Alcohol withdrawal occurs when one abruptly stops drinking after binging for too much – and for too long. This can be attributed to liquor’s sedating effects on the brain. Too much exposure changes the brain’s chemistry so that it can adapt to the depressing effects of alcohol.
As such, when alcohol intake is discontinued, the brain needs to adjust its wiring again. This process results in the unpleasant withdrawal symptoms, which are categorized in various stages.
~6 Hours After Your Last Drink
Think of it this way: the body has been used to so much alcohol that it continues to produce excessive amounts of hormones – even when there are no more alcoholic effects to counteract. This is the definition of nervous system ‘excitation.’
This excitation is not a good thing as it can lead to the following minor withdrawal symptoms, which can occur in as short as 6 hours after you stop drinking:
- Tremors
- Sweating
- Increased heart rate
- Fast breathing
- Headache
- Anxiety
- Increased alertness
- Nightmares
- Nausea or vomiting
In some cases, a more severe form of alcohol withdrawal can occur within 6 (even up to 48 hours) from the last drink. This is known as alcohol withdrawal seizure, where as much as 6 seizure episodes can take place in as short as 6 hours. This is especially dangerous because according to a study published in the Journal of Industrial Psychiatry, it can lead to Delirium Tremens. This severe form of alcohol withdrawal will be discussed at length below.
12 to 24 Hours After Your Last Drink
Alcohol hallucinosis is a severe form of alcohol withdrawal that can occur in 1-2 days after a person’s last drink. However, a study has also shown that it can occur in as little as 2 hours after abstinence. Due to an uncontrolled spike in Dopamine levels, hallucinations – whether by sight, touch, or hearing – take place. Such scary hallucinatory events can last by as much as 2 days.
Alcohol hallucinosis commonly occurs in people in their 40s or 50s. This supports the scientific hypothesis that more severe symptoms occur in people with long histories of alcoholism.
If left untreated, alcoholic hallucinosis may lead to Delirium Tremens. This disease progression is seen in approximately 5% of alcohol abusers.
24 to 48 Hours After Your Last Drink
Minor withdrawal symptoms usually persist a day or two after you stop taking alcohol. Although this is the case, episodes usually taper down after four to five days. There is no need for specialized therapy as minor symptoms are usually self-limiting. However, someone needs to look after a person in withdrawal to see if he’s getting better or worse.
48 to 72 Hours After Your Last Drink
Delirium Tremens is a severe form of alcohol withdrawal that usually occurs 48 to 72 after the last alcohol drink. Its features, however, may be delayed by as much as 7 days.
The lack of alcohol – whence it used to have many – forces the nervous system to rewire again. Such leads to mental and circulatory problems, such as:
- Profound Confusion
- Agitation
- Disorientation
- Hallucinations
- Fever
- High Blood Pressure
- Excessive sweating
- Increased heart rate
The symptoms usually peak four to five days after the last alcohol intake. The condition might continue for as long as 2 weeks.
It is suggested that those who abuse alcohol longer tend to suffer from more severe forms of withdrawal, such as Delirium Tremens. Other risk factors include a previous history of hallucinations or other severe symptoms, advanced age, other medical conditions, dehydration, low sodium or potassium levels, low platelet count, or presence of brain lesions.
Harvard Health Publishing states that approximately 1 out of 20 die from Delirium Tremens if symptoms are left untreated. Because of the mortality rate associated with this condition, Delirium Tremens is categorized as a medical emergency.
Post-Acute Withdrawal Syndrome (PAWS)
Also known as protracted withdrawal syndrome, PAWS occurs weeks or months after alcohol abstinence. According to the Semel Institute for Neuroscience and Human Behavior, as much as 75% of alcoholics develop PAWS. This onset is attributed to alcohol’s lasting effects on the brain – specifically how it changes the neurotransmitter levels in the brain.
Symptoms include anxiety, panic, depression, irritability, cognitive difficulties, sleep disturbances, and pessimism, to name a few. PAWS sufferers liken the feeling to a ‘roller coaster ride’ – one time you’re up, the other time you are down.
While PAWS is relatively temporary, the unpleasant symptoms can encourage relapse. This is why it is particularly important to monitor individuals who have just recovered from alcohol withdrawal.
Alcohol Withdrawal Treatment
In severe cases such as alcohol hallucinosis, withdrawal seizures or Delirium Tremens, admission is usually recommended. Treating the symptoms is the main focus of confinement. Interventions include the following:
- Provision of a safe and quiet environment
- Placement of restraints, which are removed once sedation is achieved
- Benzodiazepines (Diazepam or Lorazepam) to manage agitation and prevent progression to more severe symptoms
- Intravenous fluid infusion with multivitamins, folate, and thiamine (Banana Bag)
- Supplementation with vitamins and minerals
Treatment does not stop here though. Evaluation and follow-up are also done to support outpatient treatment/therapy and eventual abstinence from alcoholism.
How to Prevent Alcohol Withdrawal
According to the Royal College of London’s Alcohol Use Disorders Manual, alcoholics are advised to avoid a sudden reduction in alcohol consumption due to the possibility of severe withdrawal symptoms.
However, the best way is still to address alcoholism problems while they are just beginning. This is specifically the case for those who have a family history of alcohol abuse, as they are most likely to develop alcoholism. This also puts them at a greater risk of suffering from severe alcohol withdrawal symptoms.
The Bottom Line
Alcohol withdrawal occurs in people who dramatically cut their alcohol intake after increased consumption for a long time. Symptoms range from mild to severe – including seizures, hallucinations, and Delirium Tremens. While these conditions are unavoidable – especially in heavy drinkers – they can be managed with medications and nutritional support, all done in a safe environment.
Avoiding the sudden decrease in alcohol intake is the key to prevention. However, the best way to avoid the unpleasant symptoms of withdrawal is to address the underlying issues of alcoholism.
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