When a person who has been chronically drinking either reduces or totally stops their alcohol consumption, they will likely experience several alcohol withdrawal symptoms, the severity and duration of which will depend primarily on the amount of drinking. The withdrawal symptoms can start within six hours and will be most severe 24 to 72 hours after quitting.
These symptoms are often very unpleasant but will all end if no more alcohol is consumed. It’s important to keep in mind that withdrawal is temporary and that drinking to ease the withdrawals is unwise—a person who experiences alcohol withdrawal has an addiction which is likely problematic and is well-advised to stop drinking. However, heavy drinkers should quit under medical supervision to avoid potentially life-threatening complications, which will be discussed further below.
Common Alcohol Withdrawal Symptoms
Many alcohol withdrawal symptoms relate to agitation and overstimulation. During regular drinking, the brain compensates for the alcohol’s depressant effect by releasing an excess of stimulating neurochemicals. Once the alcohol is no longer in the system, the equilibrium which has been established is thrown off.
If you or someone you know quits drinking, you can expect several of the following psychological symptoms for two to ten days, but possibly for much longer. They include nervousness, anxiety, mood swings, irritability, feeling exhausted, an inability to think clearly or feeling empty-headed, depression, and nightmares including dreams about drinking alcohol.
Those undergoing alcohol withdrawal will be very on edge and it’s important that they be in a calm environment.
The physical symptoms range widely in severity, and less harmful ones include headache, heavy sweating, shaking (especially in the hands, this may interfere with basic activities), twitching, nausea, vomiting, complete loss of appetite, and racing heart. Insomnia is especially common and may last for months after a person quits drinking, and excessive sleeping is also a possibility.
The rest of the physical symptoms are shorter lived and should end within ten days. However, they often add up to serious discomfort, and it’s best for anyone experiencing physical alcohol withdrawal symptoms to avoid physical activity and to be in the company of supportive people. Those quitting alcohol have an increased risk for heart attack or stroke during their alcohol withdrawal and those with high blood pressure should be under medical supervision.
Approximately one in twenty people who experience alcohol withdrawal will face a more serious type of withdrawal called Delirium Tremens (DTs). It typically begins two to three days after the last drink and can last up to a week. Heavy drinkers are more likely to experience DTs.
They can be fatal: up to 4% of those who experience DTs die from them. It is important to immediately seek medical attention for someone experiencing DTs and therefore it is best for heavy drinkers to quit under medical supervision, where they can be administered benzodiazepines like Librium and other drugs which combat the most serious aspects of DTs.
The psychological symptoms all of which may become severe, include agitation, confusion, hallucinations, rapid mood swings, excessive sensitivity to light and sound, extreme anxiety, fear of dying, feelings like something is crawling on or under the skin, and overstimulation. Someone experiencing DTs can be a danger to themselves and others—using an ambulance to get them to the hospital is ideal because EMTs are trained to deal with such issues.
The physical symptoms of DTs are even more serious and can quickly become life-threatening. They include irregular heartbeat, seizures, powerful tremors, heavy sweating, very excessive sleeping, fever. There is a sizable risk for heart attack or stroke. It is vital that anyone exhibiting symptoms of Delirium Tremens be taken to a hospital as soon as possible. Without treatment, the mortality rate for DTs increases to 15-35%.
Post-Acute Withdrawal Syndrome
A much longer lasting aspect of withdrawal is called Post-Acute Withdrawal
Syndrome and it may appear after the initial withdrawals, which typically last under two weeks, have gone away. PAWS can last for a few weeks to a year or longer, but it typically peaks from one to two months after quitting. Alcoholics may be tempted to drink due to the unpleasantness of these symptoms, but it’s important to resist because that only sets them up to experience withdrawals again later.
PAWS happens during an important healing process for the brain, where damage is fixed, and neurochemical balances re-established. The standard timeframe used by the recovery community for the brain to be fully healed from drug and alcohol addiction is one year, which also the point by which most or all PAWS symptoms should disappear.
PAWS symptoms can make it harder to get through the day. The psychological symptoms include irritability and anger, emotional outbursts, memory problems, anxiety, and depression. These are often very discouraging for someone who expected to feel better after they quit drinking. It is very helpful to use support groups, to talk to medical professionals, go to AA, etc. so the former drinker can better understand these struggles and get help with them. The ex-drinker is vulnerable to relapse when these longer-term alcohol withdrawal symptoms are strongly affecting them.
The physical symptoms of PAWS include insomnia, which can be severe and very long-lasting, dizziness and increased susceptibility to falls and accidents, delayed reflexes, and low energy. Those experiencing these PAWS symptoms should avoid operating heavy machinery if possible. The insomnia can be treated with sleeping medication, but it may also be resistant to treatment. These difficulties, while longer lasting, are still temporary.