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Along with caffeine and nicotine, alcohol is one of the most consumed legal drugs in the world. Beer, wine, grain alcohol, and other spirits are enjoyed by billions around the world, and for the vast majority of people, doesn’t pose a serious threat to their lives, relationships, or careers. Unfortunately, the physically addictive and habit-forming qualities of alcohol cause a percentage of people (the number varies greatly between locations) to become alcohol-dependent, characterised as “craving, tolerance, a preoccupation with alcohol, and continued drinking in spite of harmful consequences.” (O’Flynn)
1.6 Million adults in England may have some level of alcohol dependence
While most people are aware of the dangers and effects of alcohol dependency, alcohol withdrawal symptoms (hereafter AWS) are less understood. Being able to identify and understand AWS can help someone diagnose when alcohol use is becoming destructive, create an idea of what to expect as one progresses through the symptoms, and effectively treat the symptoms to make the detox process more manageable. After going through detox, the patient can go into primary care and focus on their alcohol addiction rehab.
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Alcohol withdrawal symptoms are the physical and psychological effects of our bodies readjusting to perform their normal functions without the presence of alcohol in our systems. Prolonged alcohol misuse (more than 14 units per week, according to the NHS) leads to chemical changes in the brain and central nervous system by suppressing certain neurotransmitters and altering the brain’s chemical balance. AWS manifest when there is a sudden absence of alcohol and the body has to undergo a period of adjustment.
These symptoms, caused by a now-overactive excitatory neurotransmitter system, can vary greatly in intensity between different people. How much you drink each week, how long you’ve been misusing alcohol, and many other factors play a role in the severity and duration of AWS. All withdrawal symptoms are unpleasant and uncomfortable, and in severe cases, are downright excruciating and even life-threatening.
| Tremors | Mild shaking of the hands to severe tremors affecting multiple parts of the body. |
| Sweating | Mild sweating on the palms and forehead to profuse sweating from the whole body, even without physical exertion. |
| Nausea | Queasiness or occasional nausea to persistent nausea and frequent vomiting or dry heaving. |
| Headache | Low-level to intense headaches or even migraines. |
| Increased heart rate | Small increase to persistently rapid heart rate, irregular heartbeat, or chest pain. |
| Loss of appetite | Mild appetite loss to complete loss of appetite, inability to eat, and risk of malnutrition. |
| Seizure | Typically only in serious cases. From an increased risk of seizure to full-blown seizures and convulsions. |
| Anxiety | Mild feelings of restlessness or nervousness to intense anxiety, panic attacks, or feelings of impending doom. |
| Insomnia | Difficulty falling asleep or slight sleep disturbances to complete inability to sleep, extreme sleep disturbances. |
| Irritability | Slight irritability or mood swings to extreme irritability, uncontrollable anger, or aggressive behaviour. |
| Hallucinations | Typically only in serious cases. Ranges from mild visual distortion to vivid, disturbing auditory and visual hallucinations or delusions. |
As with the symptoms of any other disease, they don’t exactly always stick to the schedule. In the same way that the exact symptoms could vary in intensity and manifestation, a variety of factors could influence how long it takes to go through all the stages of detox. (Jesse et al.)
Typically, the first symptoms’ onset period is around 6 to 10 hours. Heavy drinkers are more likely to notice the symptoms as they present more acutely, in some cases causing them to consume alcohol early in the morning as a way to fend off the effects of AWS. First-stage alcohol withdrawal symptoms could include general restlessness, anxiety, and potentially, tremors. At this stage, it’s important to recognise that one might be experiencing both a hangover and AWS at the same time, and while certain symptoms such as nausea and headaches might overlap, they are separate and distinct medical conditions.
Between 12 to 24 hours into withdrawal, you would typically expect heightened agitation, an increased heart rate, and aggravated symptoms from the previous stage. Severe symptoms at this stage could also include increased blood pressure.
24 to 48 hours into alcohol withdrawal, many people see an increase in anxiety and general discomfort. At this stage, someone experiencing the worst symptoms could hallucinate, feel panic or an impending sense of doom, experience nightmares, and behave erratically
Between 48 and 72 hours after the last drink, mild users would typically experience more of the same as the previous 24 hours, with a slight relief or reduction of symptoms at the end of this period. Someone with acute alcohol dependency might experience delirium tremens (DTs), confusion, disorientation, and be at risk of seizures.
From 4 to 7 days, all but the most severe alcohol dependents will feel gradual improvement across both physical and psychological symptoms. The symptoms don’t just disappear at once but gradually decrease in severity as the body reestablishes normal brain chemistry levels.
After 7 days, most of the acute symptoms should be gone. Alcohol cravings may persist, but the worst is over. Upon successfully undergoing detox, one can focus on primary care, in whatever form it takes, to uncover the root causes of dependency and addiction.
Extremely heavy drinkers might experience post-acute withdrawal symptoms beyond 7 days. This could last anywhere between a few weeks and a few months and can be described as feeling less acute alcohol withdrawal symptoms. While they aren’t necessarily life-threatening, they could easily lead to relapse if one is not careful.
If one is extremely lucky and identifies that their alcohol consumption might be starting to harm their health, relationships, or career before any irreversible damage has been done, the withdrawal symptoms from a sudden switch to no alcohol would most likely be very mild and not long-lived. If this person makes some sort of decision to stop drinking, going through alcohol withdrawal at home is possible, especially if they have strong social support (Allan et al.). Symptoms such as headaches and nausea can be treated with non-prescription medication (ask your pharmacist for advice). Staying well-hydrated and eating nutritionally healthy foods also help. Unless you have pre-existing health conditions, especially those related to cardiovascular conditions, going through mild-alcohol withdrawal isn’t generally considered life-threatening.
In many cases, however, the decision to stop drinking doesn’t come until some damage has been done and normal brain chemistry levels have been altered. In these cases, those going through alcohol withdrawal experience it as painful and extremely uncomfortable, so much so that they cannot function normally, take care of themselves, and are at high risk of consuming alcohol to make the pain stop. In these cases, it is highly recommended to undergo AWS under medical supervision to ease the process and increase the odds of successfully detoxing.
Under medical supervision, a patient can expect a safe environment with alcohol out of reach, supportive and encouraging staff who will ensure that they’re adequately hydrated, and have their vital signs monitored. During a medical detox, trained and qualified medical staff might administer benzodiazepines (Mirijello et al), a class of medication that acts on the central nervous system and has sedative, relaxing, anti-anxiety, and anti-convulsive properties. They act by enhancing the activity of a neurotransmitter (GABA), which in turn reduces the severity of AWS symptoms. It’s important to note that benzodiazepines are habit-forming themselves, and should only be used when prescribed by a licenced practitioner. If the patient is experiencing life-threatening symptoms such as seizures, they might be transferred to an ICU unit until they stabilise.
The treatments above largely address physical AWS. Many psychological symptom treatments, such as counselling, therapy, psychological support, and reassurance, will commence while in detox, and continue during the primary care phase of recovery.
For more than 20 years, the addiction specialists at Gladstones Clinic have helped people of every imaginable background successfully go through the alcohol detoxification process as painlessly as possible and get them off to the best possible start on the road to recovery.
While it’s absolutely possible to beat alcohol addiction by yourself in your own home, an enormous number of people who attempt either severely reducing their drinking or stopping altogether, end up failing. Many people give up after the onset of withdrawal symptoms as they’re just too severe to endure. For this reason, among others, those who undergo detox and primary care for alcohol dependency under the compassionate and understanding medical supervision of qualified specialists have a much higher success rate. The right treatment options just make it so much easier to get through that first week!
After successfully getting you through the detox process, we provide all the care, facilities, and expertise necessary to start primary care. We diligently investigate the root cause of our patients’ addictions, create custom treatment plans, and use a variety of evidence-based treatment options, including Cognitive and Dialectical Behavioural Therapies (CBT & DBT Therapy), group and one-on-one counselling, and transactional analysis to help our patients understand and overcome their addictions.
Please visit our Alcohol Addiction Rehab Treatment page to learn more about how we help people take control of their lives back from alcohol.
Feel free to contact us if you’d like to learn more about alcohol withdrawal symptoms, Gladstones Clinic, or require more details about our rehabilitation programmes.
Allan, Carole, et al. “Detoxification from alcohol: A comparison of home detoxification and hospital-based day patient care.” Alcohol and Alcoholism, vol. 35, no. 1, 2000, pp. 66-69. Alcohol and Alcoholism, https://academic.oup.com/alcalc/article/35/1/66/142543. Accessed 1 6 2023.
Jesse, S., et al. “Alcohol withdrawal syndrome: mechanisms, manifestations, and management.” Acta Neurol Scand., vol. 1, 2016, pp. 4-16. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084325/. Accessed 1 6 2023.
Mirijello, Antonio., et al. “Identification and management of alcohol withdrawal syndrome.” Drugs, vol. 75.4, 2015, pp. 353-65. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4978420/. Accessed 01 06 2023.
O’Flynn, Norma. “Harmful drinking and alcohol dependence: advice from recent NICE guidelines.” The British Journal of General Practice: the Journal of the Royal College of General Practitioners, vol. 61,593, 2011, pp. 754-6. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223772/. Accessed 1 6 2023.
