If you are one of the 17 million people in the United States who struggle with alcohol use disorder, you may be concerned about the severity of withdrawal symptoms you may encounter when you decide to stop drinking. The withdrawal process will vary from person to person based on factors, such as your history of alcohol misuse, the use of any other drugs, and your physical and mental response to detoxing.
Once you have developed a physical dependence on alcohol, you will most likely experience withdrawal symptoms when you greatly reduce or entirely cut back on your alcohol consumption.
Common alcohol withdrawal symptoms include:
The above symptoms can be managed through medications and minor interventions from medical and substance abuse treatment specialists. More severe withdrawal symptoms, however, may require significant intervention and close monitoring.
People with a history of heavy drinking are at a greater risk of experiencing severe withdrawal symptoms such as:
Alcohol withdrawal is a dangerous process because symptoms can occur unexpectedly and become worse over time. If you attempt to detox from alcohol on your own at home, you may not be able to get medical assistance quickly enough in case of an emergency. When you suddenly stop drinking, the balance of GABA (gamma-Aminobutyric) and glutamate — two neurotransmitters in your brain that are affected by alcohol — is drastically shifted, and your body will likely have a difficult time adjusting to it.
Alcohol affects the brain by increasing GABA, which is responsible for producing feelings of happiness and calm, and decreasing glutamate, which produces excitability, such as what happens with anxiety. The more someone drinks, the harder it becomes for the brain to increase GABA and decrease glutamate. This indicates a tolerance for alcohol. Your brain then produces more glutamate and less GABA in an attempt to compensate.
The danger of this compensation occurs when you decide to stop drinking. You are no longer putting excess alcohol in your system that inhibits the natural production of GABA and glutamate. Your brain still produces them as if the alcohol were present, however, which is what leads to withdrawal symptoms. More glutamate, which causes excitability, is produced than is needed, and less GABA, which helps to maintain calm, is produced. You are thus at risk of symptoms of overexcitability, such as tremors, dangerously high blood pressure, and potentially life-threatening seizures.
Delirium tremens (also known as DTs) is the most severe form of alcohol withdrawal and can be life-threatening. It is caused by sudden and severe changes to your mental and nervous systems. It most commonly affects people who have been heavy drinkers for more than 10 years, though it can affect people with a shorter history of alcohol abuse as well. About 5 percent of people going through alcohol withdrawal experience delirium tremens.
The symptoms of delirium tremens typically occur between two to four days after your last drink, though they may not show up until a week to 10 days later.
Symptoms of delirium tremens are:
Any combination of the above symptoms constitutes a medical emergency, and treatment must begin as soon as possible. Without receiving proper medical treatment, delirium tremens has a high mortality rate. If someone is presenting with symptoms of delirium tremens, they must be admitted to a hospital where they can receive life-saving treatment.
To avoid the most dangerous effects of alcohol withdrawal, you must be very cautious about how you approach the process. Attempting to go cold turkey and manage the symptoms on your own is not safe. Rather, substance abuse experts recommend medically assisted withdrawal and going through the detox process while only under close medical supervision.
Medically assisted withdrawal is a type of planned detox that uses medications to alleviate the severity of symptoms associated with alcohol withdrawal. The severity of your alcohol use disorder will determine how much medical assistance you require to detox safely. The medical experts or substance abuse professionals at formal detox programs can determine how much medical intervention you need and provide you with individualized care based on the symptoms you have.
In addition to prescribing medications to treat uncomfortable symptoms, detox programs provide continual monitoring of your mental and physical status. Because the symptoms of alcohol withdrawal can present suddenly or unexpectedly get worse, being under close medical supervision during this time is highly recommended and greatly improves your safety.
Another approach to alcohol withdrawal that is often used in conjunction with medical assistance is the tapering method. Through tapering, or gradually reducing the intake amount of the substance the person is dependent on, a person’s body can slowly adjust to the substance leaving the body without going into shock from losing it entirely and suddenly.
Tapering also can be done by replacing the substance with another one that has similar physiological effects on the body and brain without the psychological effects of addiction. In the case of alcohol, benzodiazepines are often prescribed to manage severe withdrawal symptoms. They prevent dangerous withdrawal symptoms as well as cravings for alcohol. Over time, benzodiazepine doses are gradually reduced until the person has completely detoxed from alcohol and no longer needs benzodiazepines to manage symptoms.
In addition to managing dangerous withdrawal symptoms via medications, general supportive care can go a long way toward reducing the unpleasant symptoms of alcohol withdrawal. In general, people undergoing alcohol withdrawal should be treated in environments with low amounts of stimulation. Their bodies and minds are already at risk of suffering from excitability, so reducing stimulation as much as possible is important.
Fluids and electrolytes will likely be needed to ensure proper hydration and reduce complications associated with dehydration during withdrawal. People going through the detox process also need to focus on consuming a healthy and nutritious diet that will support their recovery. People with substance use disorders tend to neglect their diets, so they stand to benefit greatly from consuming a well-rounded and healthy diet, which may include vitamin and mineral supplements.
The main concern when withdrawing from alcohol is your safety. Given the potential dangers faced during the withdrawal process, it is important to ensure that you have the proper supports in place that can help you address difficult symptoms as they come up.
Enrolling in a medically assisted detox program or a formal inpatient rehab program is the best way to ensure safety during withdrawal. Not everyone will experience the most dangerous withdrawal symptoms, but it is reassuring to know that you are well taken care of if they do occur.
(2010). Acute Alcohol Withdrawal. National Clinical Guideline Centre: Royal College of Physicians. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/books/NBK65581/
(December 2013). Clinical Management of Alcohol Withdrawal: A Systematic Review. Industrial Psychiatry Journal. Retrieved December 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/
(January 2017). Delirium Tremens. U.S. National Library of Medicine: Medline Plus. Retrieved December 2018 from https://medlineplus.gov/ency/article/000766.htm
(October 2018). Gauging the Severity of Alcohol Withdrawal Symptoms. Very Well Mind. Retrieved December 2018 from https://www.verywellmind.com/alcohol-withdrawal-symptoms-quiz-69485
(2014). Treatment for Alcohol Problems: Finding and Getting Help. National Institute on Alcohol Abuse and Alcoholism. Retrieved December 2018 from https://pubs.niaaa.nih.gov/publications/treatment/treatment.htm