Understanding the Symptoms of Alcohol Withdrawal

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When you become dependent on alcohol, your body may experience adverse effects, if you then decide to refrain from drinking altogether. Alcoholism doesn’t only change you physically and possibly, emotionally, it also changes the physiology of your body. It’s incredible how our bodies are able to adapt; it’s just not always for the better. Even if your body functions “normally” from alcohol dependency, it doesn’t mean it can endure that level of drinking for the rest of your life.

If you have battled alcoholism and have tried to quit drinking before on your own, you may already know what it’s like to experience the tough symptoms of alcohol withdrawal. These symptoms can begin at any time from a couple hours up to a couple of days after your last drink and can range in type and severity.

The side effects in the first few days are typically the most intense you’ll feel. What’s happening is the body is trying to catch up to the abrupt change. It’s now used to functioning with alcohol; being without is new territory. As you go through the withdrawal period, it’s common to experience symptoms such as:

  • Anxiety;
  • Lack of appetite;
  • Insomnia;
  • Mood swings;
  • Confusion;
  • Nightmares;
  • Vomiting; and/or
  • High blood pressure.

Advanced symptoms of alcohol withdrawals might include heart palpitations, tremors, and abdominal pain coupled with vomiting. Alcohol withdrawal is not some kind of internal, quiet process. It is made apparent by the side effects that accompany it. In more serious cases, a study by the Louisiana State University School of Medicine shows hypertension, delirium, and seizures to also be a result of alcohol withdrawal.

The body is unpredictable. Without knowing for sure how it will react during the withdrawal process, it’s best to go through these stages in the presence of professionals who have been trained to handle any complications with your physical and mental health.

Others who have attempted to go through withdrawal alone often face challenges in avoiding relapse. It can be difficult, uncomfortable, and in some cases, quite painful. Those suffering from alcoholism may sidestep any attempts to refrain from alcohol use because of this. If you’ve tried alcohol withdrawal without any help, then you this most likely rings all too true. The silver lining is that symptoms typically subside eventually as the body begins to heal.

Alcohol withdrawal takes the supervision of qualified individuals, the determination of the person who wants to quit drinking, and time in order to have a greater chance of success. Just know that you are not alone in this process and on your path to recovery.

Acute Alcohol Withdrawal

Symptoms of withdrawal can possibly build and intensify over time, especially in the first few days and depending on which stage a person is in. The first stage is acute alcohol withdrawal, which frequently occurs in the first few hours after you’ve quit drinking. In this stage, you are at risk for developing the above-mentioned tremors or delirium. In some scenarios, people may temporarily lose consciousness.

Acute alcohol withdrawal symptoms usually reach their high point between 10 to 30 hours after your last drink and eventually subside altogether within a couple of days. Seizures are more common within the first 12 to 48 hours, which is all the more reason to take advantage of safe, monitored assistance.

Battling alcoholism is a sensitive time for your health. Remember, your body is used to having alcohol in its system. In these cases, alcohol has ruled how you think, feel, act, and function. Your tolerance level has increased and goes far beyond someone who may have just taken a drink for the first time. When this changes suddenly, when you don’t give in to your next drink, your body can react in ways you wouldn’t expect.

During the acute alcohol withdrawal period, there are serious health complications that may arise, in addition to the ones already listed. It’s not as simple as deciding not to drink at this stage. At this point, you’ll want to be in the care of others to help you through the process as safely and comfortably as possible.

Post-Acute Withdrawal Syndrome (PAWS)

The second stage known as post-acute withdrawal syndrome (PAWS) sets in after the initial withdrawal symptoms have passed. You might not experience the second stage and won’t have to deal with the lingering side effects.

But others will feel these alcohol withdrawal symptoms well after that first stage. Unfortunately, depending on your level of previous alcohol abuse, this syndrome may last for a few weeks or up to a full year. What can you expect during the PAWS stage? Symptoms may include:

  • Insomnia;
  • Anxiety;
  • Dizziness;
  • Lapses in memory;
  • Increased heart rate;
  • Emotional outbursts; and
  • Potentially higher likelihood of accidents.

This is a shorter list of the types of side effects you may experience months into recovery. After the acute withdrawal phase, you may start to feel back to normal, healthier, but PAWS can disrupt the process popping up at the least expected time.

The initial withdrawal phase itself is nearly always expected. After a few days without alcohol, of course, the body is going to need time to adjust. But the truth is the brain is greatly affected by alcohol use, even leading to brain damage in some cases.

The brain just doesn’t work as fast as we’d like to think in order to heal. In a Huffington Post article, Dr. Joseph Lee, Medical Director of the Hazeldon Youth Continuum talks about the brain and body trying to reach a “homeostasis” during the withdrawal period. At the PAWS stage of recovery, he says, you might feel worse, if not better.

On the surface, this seems like less than exciting news, since you might have to get worse before it gets better. But it does get better. That’s the important thing to focus on as you continue through your treatment and post-rehab options.

As much as we would like treatment and healing to happen at a much more rapid pace, that’s not a solution for long-term success. Your body and brain need a chance to right itself and function in the way it was meant to sans alcohol.

How Is Alcohol Withdrawal Diagnosed?

First, let’s look at who’s most at risk for experiencing alcohol withdrawal symptoms, often referred to simply as AWS. You are at risk for alcohol withdrawal symptoms, if you have developed an alcohol addiction or you drink heavily on a consistent basis without limits.

But what constitutes heavy drinking? The CDC breaks it down to equal more than eight drinks on a weekly basis for women, and the number is nearly doubled to more than 15 drinks, in the same timeframe for men. One drink is equivalent to a 12-oz. beer, 5 ounces of wine, 1.5 ounces (a shot) of hard alcohol, or 8 ounces of malt liquor.

Binge drinking is one of the most typical forms of heavy drinking, which equals four or more drinks in one sitting for women, and five or more for men. Think how easily it can be to reach the limit of heavy drinking by binging.

For example, say you’re out on a Saturday night and have a couple of beers, a few shots, and then a drink or two at the bar. That easily leads up to the definition of what can be considered heavy drinking. Drink like this every week or consistently throughout the month, and you run the risk of developing alcohol dependency and possible withdrawal side effects down the road.

While a doctor can officially diagnose alcoholism, some of the signs might be pretty clear to yourself or those around you. Do you experience hand tremors, irregular heart rate, or find that you’re often dehydrated? These are all categorized as indicators.

More formally, a doctor can diagnose alcohol withdrawal through a series of questions referred to as the Clinical Institute Withdrawal Assessment of Alcohol (CIWA) or the revised version CIWA-Ar, which tracks 10 different symptoms to measure what level of withdrawal you’re at. These are:

  • Agitation;
  • Anxiety;
  • Auditory disruptions;
  • Inability to think clearly;
  • Headaches;
  • Nausea or vomiting;
  • Profuse sweating;
  • Tactile disruptions;
  • Tremors; and
  • Visual disturbances.

Each symptom is reviewed and scored individually and the total scores define the level of alcohol withdrawal. A score of 15 or less indicates mild alcohol withdrawal; 16 to 20 is moderate; and anything more than 20 means severe alcohol withdrawal.

What does this mean and why does it matter? Determining what level of alcohol withdrawal you’re in directly correlates to what course of action would most likely be taken for treatment. Someone with a mild level of alcohol withdrawal may not experience the same or as intense of symptoms as someone at a moderate or severe level.

It goes to show that you can’t treat alcohol withdrawal symptoms the same across the board. Not only would it not be effective, but it wouldn’t be in your best interest health-wise or healing-wise. You want to receive treatment that directly correlates to your specific symptoms, struggles, and other medical history.

Why Seek Treatment?

Anyone who has experienced alcohol dependency and subsequent alcohol withdrawal knows how difficult it can be to face alone. For any family member who has seen their loved one struggle, it can be heartbreaking to see them in pain.

The symptoms of alcohol withdrawal can be unpredictable in certain ways because it’s unknown just how the body will react to such a sudden, severe change. The withdrawal period may last a few days and then, you can transition into the rehabilitation stage of treatment. In other cases, the withdrawal period lasts beyond the first week, slowing down the process. And still, in other cases, just when you think the withdrawal period is over, the worst part of it sets in.

This up and down and back and forth can be tiring and frustrating. You may feel defeated or in a funk because of how the withdrawal symptoms are making you feel. Does it sound like something you’d want to go through alone? More importantly, you may put your health further at risk by going through alcohol withdrawal without medical support by your side.

There may be a dozen reasons why you would be hesitant to seek help. It’s understandable. You may think you can do it on your own. Or that your problems aren’t anything you can’t handle alone, but in reality, it’s not about feeling shameful or less than asking for help.

What if you body reacted so strongly to your alcohol withdrawal that you began having tremors or began to seize? Would you be in a safe place or a position to be able to call emergency assistance? Would you know what to do in this situation? It’s not something anyone plans for and you shouldn’t have to, but it’s nice if you have someone by your side who does know what to do in case happen unexpectedly.

When you look at alcoholism as the disease it is, it may be easier to allow medical staff and professionals who are trained in detox, rehabilitation, and recovery treatment guide you through parts unknown. They can help answer questions like, how long does it take to detox from alcohol? That’s what their roles are. And, it only benefits you.

Where to Seek Treatment

When you make the decision to seek alcohol treatment, go where you can feel safe, secure, and comfortable. If you are assisting a loved one to get help at a recovery center, make sure you are taking into account their health, but also comfort level.

For example, if you like the tranquility of nature, choose a facility in scenic locations like the mountains or near the ocean. If you feel like you want to be closer to home, research different facilities in your area. Find out where you would be the best spot for your recovery.

Also, consider if you think you will benefit most from inpatient or outpatient care? Your doctor and those close to you will likely give you their own recommendations, but do what you need to heal. That’s the question to ask because ultimately, it is you putting in the work to get better.

At times, you may not think you need treatment or even want it, but hopefully, you can find comfort in the consistency of having supportive people and useful resources available focused on one thing: helping you recover. You’ll be able to start on a more positive path for your future. Will your next step be choosing sobriety?


  1. NCBI, Acute Alcohol Withdrawal. Accessed April 17, 2016.
  2. MedlinePlus, Alcohol Withdrawal. Accessed April 3, 2016.
  3. American Nurse Today, Understand and Managing Alcohol Withdrawal Syndrome. Accessed Feb. 23, 2016.
  4. Harvard Health Blog, Alcohol Withdrawal. Accessed Feb. 12, 2016.  

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