Alcohol Addiction, Withdrawal & Recovery

What is Alcoholism (Alcohol Use Disorder)?

Alcoholism (AUD) is a serious problem that can take a toll on your life. If you or a loved one have been struggling with alcohol abuse, there may be a number of noticeable symptoms present. You may have tried stopping alcohol but couldn’t stop for more than a week. You may drink in the morning to start your day, drink too much or more than you anticipate, have blackouts, hide your alcohol drinking or are unable to maintain your responsibilities. Alcohol usage may also be interfering with your relationships or causing you legal issues such as tickets or violent behaviors.

Excessive alcohol use can result in a host of short and long-term health issues including depression, mood swings, liver disease, ulcers, weight gain, and digestive problems.

What is Alcohol Withdrawal?

Alcohol withdrawal, or acute alcohol withdrawal syndrome (AWS), is a combination of the symptoms that occur when someone stops drinking alcohol after heavy and regular usage. Prolonged usage of alcohol causes the body to become reliant on alcohol to function. Quitting the usage of alcohol put the body in shock, causing it to get sick when trying to adjust to the missing substance. Social alcohol usage does not typically lead to withdrawal, but if you have been using frequently or for a long period of time, then it is extremely likely that you will experience severe withdrawal symptoms if you immediately quit drinking.

Alcohol withdrawal symptoms can begin within hours of your last drink, increase in severity around the second to third day, and can last for more than a week.  

Signs and Symptoms of Withdrawal

Alcohol withdrawal can bring on a host of uncomfortable and even deadly symptoms. At the onset of withdrawal, you may experience dilated pupils, fast breathing, high blood pressure, fast heartbeat, and fever. If you notice any of the signs or symptoms and have recently reduced the amount or frequency of your alcohol intake, it is extremely important that you speak with your doctor.

Depending on the length of usage and the severity of dependence, the timeline of withdrawal symptoms can differ. Most symptoms begin within 6 hours of the last drink and last heavily for a little over a week. Heavy long-term drinkers can even begin experiencing withdrawal symptoms as soon as 2 hours after the last drink.

Whether you are deliberately detoxing or have suddenly slowed your intake of alcohol, you will likely experience some of the following symptoms of withdrawal, beginning with “hangover” symptoms on day 1.

6 – 24 hours after last drink

  • Diarrhea
  • Nausea
  • Vomiting
  • Headaches
  • Anxiety
  • Abdominal pain and cramping
  • Insomnia
  • Loss of appetite

24 – 48 hours after last drink

  • Fever
  • Nightmares
  • Increased heart rate
  • Increased blood pressure
  • Itching
  • Sweating
  • Fatigue
  • Shaky hands
  • Intense cravings

48 – 96 hours after last drink

  • Feelings of sadness and hopelessness
  • Mood swings
  • Agitation
  • Seizures
  • Hallucinations
  • Delirium

Additional Symptoms of Use and Withdrawal

While the symptoms mentioned above are more common, here are a few of the more specific issues someone might experience when detoxing from alcohol:

Gastro-Intestinal Distress

Alcohol use interferes with the normal digestion process by increasing the production of gastric acid and inflammation. Some of the most common symptoms of withdrawal include stomach discomfort and gastro issues such as loss of appetite, diarrhea, nausea, vomiting, and abdominal pain and cramping. Diarrhea and abdominal cramping can last from days to weeks.

These symptoms can be managed with over the counter drugs, changes in appetite or herbal remedies. Since diarrhea and vomiting can lead to dehydration, it is imperative to stay hydrated with increased water and electrolyte intake. Probiotics and other supplements as well as a healthy diet may be needed to balance out the bacteria and enzymes in the stomach and relieve the gastro-intestinal discomfort.

Headaches

One of the first symptoms that may be experienced at the onset of alcohol withdrawal is severe headaches. These headaches may begin mild and quickly intensify. They may continue off and on for months, even years, at varying intensities. During the acute, or immediate, phase of withdrawal, these headaches may be more severe, and during the Post-Acute Withdrawal, or PAWS period, the headaches may cycle off and on for days or months at a time. You may feel like you have completely recovered, only to begin experiencing headaches again.

During detox, specialists will likely assess you for underlying health conditions to rule out the need for any other treatment. If you don’t have any other health conditions contributing to the headaches, you can expect the headaches to go away within 6 months to a year or more. Sleep disturbance and challenges adjusting to recovery may also be contributing to your headaches. If they persist, it is best to speak with a doctor or specialist.

Anxiety

Anxiety is an extremely common symptom of alcohol withdrawal. The duration and amount of usage may affect the intensity of the anxiety, as well as underlying mental health conditions. Patients with co-occurring or pre-existing conditions, may experience more extreme psychological symptoms. Anxiety causes feelings of mental anguish such as nervousness, restlessness, fear, dread, and confused thinking.  Physical symptoms of anxiety include increased heart rate, rapid breathing, stomach aches, and muscle tremors.

Sometimes anxiety can grow into disorders that interfere with day to day life, such as social anxiety, separation anxiety, agoraphobia, generalized anxiety disorder, and panic disorder. Doctors often prescribe anti-anxiety medications and anti-depressants to help manage these symptoms, but it is also a good idea to speak with a therapist and participate in cognitive behavioral therapy.

Panic Attacks

Individuals may also experience sudden, extreme bouts of anxiety called panic attacks. Panic attacks are comprised of intense physical symptoms and mental anguish such as chest tightness, heart palpitations, shaking, light-headedness, a choking sensation, and stomach issues. Loss of sense of reality, fear of impending death, and an overall fear of insanity may also come on intensively.   

Fever

Fever is another symptom of alcohol withdrawal. A fever can range from mild to severe and bring with it a host of other symptoms such as dehydration, headache, weakness, sweating and shivers. Extremely high fevers can lead to confusion, hallucinations, and even seizures. Fevers that last more than 24 hours or that increase to a temperature higher than 103 F can become dangerous.

You should seek help from a doctor immediately,  as testing and evaluation may be needed to ensure there are no infections in the body.

Insomnia

Insomnia is an extremely common symptom of alcohol withdrawal. Ceasing alcohol use can cause sleep disturbances such as inability to fall to sleep, awakening in the middle of the night, and reduced sleep quality. Insomnia can last long after withdrawal and can often negatively impact recovery. Treatments for insomnia and sleep disturbances include medication, therapy, and improved sleep hygiene.

Hallucinations

A rare, but frightening symptom associated with alcohol withdrawal is the onset of hallucinations. These hallucinations can be visual, auditory, or tactile, which causes the feeling of itching and burning skin. Psychosis, which leads to the hallucinations,  disrupts a user’s perception of reality. During psychosis, you may feel, hear or see things that are not really there. Your thoughts may change drastically and disturbingly. You may also experience delusions, memory problems, and inappropriate fear.

Itching

Alcohol withdrawal can cause feelings of itchiness, tingling and the sensation of bugs crawling underneath the skin. The itchiness leads to continuous scratching of the skin, which can sometimes result in rashes and scratches. The causes of the itching are not completely understood, but the intense feeling is very real to those going through withdrawal.

Sweating

Sweating is another uncomfortable symptom experienced during withdrawal. It is typically sudden and uncontrollable. The sweating can occur throughout the day or in the middle of the night, commonly referred to as “night sweats”. Some people have reported completely drenching their clothes and sheets with sweat. Since intense sweating can lead to dehydration, it is imperative to drink plenty of water as soon as possible.

Seizures

Severe alcohol withdrawal symptoms include seizures, also known as “rum fits”. Seizures can occur as early as 6 hours after the last drink, and peak around 24 hours. People can experience multiple seizures over the course of a few hours, and severe seizures can lead to death. It is critical that you seek emergency help if you experience a seizure of any intensity.

Delirium

About 5% of people experience delirium tremens, or DTs, which is considered the most severe form of alcohol withdrawal. Delirium tremens consists of deep sleep, extreme confusion and agitation, fever, high blood pressure, nightmares, seizures, sensitivity, and hallucinations. Delirium tremens usually begins two to five days after the last drink. It affects people who have a history of alcohol withdrawal, have been drinking for more than 10 years, or drink large amounts of alcohol everyday for months. Increased heart rate and blood pressure make delirium tremens life-threatening which is why medical treatment is strongly advised during the detox process.

Treatment & Detox

While it may be tempting to attempt to quit alcohol on your own, it is not safe. If you suspect that you have developed a dependency to alcohol, you should reach out to an alcohol recovery specialist. There are a variety of confidential resources and treatment programs available to assist you in the recovery process. Treatments include in-patient and outpatient detox programs, which vary depending on the length and severity of usage.

Doctors and specialists often prescribe benzodiazepines and other drugs to help reduce alcohol cravings, manage anxiety, and minimize withdrawal symptoms. IV fluids can be administered for dehydration and supplements such as magnesium, folic acid, and multi-vitamins may be provided for nutritional support. Long-term treatment includes cognitive behavioral therapy, meditation, mindfulness training, exercise, AA meetings and group therapy.  In addition to withdrawal and detox support, these long-term therapy options provide support for co-occurring issues, relapse prevention, and family therapy.

If you are unable to enter a treatment program, it is still best to speak with a doctor about your options for quitting alcohol. Alcohol recovery is a lifelong journey that requires a support team and dedication to abstaining from future alcohol usage.

Getting Help

For more information about overcoming alcohol addiction, managing withdrawal symptoms, or to seek help from a recovery specialist, please contact a local addiction clinic or the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357.

FAQs about Alcohol Addiction and Withdrawal

When learning about alcohol addiction or withdrawal, there is a lot of information and it may be confusing. We’ve put together the top questions and answers to help you get the right answer to your questions:

Can you have withdrawals from alcohol?

Yes. Abrupt withdrawal from chronic use of alcohol causes withdrawal symptoms. These withdrawal symptoms occur as the body detoxes from the substance. Symptoms can be mild to severe, including headaches, nausea, vomiting, insomnia, hallucinations, anxiety, and seizures.

How serious is alcohol withdrawal?

Alcohol withdrawal is serious. Some symptoms can lead to extreme dehydration and even death. It is critical to seek help from a specialist or a doctor when detoxing from alcohol.

How do you withdraw from alcohol use safely?

In order to safely withdraw from alcohol, please consult a doctor or recovery specialist. It is recommended that you enter an in-patient or outpatient recovery program where you can safely detox under the care of a doctor. Detoxing may include medications, nutritional substances, and IV fluids.

Can alcohol cessation make you sick?

Yes, alcohol cessation can cause many uncomfortable symptoms, such as nausea, headaches, and vomiting.

What happens in alcohol withdrawal?

During alcohol withdrawal, the body adjusts to the shock of no longer having alcohol in the body.

What is withdrawal from alcohol like?

Alcohol withdrawal is uncomfortable and sometimes deadly. Symptoms include headaches, nausea, vomiting, insomnia, nightmares, hallucinations, anxiety, and even seizures.

When do alcohol withdrawal symptoms start?

Alcohol withdrawal symptoms can begin as early as 6 hours after the last drinks. Some heavy, long-term drinkers have even reported feeling withdrawal symptoms 2 hours after their last drink.

When do alcohol withdrawal symptoms stop?

It varies. Immediate symptoms usually stop within a week, while some symptoms extend for weeks and months, up to or longer than a year.

Who is at risk for alcohol withdrawal?

Anyone has been drinking heavy amounts of alcohol regularly for a few months or more or binged on alcohol and suddenly stops drinking.

How to help withdrawal symptoms from alcohol

There are medications that can be prescribed to help alleviate withdrawal symptoms.

Is fever a symptom of alcohol withdrawal?

Yes, alcohol withdrawal can lead to low-grade or high-grade fevers. When detoxing from alcohol, the body temperature rises, resulting in fever.

How can you ease symptoms of alcohol withdrawal?

Medicines can be administered to ease alcohol withdrawal symptoms. One of the most effective medications are benzodiazepines. Other medications can be prescribed to minimize cravings.

What is ETOH withdrawal?

ETOH withdrawal, or ethyl alcohol withdrawal, is often interchangeably used to describe alcohol withdrawal. ETOH is a term used to refer to ethanol or ethyl alcohol. Ethanol is a pure form of alcohol that can be used as an antiseptic or cleaning agent. Typically, alcohol abusers consume alcohol that is less pure, and is combined with other substances to make it more palatable.

What is ABV?

ABV stands for alcohol by volume. This term is used to describe the amount or percentage of pure alcohol in a drink.

What are short term withdrawal symptoms of alcohol?

Short-term withdrawal symptoms of alcohol range from the “hangover symptoms” such as nausea, vomiting, and headaches, all the way to severe symptoms, such as fever, seizures and delirium tremens.

What happens to the body during alcohol withdrawal?

During alcohol withdrawal, the brain and body attempt to adjust to the cessation of the alcohol which they have become dependent on. This attempt to readjust to the change in chemicals causes uncomfortable and sometimes fatal symptoms to occur in the body, including heightened blood pressure, heart rate, and temperature.  

Is depression a symptom of alcohol withdrawal?

Yes, depression is a symptom of alcohol withdrawal in addition to anxiety and other mood disorders.

Is alcohol withdrawal exhaustion a real symptom?

Yes. Fatigue is a symptom of alcohol withdrawal.

What are alcohol withdrawal long term symptoms?

Long-term symptoms of alcohol withdrawal vary, but include headaches, anxiety, anxiety disorders, and depression.

How do you diagnose alcohol withdrawal?

Alcohol withdrawal is diagnosed by assessing the alcohol usage behaviors which preceded the symptoms (how long, how often, and how much alcohol was consumed), as well as assessing the type and severity of the withdrawal symptoms.

More about alcohol addiction, withdrawal, treatment & recovery.

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Sources & Resources

Alcohol Withdrawal Headaches. https://www.brightfuturerecovery.com/blog/how-long-to-alcohol-withdrawal-headaches-last/#headaches

Alcohol Withdrawal Symptoms. https://firststepbh.com/blog/alcohol-withdrawal-symptoms/

Alcoholism: Withdrawal. https://www.healthline.com/health/alcoholism/withdrawal

Ethanol. https://www.oxfordtreatment.com/substance-abuse/alcohol/ethanol/

Psychotic Disorder. https://www.alcohol.org/comorbid/psychotic-disorder/

Sleep Problems in Recovering Alcoholics. https://www.verywellmind.com/sleep-problems-in-recovering-alcoholics-63200

Symptoms of Alcohol Withdrawal. https://www.verywellmind.com/symptoms-of-alcohol-withdrawal-63791