What is alcohol withdrawal syndrome?

Alcohol withdrawal or alcohol withdrawal syndrome (AWS) refers to the condition and symptoms a person with alcohol abuse goes through when he abruptly stops drinking alcohol.

When we refer to a person with alcohol abuse disorders, we mean a person who has surpassed the safe drinking limits and has been regularly drinking heavily for weeks, months, or years and has become alcohol dependent. He is one who suffers from a chronic disease called alcoholism.

If you drink occasionally and stop, it is unlikely that you will experience these symptoms.

However, those who drink daily in moderate amounts will also experience withdrawal symptoms but the symptoms will be mild.

Those who drink excessively but not daily will also experience mild to moderate withdrawal symptoms.

However, it is the sudden withdrawal of alcohol in a chronic drinker that is dangerous and severe and can even be fatal. Seizures are known to occur due to the abrupt cessation of drinking and form the most dangerous symptom of AWS.

If you have been drinking regularly and heavily and have decided to quit, you should never take alcohol withdrawal lightly. Major symptoms have proved time and again to be fatal. You must seek medical help. Do not try and treat it at home.

A person usually stops drinking due to the development of one of the ill effects, chronic drinking has on the health of a person.

Ideally, the best thing to do for an individual with alcohol abuse is to do is to get himself treated by inpatient rehab with group therapy, counseling, and medication.

Causes of alcohol withdrawal symptoms

Alcohol withdrawal syndrome and its symptoms are caused by alcohol detox – abrupt cessation of drinking alcohol – by an alcohol-dependent individual.

Such people develop alcohol tolerance and dependence because of which their system is so used to alcohol that its abrupt withdrawal leads to certain health problems.

With excessive and heavy drinking over time, the alcohol in the body has a depressive action on the central nervous system.

The brain has become used to functioning in a sluggish manner due to continuous exposure to the depressant action of alcohol. Brain chemistry undergoes a change due to continued exposure to the chemicals in alcohol.

The nerves too, send impulses in a rather altered manner. Chronic alcohol exposure reduces the ability of the neurons to transmit impulses thereby affecting normal brain function.

This goes on for weeks, months, or even years. The neuronal adjustment to alcohol is so strong that the brain requires the continued presence of alcohol to function.

It is the nervous system, which helps the body to adjust at times of stress. After the sudden and total withdrawal of alcohol, the central nervous system goes into a hyperactive state due to the body’s efforts to adjust to the absence of alcohol, which it has been used to for many years.

This hyperactivity comes about because of the absence of the alcohol’s inhibitory action on the brain, which now goes into a rebound overdrive. The symptoms of withdrawal are a manifestation of this adjustment.

Alcohol withdrawal signs and symptoms

The common symptoms of alcohol withdrawal also referred to as alcohol detox symptoms usually manifest after an alcohol withdrawal duration of 3 hours and when there are no remnants of alcohol in the blood.

The less common and more severe symptoms manifest from the 3rd day of alcohol withdrawal. Alcohol withdrawal may involve psychological and/or physical symptoms. They may be mild or severe and the intensity of the symptoms depends on a number of factors.

  • Age of the person
  • Genetics of the person
  • Duration of the person’s alcoholism
  • Amount of liquor the person was consuming and the degree of alcoholism
  • Presence of any associated disease or health disorder

Alcohol withdrawal syndrome, therefore, is characterized by unpleasant physical and mental symptoms caused by the abrupt cessation of alcohol.

For better understanding, the symptoms are divided into three stages according to their severity. About 90% of alcohol withdrawal patients experience mild to moderate symptoms. The more severe symptoms are reserved for the “privileged” 10%.

Stage one symptoms

Stage one includes those symptoms, which occur within a withdrawal duration of a few hours. Alcohol is present in the blood but has decreased to levels of 0 to 100mg. Symptoms of this stage include

  • Insomnia – Inability to sleep
  • loss of appetite
  • shakes or tremors. This is a typical and early symptom of alcohol withdrawal. The more severe form of this symptom is seen in delirium tremens explained below under the 3rd stage.
  • muscular weakness
  • an agitated state of mind
  • nightmares
  • emotional changes and
  • an increased heart rate

Stage two symptoms

The symptoms of the second stage of alcohol withdrawal syndrome occur 24 hours after you have stopped drinking. They are

  • cold,  clammy, and pale skin
  • sweating
  • nausea
  • vomiting
  • headache
  • dilated pupils
  • upset stomach
  • alcohol withdrawal seizures

Stage three

The symptoms of stage three occur 48 to 72 hours after the cessation of drinking alcohol. They include the symptoms of stages one and two in addition to the following:

  • Increased agitation
  • Fever
  • Delirium tremens is an acute episode of delirium, which is seen usually 72 hours after stopping alcohol. It is the most severe form of alcohol withdrawal. Symptoms of delirium tremens include grand mal seizures, tremors, nausea and vomiting, and fast heartbeat. Symptoms that are more serious include confusion, disorientation, loss of consciousness, angry behavior, sweats, sleep disorder, and hallucinations. If untreated, this condition can lead to death.

Patients with very mild symptoms may need supportive care only, while patients with moderate-to-severe manifestations may require aggressive pharmacologic intervention.

Alcohol withdrawal timeline

The alcohol withdrawal timeline refers to the duration of the withdrawal symptoms after the person has stopped drinking alcohol.

It denotes how long the withdrawal symptoms will last after having stopped alcohol. There is however no way to predict how long the symptoms will last in a particular individual.

It depends on how much the person has been drinking and for how long. It also depends on the constitution of the person’s body because different people respond differently to alcohol’s effects on the body.

Alcohol withdrawal symptoms can begin within a couple of hours of having stopped alcohol. They may last for months or even years. Time is the best healer and with time, the symptoms decrease and eventually fade out.

Mild alcohol withdrawal symptoms present themselves in people who have been drinking less or moderately. Heavy and excessive drinkers present with severe symptoms, which take a longer time to disappear.

The alcohol withdrawal timeline, therefore, will vary and professional help is required for heavy drinkers who have given up on alcohol.

  • Tremors (shakes) usually begin within 5 to 10 hours after the last alcohol drink and typically peak at 24 to 48 hours.
  • Alcohol withdrawal hallucinations usually begin within 12 to 24 hours after the last drink and may continue for as long as 2 days.
  • Alcohol withdrawal seizures may occur 6 to 48 hours after the last drink and may continue over several hours. The risk peaks at 24 hours.
  • Delirium tremens commonly begins two to three days after the last alcohol drink, but it may start even after a week. It peaks in intensity usually four to five days after the last drink.

Protracted withdrawal syndrome

This is the name given after the acute stage of alcohol withdrawal has subsided and certain symptoms persist but at a subclinical level.

Protracted withdrawal syndrome can last for months to years after cessation of alcohol. Symptoms of this syndrome are craving for alcohol, nausea, and vomiting, occasional headache, insomnia, disorientation, and loss of interest in affairs and activities.