This means that more alcohol is present in the body, and the brain has to change its levels of neurotransmitters even more. As the levels of neurotransmitters continue to deviate from what is considered “normal,” it takes even longer for the brain to go back to normal.

Now, when someone stops consuming alcohol, the imbalance of neurotransmitters in the brain becomes inappropriate. It takes a long time for the neurotransmitters to go back to normal, and this could contribute to alcohol withdrawal symptoms.

Why Is Medical Supervision Of The Withdrawal Process Necessary?

When someone goes through alcohol withdrawal, it is important for them to be under the supervision of a trained medical professional. Someone who has been drinking for a long time will be almost guaranteed to go through alcohol withdrawal. The effects of alcohol withdrawal can be extremely uncomfortable, and a doctor can help keep someone comfortable as the process unfolds.

Remember that some of the symptoms of withdrawal could be life-threatening. For this reason, medical supervision of alcohol withdrawal and its side effects is necessary.

What Are The Alcohol Withdrawal Symptoms?

Alcohol withdrawal covers many symptoms that develop in many people. Some symptoms are emotional, while others are physical.

Not everyone is going to experience all of the symptoms below, and the severity of the symptoms will directly correlate to how much someone has been drinking and how long they have been drinking.

Individuals with heavy alcohol dependence are most likely to experience severe withdrawal symptoms.

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Mild Alcohol Withdrawal Symptoms

There are some mild symptoms of alcohol withdrawal that could make someone uncomfortable. A few examples of minor withdrawal symptoms include:

  • Shaking and tremors
  • Anxiety
  • Depression
  • Fatigue and tiredness
  • Mood swings
  • Night sweats
  • A fever
  • Headache
  • Nightmares
  • Problems sleeping despite fatigue
  • Abdominal pain
  • Confusion or disorientation
  • A loss of appetite
  • Hypersensitivity to lights and sounds

It is possible for someone suffering from alcohol withdrawal to develop many of the symptoms above. Some of these symptoms can get worse if someone has been drinking for a long time.

Severe Alcohol Withdrawal Symptoms

It is also possible for someone who has been drinking for a long time to develop severe symptoms of alcohol withdrawal. After going without drinking for a long period of time, some of the more dangerous symptoms include:

  • A high, spiking fever
  • Severe tremors that make it difficult for someone to hold something without dropping it
  • A significant increase in heart rate 
  • High blood pressure
  • Severe, intractable nausea and vomiting
  • Severe, poignant agitation and temper issues
  • Delusions
  • Seizures

Seizures are one of the most dangerous symptoms of alcohol withdrawal because they can be fatal. If the seizure is not stopped, it can overload the central nervous system, leading to extremely dangerous consequences. This is arguably the biggest reason why anyone going through alcohol withdrawal should go through the process in a medical facility.

Delirium Tremens (DTs)

Some individuals are prone to getting the “DTs,” which is an acronym for delirium tremens. This is a very severe alcohol withdrawal syndrome that develops in a minority of people who are dependent on alcohol.

Many of the severe symptoms of alcohol withdrawal listed above take place in individuals who go through delirium tremens. Some of the main symptoms of this syndrome include:

  • Complete confusion regarding their surroundings
  • A high fever and rapid heart rate
  • Hallucinations, both seeing things that are not there and hearing things that are not there
  • Shaking to the point where it is no longer controllable
  • A massive change in overall mental status
  • Seizures and convulsions
  • Uncontrollable vomiting 

Many of these symptoms can lead to additional complications if they are not treated appropriately. Medical professionals have tools at their disposal that they can use to manage many of the symptoms related to delirium tremens. These treatment methods can only be administered if someone goes through this process in a medical facility.

Delirium tremens are more likely in individuals who have an abnormal liver function, a long history of drinking heavily, a previous history of mental health issues, and a previous history of seizures.

A Timeline Of Alcohol Withdrawal Symptoms

There is no set alcohol withdrawal timeline regarding when the symptoms above will show up because everyone is different. There are a lot of factors that will play a role in when the symptoms of alcohol withdrawal appear and which symptoms show up.

Someone’s length and severity of alcohol use will have an impact on the timeline of these symptoms. Furthermore, someone’s overall mental and physical health will play a role in how they respond to these symptoms. Finally, remember that some people with alcohol use disorder also have concomitant substance use disorders, meaning that they may use other drugs. This can also play a role in how their specific withdrawal syndrome unfolds.

A Sample Timeline

Even though there is no set timeline related to alcohol withdrawal symptoms, there is a pattern that the symptoms tend to follow. They include:

  • Generally, the earliest symptoms of alcohol withdrawal will show up between four and 12 hours after the last drink.
  • Then, the worst symptoms of alcohol withdrawal will show up between 24 and 72 hours after the last drink was consumed.
  • If delirium tremens is going to appear, it usually shows up on day two or three.
  • By day 4 or 5, the worst symptoms should have subsided, but it is not unusual for less severe symptoms to stick around for a few extra days.

Remember that alcohol withdrawal syndrome can look different for different people depending on a number of factors.

Which Symptoms Show Up First?

As a good rule of thumb, the less severe symptoms are the ones that show up first and the ones that tend to stick around the longest. Moderate or severe symptoms tend to show up in the middle.

  • The First Few Hours: During the first few hours of alcohol withdrawal, most people will start to get a bit restless and irritable. They may have a short temper during this time, and they might not want to eat or drink anything because they feel nauseous. The skin might start to turn pale, and they might have a difficult time sitting still.
  • By the End of the First Day: By the end of the first day, depression and mood swings will probably start to set in. If someone tries to sleep, they will probably develop nightmares and night sweats. They may also complain of nausea, vomiting, and confusion. Some people claim that they feel like they are in a brain fog. 
  • During Days 2 and 3: During the second and third days, vomiting will continue and probably get worse. The tremors may also get worse, and the individual will be at risk of visual and auditory hallucinations. It is also important to be vigilant for seizures. This is when delirium tremens will occur if it is going to happen. 
  • The Process Subsides: After day 3, the most severe symptoms should subside. A new normal will probably set in, but some of the mild symptoms of alcohol withdrawal syndrome may persist for a few days.

Even though the alcohol detox process can be uncomfortable, it is also important because the recovery process cannot continue until the alcohol has been removed from the body. Remember that medical professionals have tools at their disposal to make the process more comfortable. Medical attention is important because seizures and other health conditions could constitute a medical emergency.

How Do Medical Professionals Treat Alcohol Withdrawal?

There are multiple tools doctors can use to help with alcohol withdrawal treatment. Generally, the process starts by providing them with supportive care. Some of the most important treatments include:

  • Placing the individual in a quiet environment
  • Turning down the lights or turning them off entirely
  • Ensuring that people go in and out of the room as little as possible
  • Providing them with plenty of food and lots of fluids

Because people with alcohol withdrawal may have nausea and vomiting, medical professionals might decide to place an IV instead. That way, individuals going through alcohol withdrawal do not develop dehydration. Over-the-counter medications can also help with alcohol treatment and detoxification by helping to deal with alcohol cravings.

Medical professionals can also provide anxiolytic medication that can help people calm down during this process. Doctors will also monitor vital signs closely, including heart rate, blood pressure, and body temperature.

The most important reason why people going through alcohol withdrawal need to do so in the presence of medical professionals is the possibility of withdrawal seizures and hallucinations. Medical professionals might need to administer emergency medications, such as benzodiazepines, to stop a seizure and protect the brain. Doctors have a variety of options they can utilize to help someone stay stable during this time, and they can provide supportive care until alcohol withdrawal syndrome subsides.

What Are The Signs Of Alcohol Dependence?

First, individuals should know that people who have alcohol dependence are more likely to develop severe alcohol withdrawal symptoms. What does alcohol dependence look like?

Someone who is addicted to alcohol may display some of the following signs:

  • The individual may continue to drink despite alcohol having a negative impact on their relationships with friends, family members, and colleagues.
  • Someone who suffers from alcohol abuse disorder will skip personal and professional obligations to continue heavy drinking.
  • Individuals with alcohol dependence need to consume more alcohol to achieve the same effects because they have developed a tolerance to alcohol.
  • People with alcohol use disorder will try to hide the amount of alcohol they drink.
  • People who are dependent on alcohol will often lie about their alcohol consumption.
  • The individual may be unable to function without drinking alcohol.
  • They may have a drink first thing in the morning, often called an “eye opener.”
  • They might steal money from someone else in an effort to buy alcohol and engage in binge drinking.

It is not necessary for someone to have all of the symptoms above to be dependent on alcohol. Instead, it is not unusual for someone who has become dependent on alcohol to display one or more of the symptoms above.

Choosing A Treatment Center

If you or someone you know is starting the process of recovering from alcohol use disorder, it is important to choose the right treatment center. Some of the most important factors include:

  • Do they have a safe, comfortable environment where you can begin your journey toward sobriety?
  • Do they have experience treating individuals who go through alcohol withdrawal syndrome?
  • Do they have appropriately licensed medical professionals with the right tools to assist with the recovery process?
  • Do they have a lot of positive reviews and ratings from other people and support groups?
  • Do they offer both inpatient and outpatient treatment?

If you are looking for a medical facility in Tampa, Florida that can help you recover from alcohol withdrawal syndrome, look no further than Riverside Recovery. 

Riverside Recovery of Tampa Provides Alcohol Withdrawal Treatment

At Riverside Recovery of Tampa, we are proud to be one of the most trusted substance abuse and addiction treatment programs in Tampa, Florida. We understand that alcohol withdrawal can be dangerous, and that is why we follow all the best practices and provide you with the best medical care in the region. Our team can help you or a loved one during every step of your journey toward sobriety, and that includes the first one.

If you would like to learn more about how we can help you and your family, contact us today to speak to a member of our team. 

  1. National Library of Medicine–Neurotransmitters in alcoholism: A review of neurobiological and genetic studies

  2. Banerjee N. Neurotransmitters in alcoholism: A review of neurobiological and genetic studies. Indian J Hum Genet. 2014;20(1):20-31. doi:10.4103/0971-6866.132750