Alcohol withdrawal is a syndrome seen commonly in those addicted to alcohol. Symptoms of acute alcohol withdrawal will often arise after a person has become physiologically dependent on alcohol and then suddenly stops or cuts back on drinking 1. Withdrawal symptoms range from mild to severe, and may potentially be life-threatening 1. A detox program can greatly reduce the dangers associated with alcohol withdrawal syndrome and promote long-term sobriety.
In this article, you will learn more about the following:
- Alcohol withdrawal symptoms.
- Alcohol withdrawal timeline.
- Post-acute withdrawal symptoms.
- Alcohol withdrawal treatment.
- Medication for alcohol withdrawal.
Alcohol Withdrawal Symptoms
The duration and severity of alcohol withdrawal symptoms varies from person to person and will depend upon several factors, such as:
- The length of time a person has consumed alcohol.
- The amount of alcohol they consumed.
- The person’s individual physiology.
- The presence of polydrug abuse.
- The presence of any medical or psychiatric issues.
The psychological and physical symptoms that are commonly experienced by those going through alcohol withdrawal include 1,2:
- Agitation and/or irritability.
- Nervousness or anxiety.
- Mood swings.
- Inability to think clearly.
- Clammy skin or excessive perspiration.
- Dilated pupils.
- Paleness of skin.
- Shaking or tremors.
- Loss of appetite.
- Rapid heart rate.
There is a risk of severe withdrawal for those who have drunk heavily over a long period of time 1. At the extreme end of the spectrum, this dangerous form of withdrawal is known as delirium tremens (or, colloquially, as the DTs) and can be fatal 1. Someone experiencing any of the following symptoms should call 911 or go to the nearest emergency room. These symptoms include 1:
- Extreme agitation.
- Profound confusion or disorientation.
- Visual or auditory hallucinations.
Medically supervised detox can help you or a loved one to withdraw safely and comfortably from alcohol. Help is available—contact one of our treatment support representatives today at 1-888-241-8971 to learn about detox options.
Alcohol Withdrawal Timeline
According to the typical alcohol withdrawal timeline, acute withdrawal symptoms—the predictable symptoms that occur following the abrupt cessation of alcohol consumption—tend to appear within 8 hours after an individual’s last alcoholic drink 1,3. Typically, these symptoms gradually increase in intensity and peak within 24-72 hours 1,2. The average withdrawal timeline for alcohol is 5 to 7 days, but a person who suffers from a severe and long-term alcohol use disorder may experience post-acute withdrawal symptoms (PAWS) for as long as 3 years after quitting drinking 3.
Post-Acute Withdrawal Syndrome
Post-acute withdrawal symptoms or protracted withdrawal symptoms occur when someone in recovery continues to experience withdrawal symptoms well beyond the expected timeline of acute withdrawal 3. Long-term alcohol abuse can cause chemical changes in the brain that impact behavior and emotions. Over time, the brain and body adapt to the presence of alcohol and its rewarding effects and its absence results in the arrival of unpleasant withdrawal symptoms 3. Protracted withdrawal symptoms can cause discomfort and distress for years after discontinuing alcohol consumption which, in some cases, may play a role in relapse, should it occur.
Some common post-acute withdrawal symptoms include 3:
- Concentration and memory problems.
- Impaired decision-making and problem-solving.
- Alcohol cravings.
- Irritability and/or hostility.
- Mood instability.
- Anhedonia (an inability to feel pleasure).
- Reduced libido.
- Physical pain.
Not everyone experiences protracted withdrawal symptoms. Some people may not experience any post-acute withdrawal symptoms after initial withdrawal symptoms dissipate, while others may experience uncomfortable physical and psychological symptoms for months or years. Seeking the care of an experienced substance abuse treatment professional can help recovering individuals manage protracted withdrawal—easing the transition to sobriety and reducing the likelihood of relapse.
Alcohol Withdrawal Treatment
Alcohol withdrawal treatment starts with detox. Detoxing from alcohol and, next, maintaining sobriety in the long-term can be difficult1. Detox programs and inpatient treatment facilities provide an environment where the process is more comfortable and safe, and will increase the chances of a successful recovery.
- Detox facilities: Alcohol detox centers will medically manage the process of withdrawal.4The services will include short-term management of any significant medical and psychiatric issues as well as medication-assisted therapy for alcohol dependence to stabilize withdrawal symptoms. Detox alone does not constitute a comprehensive form of substance abuse treatment, but services will be provided to help a person prepare to transfer into some form of ongoing care (e.g., inpatient or residential treatment, outpatient programs)4.
- Inpatient facilities: Inpatient or residential treatment programs are common destinations for people coming out of alcohol detox centers. Inpatient treatment facilities help people better understand underlying thoughts, feelings, and experiences that may be driving substance abuse. These facilities provide a safe environment in which to live throughout the treatment duration, and will also help a person to develop healthy coping skills and learn how to live a life of sobriety in a meaningful way. Services provided include individual, couples, family, group, nutritional, and recreational therapy in addition to medication-assisted therapy for ongoing symptoms.
For those who do not require a residential setting to continue with recovery, partial hospitalization or intensive outpatient programs may be recommended for ongoing treatment for alcohol abuse.
- Partial Hospitalization (PHP): PHP is a full day outpatient service that provides group therapy to reinforce positive lifestyle changes and coping skills that will aid in maintaining long-term sobriety. Medication-assisted therapy is part of the services PHP provides.
- Intensive Outpatient (IOP): IOP provides the same group therapy services as PHP but will do so only half of the day and will not directly facilitate medication-assisted therapy. IOP and some other outpatient treatment varieties will expect you to have any medications managed by a treatment provider outside of the program.
If you or a loved one is dependent on or addicted to alcohol, treatment is available and can help you on the path to a sober life. Contact one of our dedicated staff today at 1-888-241-8971 to discover the treatment option that is best suited for your recovery.
Medication for Alcohol Withdrawal
There are several medications commonly used to manage the acute alcohol withdrawal syndrome. These medications help to reduce the severity of withdrawal symptoms, reduce the risk of seizures and delirium tremens, and/or help reduce cravings that are associated with relapse. These medications include 2:
- Benzodiazepines such as chlordiazepoxide and Valium .
- Carbamezepine (Tegretol) or other anticonvulsants.
- Atenolol, propanolol, or other beta blockers.
- Clonidine or other alpha-agonists.
In addition to these medications, there are also medications that may be prescribed after detox is completed to deter future alcohol use and to help with any protracted symptoms associated with alcohol dependence. These medications include 4,5:
- Acamprosate, which may be used to reduce some of the protracted withdrawal symptoms of alcohol.
- Antabuse, which is a medication that discourages future alcohol use by causing symptoms such as flushing, nausea, and heart palpitations when alcohol is consumed.
- Naltrexone, which blocks the rewarding effects, such as euphoria, associated with alcohol use.
Medication, when combined with behavioral therapy, can help patients to obtain and maintain sobriety while rectifying maladaptive behaviors and forming new, healthy patterns of behavior.
Aftercare is any combination of services that a person uses after detox and initial rehabilitation is complete. Aftercare often continues for years and can increase the likelihood of success a person has in sobriety years down the road. It is estimated that more than 60% of those who seek aftercare will remain sober after 3 years compared to 43% of those who do not seek aftercare 6. Some aftercare options include:
- Individual therapy: Individual therapy can help guide a person through the recognition and healing of any underlying issues driving substance abuse.
- Support groups: 12-step programs, such as Alcoholics Anonymous (AA), provide members with an encouraging and supportive environment in which they can share their experiences related to alcohol abuse and recovery. Groups, such as SMART Recovery, that utilize an evidence-based approach, are viable options for those who want an alternative to AA.
- Sober living homes: Sober living homes provide accountability and a safe environment free of substances where a person can focus on learning to live a life of sobriety.
Each treatment program and level of care is unique in the approach they will have in treating substance use and the services they will provide to accomplish that goal. Finding a treatment program that works for you as an individual will enhance your experience and your chances of success.
Find a Treatment Program Today
It’s never too late to begin on the road to recovery. If you or a loved one is dealing with an addiction to alcohol, treatment can help facilitate positive change. Help is available when you are ready. Contact one of our knowledgeable staff members today at 1-888-241-8971 to take your first steps towards living a life of sobriety.
1. U.S. National Library of Medicine. (2015). Medline Plus, Alcohol withdrawal.
2. Kosten, T. R., & O’Connor, P. G. (2003). Management of drug and alcohol withdrawal. New England Journal of Medicine, 348(18), 1786-1795.
3. Substance Abuse and Mental Health Administration. (2010). Protracted withdrawal. Substance Abuse Treatment Advisory, 9(1), 2-5.
4. Knowledge Application Program. (2013). Detoxification and substance abuse treatment: A treatment improvement protocol TIP. Rockville, MD: U.S Department of Health and Human Services.
5. National Institute on Drug Abuse. (2012). Alcohol Addiction.
6. Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction (Abingdon, England), 101(2), 212–222.