Alcohol withdrawal can occur in anyone who drinks alcohol regularly, not necessarily only those who are alcoholics. Usually, it happens in people who have been drinking large amounts of alcohol for long periods of time. Alcohol withdrawal occurs when someone stops using alcohol after their body is used to having it in their system. Alcohol withdrawal symptoms can be very serious and often require medical treatment.
What Causes Alcohol Withdrawal?
Alcohol withdrawal occurs when someone stops drinking, and the body responds with various withdrawal symptoms because the alcohol is no longer present. Alcohol normally has a depressant effect on the brain and other organs, so the sudden removal of alcohol from the system can cause over-excitement.
When someone has used alcohol regularly for a long period of time, many-body systems adapt to the presence of alcohol, so when alcohol is no longer available, various responses will occur.
Alcohol Withdrawal Timeline
The stages of alcohol withdrawal can vary in duration and severity depending on how long someone has been using alcohol. In general, mild withdrawal occurs shortly after alcohol use is stopped, and progresses in severity as withdrawal continues, that is if the person continues to not drink alcohol.
Stages of Alcohol Withdrawal Symptoms
The stages of alcohol withdrawal usually progress from mild to severe, worsening over time before improving. Withdrawal symptoms can start within six hours of the last drink. The stages of alcohol withdrawal and symptoms associated with each stage are outlined below.
Stage 1: Mild Alcohol Withdrawal
The first stage of alcohol withdrawal happens around six hours after the last drink of alcohol or reduction in drinking. These symptoms can last from 24 to 48 hours. In this stage, people usually do not become delirious or have hallucinations. The symptoms associated with mild alcohol withdrawal include:
- Increased heart rate
- Upset stomach
Stage 2: Moderate Alcohol Withdrawal
With the next stage of alcohol withdrawal, symptoms become more serious and sometimes involve vivid hallucinations. These hallucinations don’t occur in everyone going through withdrawal, but they can involve seeing, hearing or feeling things that are not there.
Even though hallucinations may be occurring in this stage, the person is generally aware of their surroundings. If a person does experience hallucinations, they can last for about one to six days, and in rare cases, over a month.
Stage 3: Severe Alcohol Withdrawal
Sometimes seizures can occur in this stage. These can start within six to 48 hours of the last drink. Seizures can happen just once or twice or may happen multiple times. If someone experiences an alcohol withdrawal seizure, there is a high risk of progressing to the most severe stage, called delirium tremens (DT).
Delirium tremens is a syndrome involving severe tremors and hallucinations as well as disorientation and agitation. DT usually happens within 48 to 72 hours of the last drink and can last as long as two weeks. People experiencing DT are often confused, have altered the perception of reality and have sleep disturbances. DT is a very serious condition with a mortality rate of about eight percent. It is important to be aware of the symptoms of DT so a person receives adequate treatment.
Factors Impacting Alcohol Withdrawal
The severity of alcohol withdrawal depends on several individual factors and the longer someone has used large amounts of alcohol, the more likely they are to experience severe withdrawal symptoms when they stop drinking. Some of the factors that are associated with severe alcohol withdrawal symptoms, including seizures or delirium tremens include:
- Increased age
- Other illnesses
- Previous history of DT or seizures related to alcohol withdrawal
- Severe initial withdrawal symptoms
- Deficiencies in electrolytes like sodium or potassium
- Low platelets (cells involved in blood clotting)
- Liver problems
- Preexisting brain abnormalities
Detoxing From Alcohol
Alcohol detoxification is when a person slowly decreases alcohol intake over a period of time, instead of stopping “cold turkey.” This allows the body to get used to the lower amounts of alcohol and adapt more slowly, which can decrease withdrawal symptoms.
Sometimes other drugs can be used to assist with alcohol detoxification, such as benzodiazepines. These medications are also depressants, so they have similar effects on the body as alcohol does. Either way, slowly decreasing the amount of alcohol or benzodiazepine over time can ease the discomfort and severity of withdrawal.
Patients who are detoxing from alcohol can benefit from intravenous fluids, low-stimulation environment and other medical interventions such as medications and vitamin supplementation. Patients with mild detox symptoms may not require medication at all, although they should usually be observed in a professional environment in case the progression of withdrawal occurs.