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Alcohol Withdrawal Symptoms, Effects & Management

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Last Updated - 07/05/2024

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Key Takeaways

  • Alcohol withdrawal occurs when a heavy drinker suddenly stops or reduces alcohol intake, leading to symptoms like anxiety, restlessness, and seizures.
  • Early symptoms of withdrawal can include anxiety, insomnia, physical discomfort, and gastrointestinal issues.
  • Severe withdrawal symptoms, such as delirium tremens and seizures, can be life-threatening and require medical attention.
  • Post-acute withdrawal Syndrome (PAWS) can cause long-lasting psychological symptoms and is a risk factor for relapse.
  • Long-term cognitive effects of alcohol withdrawal may include memory and concentration issues.
  • Medication-assisted treatment (MAT) using benzodiazepines and other medications can manage withdrawal symptoms.
  • Psychotherapy and counseling are essential for addressing the psychological aspects of addiction and supporting recovery.
  • Prevention of alcohol withdrawal symptoms involves moderation, abstinence, and seeking medical advice before quitting.

Understanding Alcohol Withdrawal and Its Risks

Alcohol withdrawal is a challenging condition that occurs when an individual abruptly stops or significantly reduces alcohol intake after a period of heavy and prolonged use.


The body, having adapted to the presence of alcohol, must readjust to its absence, often leading to a range of symptoms that can vary in severity. These symptoms typically begin within 6 to 24 hours after the last drink and may include anxiety, restlessness, insomnia, and, in more severe cases, hallucinations and seizures.

Risk Factors

Individuals most at risk for alcohol withdrawal are those who engage in heavy drinking, defined as 15 or more drinks per week for males and eight or more drinks per week for females. Additionally, those with a history of alcohol use disorder (AUD) and prior withdrawal experiences are more likely to suffer from withdrawal symptoms.

Severity and Complications

It is important to note that alcohol withdrawal can be life-threatening, particularly due to the risk of severe symptoms like delirium tremens and seizures, which usually occur between 24 to 72 hours after cessation.

Medical Attention and Treatment

Given the risks associated with alcohol withdrawal, individuals need to seek medical attention when attempting to stop drinking, especially if they have been heavy drinkers or have AUD. Medical professionals can provide a safe detoxification process, often involving medications to manage symptoms and prevent complications. 

Supportive care and treatment programs are also crucial for guiding individuals through the withdrawal process and supporting long-term abstinence from alcohol.

Identifying Early Symptoms of Alcohol Withdrawal

The initial phase of alcohol withdrawal is a critical period that typically starts within 6 to 24 hours following the cessation of alcohol intake. Recognizing the early symptoms is essential for timely intervention and management. 

These early signs are indicative of the body’s adjustment to the absence of alcohol and may include a range of physical and psychological manifestations.

  • Anxiety and Insomnia: A heightened state of anxiety and difficulty sleeping are common early symptoms, often accompanied by restlessness and nightmares.
  • Physical Discomfort: Individuals may experience hand tremors, headaches, rapid heartbeat, increased blood pressure, and profuse sweating. These symptoms can be distressing and uncomfortable.
  • Gastrointestinal Issues: Nausea and vomiting are also typical during this stage, contributing to a general feeling of malaise.
  • Hyperactivity of the Autonomic Nervous System: Symptoms such as rapid breathing and low-grade fever may occur as the body reacts to the sudden drop in alcohol levels.

It’s important to note that the severity of these symptoms can vary based on the individual’s drinking history and overall health. These early symptoms may sometimes escalate to more severe conditions, necessitating medical attention. 

Therefore, individuals undergoing alcohol withdrawal should seek professional support, as withdrawal can potentially lead to life-threatening complications.

Understanding Anxiety and Restlessness in Alcohol Withdrawal

Alcohol withdrawal can lead to a range of psychological symptoms, with anxiety and restlessness being among the most common and distressing.

Anxiety During Withdrawal

Anxiety during alcohol withdrawal is characterized by feelings of nervousness, unease, and an overactive mind.

Restlessness and Agitation

Restlessness manifests as an inability to relax or stay still, often accompanied by agitation.

Physiological Basis

The physiological basis for these symptoms lies in the brain’s adaptive changes to chronic alcohol exposure.

Neurochemical Imbalance

Alcohol functions as a central nervous system depressant, altering neurotransmitter activity. Chronic use leads to neurochemical imbalances that contribute to heightened anxiety and restlessness during withdrawal.

Impact on Stress Systems

Chronic alcohol use affects the brain’s stress system, particularly the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol levels that can exacerbate anxiety symptoms.

Treatment and Recovery

Understanding and treating these withdrawal symptoms are critical for a successful recovery and long-term abstinence from alcohol.

Understanding Insomnia and Nightmares During Alcohol Withdrawal

Alcohol withdrawal significantly disrupts sleep patterns, leading to conditions like insomnia and nightmares.

Insomnia During Withdrawal

Insomnia, a common withdrawal symptom, is characterized by difficulty falling asleep due to heightened nervous system activity and increased anxiety levels.

Impact on Symptoms

Withdrawal-induced sleep disturbances often exacerbate other symptoms, such as mood swings and depression, creating a challenging recovery environment.

Relapse Risk

Studies highlight that sleep issues during withdrawal are prevalent and may lead to relapses, as individuals seek alcohol’s sedative effects to counteract sleep disturbances.

Nightmares During Withdrawal

Nightmares are another distressing symptom affecting 25% to 75% of individuals detoxifying from alcohol. These vivid and unsettling dreams impair sleep quality, contributing to a non-restorative sleep experience.

Physiological Factors

Physiological changes during withdrawal, including alterations in REM sleep patterns and stress-related hormone activation, contribute to nightmares. Research indicates that alcohol’s impact on sleep extends to sleep latency, NREM sleep, and REM sleep, influencing the severity of insomnia and nightmares.

Management Strategies

Effective management of these sleep-related withdrawal symptoms includes Cognitive Behavioral Therapy for Insomnia (CBT-I) and professional support in alcohol treatment centers. Treatment strategies often combine medication-assisted treatment and behavioral therapies to alleviate insomnia and prevent relapse triggered by sleep disturbances.

Understanding Severe Alcohol Withdrawal Symptoms

Severe symptoms of alcohol withdrawal typically manifest between 24 to 72 hours after the last alcohol intake.

Neurotransmitter Imbalance

These symptoms result from the body’s reaction to the absence of alcohol, disrupting the balance between excitatory and inhibitory neurotransmitters.

Life-Threatening Symptoms

The most alarming symptoms include delirium tremens (DTs), hallucinations, and seizures, which can be life-threatening and require immediate medical attention.

Delirium Tremens (DTs)

DTs are characterized by severe confusion, agitation, fever, and hallucinations, constituting a medical emergency with a risk of death if untreated.

Risk Factors

The risk of DTs is higher in individuals with a history of heavy, prolonged alcohol use or previous withdrawal episodes.


Seizures can occur within the first 48 hours of withdrawal, with a peak risk around 24 hours, presenting as single or multiple episodes and indicating severe withdrawal.

Additional Complications

Other severe symptoms may include high blood pressure, heavy sweating, and rapid heart rate, necessitating medical supervision during withdrawal.

Treatment Approaches

Treatments often involve benzodiazepines to manage symptoms and prevent complications, alongside supportive care such as IV fluids and treatment for co-occurring conditions.

Seeking Professional Help

Recognizing the gravity of severe alcohol withdrawal is crucial, and seeking professional help through resources like the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is recommended for guidance to appropriate treatment options.

Understanding Delirium Tremens in Alcohol Withdrawal

Delirium Tremens (DTs) is a severe and potentially life-threatening condition that can occur during alcohol withdrawal, typically manifesting within 48 to 96 hours after the last drink.

Symptoms of DTs

DTs are characterized by sudden and severe changes in mental status and autonomic nervous system dysfunction. Symptoms may include agitation, global confusion, hallucinations, fever, and seizures, necessitating immediate medical intervention.

Mortality Risk

Research indicates that DTs have a high mortality rate without treatment, emphasizing the critical need for medical supervision during alcohol withdrawal.

Risk Factors

Risk factors for DTs include a history of prolonged heavy drinking, previous withdrawal episodes, older age, and pre-existing health conditions.

Neurological Adaptations

The central nervous system adapts to alcohol over time, and sudden cessation can lead to an overactive response, triggering DTs symptoms.

Management and Treatment

Managing DTs often requires hospitalization, potentially in an intensive care unit, with treatments including benzodiazepines, antipsychotics, and supportive care to stabilize vital signs and manage complications.

Prevention and Guidelines

According to US dietary guidelines, preventing DTs is best achieved through safe drinking practices or abstinence.

Seeking Medical Advice

Individuals with a history of heavy alcohol use should seek medical advice before quitting to prevent withdrawal symptoms and complications like DTs. Medical professionals can offer structured detoxification processes and ongoing support during recovery.

Understanding Seizure Risks During Alcohol Withdrawal

Seizures are a significant risk during the withdrawal phase for individuals with a history of prolonged and heavy alcohol use.

Timing of Seizures

These seizures typically manifest between 6 to 48 hours following the cessation of alcohol consumption, coinciding with the period when blood alcohol levels decline to zero.


Seizures during alcohol withdrawal occur in approximately 3% of cases and are part of the broader spectrum of alcohol withdrawal syndrome (AWS).


The pathophysiology behind alcohol withdrawal seizures involves the central nervous system’s adaptation to chronic alcohol exposure, leading to an imbalance in neurotransmitter activity upon sudden cessation.

Treatment Approach

Treatment for alcohol withdrawal seizures often involves benzodiazepines like lorazepam or diazepam to reduce seizure risk and manage AWS symptoms.

Adjunctive Medications

In some cases, adjunctive medications such as gabapentin, carbamazepine, or valproate may be used alongside benzodiazepines.

Comprehensive Care

Comprehensive care includes monitoring for severe withdrawal symptoms and addressing co-occurring health issues like dehydration or electrolyte imbalances.

Importance of Medical Supervision

Preventing seizures and other severe complications of alcohol withdrawal requires medically supervised detoxification and withdrawal management to ensure safe navigation of the withdrawal process.

Understanding Post-Acute Withdrawal Syndrome (PAWS)

Post-Acute Withdrawal Syndrome (PAWS) is a set of persistent withdrawal symptoms that occur after the initial acute withdrawal phase from alcohol or drugs.

Duration and Nature of Symptoms

These symptoms can last weeks, months, or even years and are primarily psychological rather than physical. PAWS significantly impacts an individual’s ability to function and is a notable risk factor for relapse.

Common Symptoms

Common symptoms include mood swings, anxiety, sleep disturbances, and cognitive impairments such as difficulty with memory and concentration.

Influencing Factors

Factors influencing the severity and duration of PAWS include the type of substance used, length and amount of use, age, gender, and overall health.


Approximately 90% of recovering opioid users and 75% of recovering alcoholics and psychotropic abusers may experience PAWS.

Medical Care Recommendations

Due to the complexity of these symptoms, professional medical care is often recommended to manage PAWS effectively.

Treatment Approaches

PAWS is not formally recognized as a diagnosis in the DSM-5 but is widely acknowledged in clinical practice. Treatments may involve medication-assisted treatment, psychotherapy, and support groups.

Importance of Continuing Care

Healthcare providers emphasize continuing care programs post-treatment to manage symptoms and reduce the risk of relapse.

Emotional and Psychological Challenges in Post-Acute Withdrawal Syndrome

Post-acute withdrawal syndrome (PAWS) presents a significant challenge in the recovery process, with emotional and psychological symptoms persisting long after the acute withdrawal phase.

Emotional and Psychological Symptoms

These symptoms include depression and mood swings, which can jeopardize an individual’s recovery journey. Research indicates that these emotional fluctuations are intense and unpredictable, ranging from unexplained euphoria to deep depression.

This instability can make it difficult for individuals to manage their emotions and for healthcare providers to anticipate and treat these symptoms effectively.

Long-Term Impact

PAWS symptoms may resurface months or even years after achieving sobriety, often without warning, posing a continued challenge.

Risk of Relapse

The severity of mood swings and depression during PAWS can lead some individuals to relapse as they seek to self-medicate to alleviate psychological discomfort. Understanding that these symptoms are a normal part of the recovery process is crucial for individuals in recovery.

Coping Strategies

Coping with PAWS requires a multifaceted approach involving therapy, medication, support groups, and lifestyle changes. Education about PAWS helps set realistic expectations and prepares individuals for long-term recovery with the right support and treatment strategies.

Long-Term Cognitive Effects of Alcohol Withdrawal

Long-term alcohol withdrawal can have significant cognitive implications, impacting a person’s memory, concentration, and overall brain function.

Cognitive Deficits in Alcohol-Dependent Patients

Studies show that alcohol-dependent patients often exhibit cognitive deficits compared to healthy controls, particularly affecting attention and executive function. For instance, an ANOVA analysis revealed a significant difference in cognitive performance between these groups, emphasizing the lasting effects of alcohol on mental health.

Persistent Cognitive Impairments

Research indicates that cognitive impairments can persist even after prolonged periods of abstinence from alcohol. 

For example, a systematic review and dose-response analysis found that non-drinkers and moderate drinkers showed different rates of cognitive decline, suggesting that even moderate alcohol consumption could have long-term cognitive consequences. The cerebellum, crucial for mental processing, often shows reduced white matter volume in individuals with a history of alcohol abuse, contributing to diminished cognitive abilities.

Influence of Demographic Factors

Demographic factors such as age, gender, and comorbidity with neurological conditions can influence the extent of cognitive impairment in alcohol withdrawal.

Neuroinflammatory Response and Volume Loss

The neuroinflammatory response triggered by alcohol consumption can lead to volume loss in both gray and white matter, contributing to cognitive deficits and potential dementia in severe cases.

Long-Term Cognitive Functioning

Even with recovery, certain cognitive functions, such as visual-spatial abilities, may remain impaired, as highlighted by Practical Neurology. This underscores the importance of early intervention and comprehensive treatment plans that address cognitive recovery as well as abstinence.

Importance of Early Intervention

Early intervention is crucial in managing cognitive impairments associated with long-term alcohol withdrawal and promoting cognitive recovery through appropriate treatment strategies.

Managing Alcohol Withdrawal: Treatment Approaches

Alcohol withdrawal treatment aims to manage symptoms and support individuals through the detoxification process.

Treatment Approaches Based on Symptom Severity

The severity of symptoms dictates the treatment approach, ranging from outpatient care for milder cases to inpatient hospitalization for severe withdrawal, including delirium tremens and seizures. Honesty about alcohol and substance use is crucial for appropriate care.

Role of Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is a cornerstone of alcohol withdrawal management. Benzodiazepines are commonly prescribed to alleviate anxiety and prevent seizures.

Additional Medications and Support

In cases where benzodiazepines are insufficient, additional medications may address symptoms like nausea or correct dehydration and electrolyte imbalances. Resources from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) help understand treatment options.

Importance of Support Services

Support services, including therapy and counseling, play a significant role in recovery by addressing the psychological aspects of addiction and withdrawal, facilitating long-term sobriety. Mutual support groups like Alcoholics Anonymous provide a community for shared experiences and encouragement. Online support groups are available for those unable to attend in person.

Recovery Timeline

The timeline for recovery varies, with symptoms potentially lasting from days to weeks. In some cases, post-acute withdrawal symptoms may persist for months, underscoring the need for ongoing support and treatment.

Medication-Assisted Treatment for Alcohol Withdrawal

Medication-assisted treatment (MAT) plays a crucial role in managing alcohol withdrawal symptoms, which can range from mild anxiety to severe complications such as seizures and delirium tremens (DTs).

First-Line Treatment with Benzodiazepines

Benzodiazepines, a class of sedative medications, are widely regarded as the first-line treatment for alcohol withdrawal. They work by reducing the hyperactivity of the central nervous system that occurs when a person stops drinking alcohol.

Effectiveness of Benzodiazepines

Studies have shown that benzodiazepines such as chlordiazepoxide and diazepam are more effective than placebo in preventing alcohol withdrawal seizures and can help control delirium and agitation.

Additional Medications in MAT

Other medications used in MAT include anticonvulsants like gabapentin and carbamazepine, which may be used alongside benzodiazepines if symptoms persist. Adjunctive medications like clonidine and beta-blockers can also manage symptoms such as persistent hypertension or tachycardia.

Considerations for Treatment

Each medication has potential side effects, and treatment must be tailored to the individual’s needs and the severity of their withdrawal symptoms.

Long-Term Medications

Long-term medications like acamprosate and naltrexone are used to reduce the desire to drink and maintain abstinence. The choice between these medications should be individualized based on patient and physician preference.

Benefits of MAT

When used correctly and under medical supervision, MAT significantly improves the safety and comfort of the withdrawal process, prevents progression to more severe symptoms, and supports long-term recovery efforts.

The Role of Psychotherapy and Counseling in Alcohol Withdrawal Recovery

Psychotherapy and counseling are critical components in the treatment of alcohol withdrawal symptoms and the broader recovery process.

Addressing Psychological and Emotional Aspects

These therapeutic interventions address the psychological and emotional aspects of addiction, providing support and strategies to manage cravings, reduce the risk of relapse, and navigate recovery complexities.

Understanding Root Causes through Psychotherapy

Patients can understand the root causes of alcohol abuse through psychotherapy, including cognitive-behavioral therapy (CBT), motivational interviewing, and other evidence-based approaches. CBT helps patients identify triggers and thought patterns that lead to drinking, offering alternative coping mechanisms and behavioral strategies.

Relapse Prevention Strategies

Psychotherapy also plays a vital role in relapse prevention by equipping individuals with skills for maintaining long-term sobriety. Counseling provides a supportive environment for individuals to explore emotional issues and develop healthier ways of coping with stress and anxiety, common underlying factors in alcohol use disorders.

Role of Support Groups

Support groups and mutual aid groups recommended by the National Institute on Alcohol Abuse and Alcoholism complement individual therapy by offering social support and shared experiences crucial for maintaining abstinence post-withdrawal.

Beyond Symptom Management

Psychotherapy and counseling contribute not only to managing withdrawal symptoms but also to fostering sustainable recovery and improving overall mental health and well-being.

Strategies to Prevent Alcohol Withdrawal Symptoms

Preventing alcohol withdrawal symptoms primarily involves strategies focused on reducing or eliminating alcohol consumption. Moderation and abstinence are key approaches that can significantly mitigate the risk of experiencing withdrawal symptoms. 

Here are some strategies to consider:

  • Understanding Limits: Recognize the definition of excessive drinking, such as binge and heavy drinking, and stay within moderate drinking limits.
  • Self-Assessment Tools: Utilize online self-assessment tools to evaluate your drinking patterns and understand potential risks associated with alcohol use disorder.
  • Medical Consultation: Seek professional medical advice for a precise diagnosis and discuss suitable treatment or moderation plans.
  • Mutual Support Groups: Participate in mutual support groups recommended by the National Institute on Alcohol Abuse and Alcoholism to foster a community of support and accountability.
  • Medication-Assisted Treatment: In some cases, medications such as acamprosate or naltrexone may be prescribed to help reduce the desire to drink.
  • Educational Resources: Explore educational tools and resources, like the Rethinking Drinking website, to gain insights into healthier drinking habits and support for abstinence.
  • Healthy Lifestyle Choices: Adopt a balanced diet, avoid caffeine and sugar, and engage in regular physical activity to support overall well-being and reduce cravings.

Prevention strategies should be personalized to fit individual needs and may include a combination of these approaches to effectively prevent the onset of alcohol withdrawal symptoms.

Overcoming alcohol use disorder might seem impossible. But that’s not the case. Many people can recover if they go to a specialized rehab center that uses proven treatments. Alcohol treatment uses various methods to help with withdrawal and addiction. With these interventions, people can find health and happiness in sobriety.

Alcohol addiction treatments may include:

  • Medication-assisted treatment: This treatment uses medicines to reduce AUD symptoms like cravings and withdrawal.
  • Individual and group therapy: Talking with therapists either one-on-one or in groups can help people recover. Methods include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT).
  • Relapse prevention programs: These programs teach people how to avoid relapse, understand the process and develop healthy coping methods.
  • Family therapy: AUDs affect the entire family. Working with a family therapist can start the path to healing the relationships damaged by alcohol misuse.
  • Recreational therapies: These therapies help people in recovery find joy in their new, sober life, improving their physical and mental health.

Treatment Options are Available

At Orlando Recovery Center Drug and Alcohol Rehab, we offer many alcohol addiction treatment options led by trained medical professionals. Our levels of care include medical detox, inpatient rehabilitation and intensive outpatient programs (IOPs). No matter where you are in your recovery journey, our team will be there every step of the way. Start your admission today.


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