Signs and Symptoms of Alcohol Withdrawal

Alcohol withdrawal occurs when a person suddenly stops (or significantly reduces) alcohol intake after long-term dependence. 

Mild symptoms include night sweats, irritability, anxiety,  nausea, and more. Severe symptoms involve seizures, hallucinations, and delirium tremens (a rapid onset of confusion that happens usually between 2-5 days from the last drink).

Symptoms can occur within several hours of a person’s last drink. But, they typically peak after 24 to 72 hours and may last for several weeks. 

Timing and severity vary, depending on the length of alcohol dependence and the amount someone regularly consumes. 

If you plan to stop drinking, it’s best to seek assistance from your healthcare provider rather than quitting (especially “cold turkey”) on your own. Without proper medical monitoring and treatment, alcohol withdrawal can be a serious, potentially fatal condition. 

Psychological Symptoms

Alcohol is known as a psychotropic depressant, because it slows down your nervous system. As your body gets used to alcohol, it compensates by stimulating the brain and nervous system to keep you awake.

When you stop drinking, the brain still experiences hyperactivity or overexcitement. This is what causes psychological (mental and emotional) withdrawal symptoms.

The following symptoms are more common if someone quits suddenly (cold turkey, without weaning). But, they can occur when anyone with alcohol dependence stops drinking.

Anxiety

Anxiety is a common symptom of alcohol withdrawal. It can make you feel jittery, tense, nervous, or “on edge”. 

You can also have panic attacks which cause: 

• Sudden, intense anxiety
• An impending sense of doom 
• Shakines
• A racing heart 
• Nausea
• Dizziness

Depression

Depression includes feelings of sadness, hopelessness, worthlessness, and loss of interest in activities you usually enjoy.

Fatigue

Fatigue is a feeling of exhaustion, lack of energy, or weakness that doesn’t resolve with rest or caffeine. It can make it difficult to perform simple daily activities.

Irritability

Irritability involves extreme impatience, annoyance, and frustration. You may anger more easily or have a shorter temper than usual. You may also feel “jumpy” or shaky and have difficulty concentrating or thinking clearly.

Mood swings

Mood swings are sudden shifts in mood. You may feel happy and hopeful one moment but sad and depressed a short time later. 

Treatment options for psychological withdrawal symptoms depend on a person's level of alcohol dependence, the severity of symptoms, and where they receive treatment (at home or in a healthcare facility). 

GI Symptoms

Gastrointestinal (GI) symptoms include nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. 

Prevention of nausea, vomiting, and diarrhea involves:

• Drinking plenty of water and non-alcoholic electrolyte drinks (Pedialyte or sports drinks)
• Eating small, light meals (even a few saltine crackers can help absorb stomach acid and stimulate your appetite)
• Avoiding large meals, spicy foods, or fatty foods
• Progressive muscle relaxation, acupuncture, or acupressure (alternative methods)

Mild gastrointestinal symptoms often resolve by resting in a dark room with a cool rag on your forehead or behind your neck. You can also try ginger ale, ginger cookies, or ginger tea.

Moderate nausea may require over-the-counter (OTC) medications such as:

• Dramamine (dimenhydrinate) 
• Benadryl (diphenhydramine) 

You can also try Pepto-Bismol (bismuth subsalicylate) or Imodium (loperamide) for diarrhea or stomach discomfort.

Severe, persistent GI symptoms require medical treatment to relieve symptoms and prevent dehydration. This might involve:

• Prescription anti-emetics (anti-nausea)
• Benzodiazepines (help with nausea in addition to psychological symptoms)
• Intravenous (IV, in the vein) fluids
• A “banana bag” (IV fluids with thiamine, folate, and multivitamins)
• Parenteral nutrition (nutrition in a central intravenous line, in severe cases)
• Long-term vitamins to help with nutritional deficiencies

Skin Symptoms

Alcohol withdrawal can cause paleness, clamminess, and sweatiness a couple of days after a person’s last drink. Some people also report itchiness. 

Sweating is how the body responds to changes in your blood vessels and tries to cool itself down. You may find it helpful to: 

• Make your room cooler 
• Take a cool shower
• Rest in a dark room with a cool rag on your head, neck, or groin

Excessive sweating can cause dehydration and deplete your body of essential nutrients, salt, and minerals.

Notify a healthcare provider if sweating lasts over a day or two or continuously disrupts sleep. This is especially important if you are not drinking enough water or electrolyte drinks. 

Other Symptoms

Alcohol withdrawal may cause other symptoms that don’t fit in the previous categories. This might include:

• A rapid heart rate (heart rate over 100)
• Heart palpitations (feel your heart beat or “jump”) 
• Chest pain
• Fever
• Tremors (shaking of the hands, arms, or legs)
• Headache 
• Insomnia (difficulty falling or staying asleep)
• Seizures (most common in the first 12 to 48 hours)
• Dilated (larger) pupils

When To See a Healthcare Provider

Alcohol withdrawal is a serious condition that can become life-threatening. It mostly occurs in patients trying to stop long-term heavy drinking, and is psychologically manifested in anxiety and irritability. This is because the brain is more prone to hyperexcitement.

Call a healthcare provider or an alcohol treatment center if you:

• Plan to stop drinking after long-term alcohol use
• Have persistent symptoms of alcohol withdrawal 
• Need help managing symptoms or getting nutrition

If you go to the hospital for a different reason, inform the healthcare providers about your alcohol consumption. They can monitor and treat you for withdrawal symptoms. 

Seek emergency care if you experience:

• Symptoms of delirium tremens (see below)
• Seizures 
• Fever 
• Severe confusion
• Hallucinations (seeing, hearing, or feeling things that are not there when fully awake)
• Irregular heartbeat
• Chest pain

Delirium tremens is a sudden, severe nervous system disruption that can occur with alcohol withdrawal. It is an emergency condition that most commonly affects those who:

• Don’t eat enough food
• Have a previous history of alcohol withdrawal
• Drink four to five pints (1.8 to 2.4 liters) of wine daily for several months
• Drink seven to eight pints (3.3 to 3.8 liters) of beer daily for several months
• Drink one pint (0.5 liters) of “hard” liquor daily for several months
• Regularly consumes excess alcohol for more than ten years

A Quick Review

Alcohol withdrawal occurs when someone stops consuming alcohol after long-term dependence. It’s typically more severe for those who have been drinking large amounts of alcohol daily for a long-time or who have had alcohol withdrawal before.

Symptoms vary and range in severity. They include mild symptoms such as stomach problems, anxiety, and sweatiness. But, it can also be dangerous, causing seizures or delirium tremens.

It’s best to seek medical assistance and taper off alcohol (rather than quitting “cold turkey”) to avoid these potentially fatal symptoms.