Alcohol is one of the most common recreational substances in the world. Despite its legal status and cultural acceptance, it is a serious psychoactive substance that can profoundly affect your health. Alcohol can be dangerous to abuse, but it can also be dangerous to quit too quickly. If you’ve been drinking heavily for a time and then quit cold turkey, you may experience some of the most dangerous withdrawal symptoms of any substance. Alcohol withdrawal can include dangerous symptoms like seizures, which can come on suddenly and lead to serious consequences.
What causes alcohol withdrawal seizures, are there any warning signs, and how can alcohol dependence be treated safely. Learn more about alcohol withdrawal seizures and how they can be treated.
How Does Alcohol Work in the Brain?
Alcohol is the common name for drinking alcohol, but it’s actually a specific chemical in a broad category of chemicals called alcohol. The alcohol you can drink is called ethanol. It is produced naturally through the breaking down of sugars in plants and fruit. Alcohol can manipulate chemicals in your brain to create psychoactive effects.
While other types of alcohol are poisonous to humans, it’s thought that we developed the ability to drink ethanol because it’s naturally produced in fallen fruit. The production and consumption of alcohol have also been practiced for thousands of years. Still, alcohol can significantly affect the brain and body. When you drink heavily, it can lead to various serious consequences, including dependence and addiction.
Alcohol works in the brain by influencing a chemical called GABA, or gamma-Aminobutyric acid. GABA is a neurotransmitter responsible for slowing down activity in your brain so you can sleep, relax, and release stress. When you sense danger, your body goes into a fight-or-flight state. When you need to recover and relax, your body will go into a rest-and-digest state. GABA is an important chemical in facilitating that state.
Alcohol can also bind to GABA receptors alongside GABA. Unlike other drugs, it doesn’t replace or block GABA. Instead, it attaches to another binding site on the receptor. When GABA comes to bind to the nerve cell, it opens up a channel to a negative charge that slows down brain activity. Alcohol and other central nervous system depressants keep that channel open, causing more intense sedating effects.
What Causes Alcohol Dependence?
Chemical dependence is one of the most significant factors in your risk of experiencing dangerous withdrawal symptoms when you quit drinking. Alcohol dependence occurs after a period of consistent drinking or frequent binge drinking. Drinking every once in a while and even heavy drinking on the weekends may not lead to chemical dependence on alcohol, although it could lead to other dangerous consequences. Dependence is a chemical response to the consistent presence of alcohol in your brain and body.
Your body is adaptable, and your brain chemistry will adjust to alcohol’s presence over time. Since alcohol causes inhibitory effects on your brain, your brain may produce fewer of its own inhibitory effects. It may also increase excitatory effects in an attempt to balance brain chemistry. Once your brain chemistry has adapted to alcohol, you’ll feel the effects of chemical imbalance when you go several hours without a drink.
Is Dependence the Same as Addiction?
Addiction and dependence are related, but they are not the same thing. While dependence is the result of changes in your brain’s chemical balance, addiction involves your brain’s reward system. This system encourages you to repeat important activities, such as eating. This part of your brain works with feel-good chemicals like dopamine, which are responsible for rewarding, pleasurable feelings.
Alcohol primarily works with GABA, but it also elevates the brain’s dopamine levels. Chronic drinking can cause your brain to associate alcohol with a source of dopamine release. Your reward system may confuse alcohol with other healthy sources of rewarding chemical releases. Addiction is when your brain has come to treat using a chemical substance as an important life-sustaining activity. Addiction is often characterized by compulsive drug or alcohol use. Even if you experience serious consequences from alcohol use, it will be hard to resist the cravings and urges to drink.
Addiction can make it even harder to stop using alcohol, and it often involves or leads to chemical dependence.
What Happens When You Stop Drinking Cold Turkey?
If you’re taking any drug or substance that can cause chemical dependence, quitting cold turkey can be dangerous. When your body develops chemical dependence on alcohol, it adapts to a consistent chemical balance change over time. When you stop drinking abruptly, a significant chemical change happens all at once. This will throw your body into chemical imbalance, which leads to uncomfortable feelings of withdrawal.
The kinds of withdrawal symptoms you experience will depend on the substance you were dependent on. Alcohol is a central nervous system depressant, which means that it slows down nervous system activity in the brain. When that depressant is removed, you may feel a sudden lack of its rewarding effects, leading to nervousness, insomnia, and anxiety.
However, alcohol, along with other depressants, is among the most dangerous substances during the withdrawal phase, especially if you quit cold turkey. The overstimulating effects of alcohol withdrawal can lead to increased blood pressure, heart palpitations, sleeplessness, fever, hallucinations, panic, and seizures.
What Causes Alcohol Withdrawal Seizures?
As a response to chronic alcohol misuse or abuse, your body will adapt by tilting your chemical balance toward more excitatory chemicals. When the inhibitory presence of alcohol is discontinued suddenly, your brain chemistry will be more stimulated than normal, causing withdrawal symptoms consistent with overstimulation, like anxiety, tremors, and sleeplessness. Unconscious functions that your nervous system controls will also be affected. That’s why alcohol withdrawal can also cause increased body temperature, fast heart rate, and hypertension.
Depressants like alcohol can cause your muscles to relax, but withdrawal can cause tremors, muscle tightness, and seizures. Alcohol withdrawal seizures are similar to tonic-clonic seizures, which are often seen with issues like epilepsy. These seizures can be violent, and they occur in two phases. The first may involve a loss of consciousness with increased muscle rigidity. The second phase involves rapid tightening and relaxing of the muscles, which involve convulsions that can lead to serious injuries. The aftermath can involve intense fatigue and confusion.
Alcohol withdrawal seizures typically aren’t deadly on their own, but they can lead to dangerous complications. Seizures can come on suddenly. If you’re in a standing position or around dangerous objects, a seizure can cause a potentially fatal accident or injury. Seizures can also cause your blood pressure and heart rate to increase. Along with alcohol’s other effects on your heart, you could experience dangerous heart-related symptoms, such as stroke or cardiac arrest.
Do Withdrawal Seizures Come with Warning Signs?
Alcohol withdrawal seizures are very similar to seizures caused by epilepsy and other diseases. Seizures can happen without warning, but many people report some common warning signs that you may notice before a seizure occurs. There are two phases of a seizure that happen before the seizure actually happens: the prodrome stage and the aura stage.
The prodrome stage can last for 10 minutes and involves some of the first signs that a seizure may be about to happen. Symptoms that you may experience in this stage include confusion, anxiety, irritability, and headache. Some people describe a general “funny feeling” that happens in this phase.
The aura stage can involve the early stages of a seizure or another warning sign that a seizure is coming. When the seizure begins during the aura stage, it may be called a partial seizure or a simple focal seizure. If it comes with warning signs, you could experience deja vu, intense anxiety, muscle twitches, loss of bowel or bladder control, numbness or tingling, nausea, and confusion. However, if you’re experiencing some of these symptoms, it could also mean you are about to experience a potential symptom that is particular to alcohol withdrawal called delirium tremens.
What Is Delirium Tremens?
One of the most disturbing aspects of alcohol withdrawal is delirium tremens (DTs). Delirium tremens is a set of severe symptoms associated with acute alcohol withdrawal syndrome. The condition is characterized by the sudden onset of severe confusion along with other physical symptoms. Other symptoms include:
- Shaking and tremors
- Shivering
- Heart palpitations
- Irregular heartbeat
- Sweating
- Seizures
- Hallucinations
- Panic attacks
- Nightmares
- Agitation disorientation
Delirium tremens can occur after quitting alcohol abruptly, but it may also occur with other central nervous system depressants. Still, delirium tremens is more commonly associated with alcohol use disorders. It’s most likely to occur a few days after your last drinking, especially when you quit cold turkey. When it starts, it can last for a few days. It may be difficult to discern from other alcohol withdrawal symptoms. However, delirium tremens is typically more intense and comes on suddenly as compared with other withdrawal symptoms. In many cases, delirium tremens symptoms are worse at night.
Hallucinations are often associated with the syndrome. Delirium tremens has several nicknames, including bats and pink elephants, which refer to the disorienting hallucinations that may occur. Alcohol withdrawal can cause muscle twitches and fasciculations, which can contribute to tactile hallucinations. Many people with delirium tremens report the feeling of bugs crawling on their skin.
The main concern over the development of delirium tremens during alcohol withdrawal is the threat of mortality that comes with it. Delirium tremens is estimated to come with a 35% risk of death if you go through it without treatment.
How Common Is Delirium Tremens?
Not everyone who experiences alcohol withdrawal will experience delirium tremens. Alcohol use disorders cover a range of severity from mild to moderate to severe. Someone with a mild-to-moderate alcohol use disorder may have a problem with alcohol without developing significant dependence. In such cases, alcohol withdrawal may not occur when they cut back or quit drinking. However, about half of people with alcohol use disorders will experience withdrawal symptoms. Around 3% to 5% experience delirium tremens.
Delirium tremens can be treated or avoided with treatment. Treatment significantly lowers the likelihood that symptoms will become deadly. If you seek medical treatment before quitting alcohol cold turkey, you may be able to taper slowly with a medical professional’s help. Tapering can help avoid serious withdrawal symptoms, including delirium tremens.
What Is Kindling?
Kindling is a term describing a neurological phenomenon that makes alcohol withdrawal symptoms worse after previous withdrawals from depressant drugs. People who go through depressant withdrawal can have more severe symptoms with subsequent withdrawal periods. This higher risk of severe withdrawal symptoms can happen even if you’ve used different kinds of central nervous symptom depressants. For instance, if you’ve gone through benzodiazepine withdrawal, you may experience severe withdrawal when going through alcohol withdrawal and vice versa.
Kindling is caused by the chronic use of drugs that cause GABA receptors’ downregulation. Chronic depressant use and withdrawal can cause hypersensitivity in your nervous system. It’s worth noting that opioids share many similarities with depressants, but they don’t work with GABA in the brain as alcohol does. If you’ve gone through opioid withdrawal before, you may need to experience the kindling effects. However, alcohol withdrawal can still be dangerous, even without kindling.
The effect also compounds. That means each withdrawal period can make the next one worse. The dangerous withdrawal symptoms that are more likely through kindling include seizures, heart problems, and death. If you’ve gone through alcohol or depressant withdrawal in the past, you should seek medical attention before quitting alcohol.
What Are the Stages of Alcohol Withdrawal?
Alcohol’s half-life is around four to five hours, which means your body will process the chemical out of your bloodstream within that time frame. After that, many of alcohol’s effects will have faded or will begin to fade. It won’t be long after alcohol reaches its half-life that you start to experience withdrawal symptoms. However, your withdrawal timeline can depend on several factors. The length of time you were drinking heavily, the amount you would drink regularly, and the amount you drank last.
If you have a more severe chemical dependence on alcohol, you may experience more severe symptoms more quickly. Quitting cold turkey can come with some severe withdrawal symptoms, and it can be dangerous. Tapering is a safer option, but a tapered withdrawal may last longer.
Acute withdrawal typically lasts for a week to 10 days, but your experience may be different from someone else’s. The following is a general timeline for alcohol withdrawal:
- 12 hours. You’ll likely experience your first withdrawal symptoms within 12 hours after your last drink. If you’ve become severely dependent on alcohol, you may experience symptoms as soon as six hours after your last drink. It’s common for people with alcohol use disorders to go to sleep after drinking and wake up with withdrawal symptoms in the mornings. Symptoms can include agitation, anxiety, headaches, and nausea.
- 24 hours. Within 24 hours of your last drink, your symptoms can intensify. You may also start to experience more serious withdrawal symptoms, including tremors, disorientation, and seizures. Severe withdrawal symptoms don’t happen to everyone, but they are a risk that you should address with your doctor.
- 3 days. Your symptoms are likely to peak within three days, but this is also the window of time when you could experience delirium tremens. If it happens, it typically occurs after a few days of sudden abstinence.
- 10 days. Most of your acute withdrawal symptoms will fade within 10 days. Some people may see symptoms subside as early as five days after their last drink. However, some symptoms can be persistent, like agitation, anxiety, or sleep problems. You may experience post-acute withdrawal syndrome, which can sometimes involve seizures.
How Is Alcohol Withdrawal Treated?
If you seek treatment for an alcohol use disorder, you will likely begin with a medical assessment. If you’re dependent on alcohol, you may need to go through a tapering period with the help of a doctor. People with moderate-to-severe alcohol use disorder often begin with a medical detox program.
Medical detox is highly intensive inpatient treatment with medically managed services. Alcohol dependence may be treated with various options, including medications. As your body adjusts to life without the medication, you may be given medication and therapy options to help you get through the withdrawal phase as safely as possible.
Detox is an inpatient setting with medical staff available at all times. You may be given anxiolytic and sedative medications to help overcome the anxiety and insomnia that is common with alcohol withdrawal. Drugs like benzodiazepines are often used to treat alcohol withdrawal, and they can also be used to taper you off alcohol.
Benzodiazepines are also central nervous system depressants that work in the brain the same way as alcohol. They can ease many alcohol withdrawal symptoms, allowing your body to adjust slowly. However, benzodiazepines can also be addictive, so they should be taken with a doctor’s guidance. They should not be taken until alcohol withdrawal has already started. Mixing benzodiazepines and alcohol could be life-threatening.
While you’re in inpatient treatment, you may also be treated with IV fluid, which can help keep you hydrated through the withdrawal process. Medical detox programs may also involve therapies to address alcohol use disorders. Individual and group therapy sessions can help to address some of the underlying causes of your alcohol addiction.
What Happens After Alcohol Detox?
If you’ve developed alcohol use disorder in addition to alcohol dependence, detox may not be enough to address your alcohol problem. Detox alone may help you achieve sobriety, but that sobriety may be short-lived. Alcohol withdrawal can last for five to 10 days, but alcohol cravings and compulsions to use may continue for a long time. Even if you are no longer dependent on alcohol, you may have a compulsion to drink that’s hard to control.
After you complete alcohol detox, you may continue in other levels of care for addiction treatment. If you still have high-level needs after detox, you may continue in inpatient treatment. This may be necessary for many people who have gone through alcohol withdrawal. After the acute withdrawal phase has ended, you may continue to experience some symptoms. Alcohol is sometimes associated with post-acute withdrawal syndrome, a set of symptoms that continues a week or more after your last drink.
Post-acute withdrawal symptoms can include:
- Foggy thinking
- Anxiety
- Panic attacks
- Alcohol cravings
- Fatigue
- Depression
- Poor focus
- Mood swings
In some cases, seizures may occur after the acute withdrawal phase is over. Inpatient and residential treatment can provide additional medical monitoring to ensure your safety and sobriety.
From there, you may continue in residential or outpatient addiction treatment, depending on your needs. Addiction treatment often involves cognitive behavioral therapy (CBT), family therapy, group and individual therapies, and therapies to address co-occurring mental health issues.
