Signs Of Alcohol Withdrawal

    When an individual stops drinking alcohol suddenly or cuts back on their total intake, the resulting signs and symptoms experienced are termed alcohol withdrawal syndrome. Heavy drinkers experience alcohol withdrawal symptoms if they:

    • Stop drinking suddenly
    • Cut back on alcohol consumption too quickly
    •  Do not eat properly while cutting back on alcohol
    • Become sick, contract an infection, experience a head injury
    • Have undergone surgery 

    The prevalence of alcohol withdrawal is about 20% in inpatients and 40% of hospital emergency admissions.

    Alcohol suppresses brain activity and instills a feeling of relaxation. That is why when a heavy drinker suddenly stops alcohol consumption, the nerve cells in the brain fire repeatedly and cause the symptoms known as alcohol withdrawal syndrome.

    The signs of alcohol withdrawal are physical and emotional. They occur approximately six hours after the last drink, and can reach their peak intensity in about 72-hours; these withdrawal symptoms can subside within a week. The severity of alcohol withdrawal signs ranges from mild to severe.

    The symptoms of alcohol withdrawal have their origin in the central nervous system. The brain cells get dependent on alcohol and upon withdrawal, there is a decrease in response from the GABA receptors

    The severity of the condition varies and is dictated by factors like:

    • The extent of alcohol intake (amount and frequency)
    • The duration of alcohol dependence
    • Any previous history of alcohol dependence

    The symptoms are grouped as:

    1. Alcohol withdrawal hallucinosis

    Hallucinations are sensory perceptions experienced by a person that is not real. These may be in the form of visions, voices, touch sensations like bugs crawling on the body, etc.

    The hallucinations associated with alcohol withdrawal are temporary and usually subside as the treatment continues.

    1. Seizure associated with withdrawal

    Seizure activity may or may not accompany the withdrawal symptoms. About 2-5% of individuals experience seizure activity.  They may occur as a single occurrence or multiple minor seizures within forty-eight hours of alcohol cessation. Some people may experience seizures within the first week of alcohol abstinence.

    The term Kindling Effect describes the seizure activity in patients with a previous history of alcohol detoxification. Every withdrawal episode irritates the brain cells. Every time an attempt is made at detox lowers the threshold for seizure activity. This means that every new attempt at alcohol detox raises the risk of seizure attack happening in less time.

    1. Delirium Tremens

    This is the most severe of all symptoms experienced during alcohol withdrawal. These usually occur within three days to a week of alcohol abstinence.

    • A state of agitation or irritability
    • General anxiety marked by periods of excitement
    • Confusion and restlessness
    • Delirium or when the mind is highly disturbed, confused thinking and a reduced awareness of the surroundings
    • Delusions or believing something opposite to reality
    • Problems with eye and muscle movements
    • Fear and apprehension of the unknown
    • Hallucinations or sensory experiences that are not real
    • Increased heart rate or breathing rate
    • A hyper response to unexpected stimuli, also called an increased startle reflex
    • Involuntary muscle contractions
    • Seizures
    • Chest pain
    • Excessive sweating
    • Fatigue and lethargy
    • Nausea
    • Fever
    • Stomach pain
    • Nightmares
    • Sensitivity to light, sound, or touch
    • Sudden mood changes

    Diagnosis Of Alcohol Withdrawal

    According to the Clinical Institute Withdrawal Assessment of Alcohol criteria, the doctor would look and ask for certain signs and symptoms to diagnose the condition. These include:

    • Agitation
    • Anxiety
    • Auditory disturbances (hallucinations)
    • Inability to think clearly and lack of rationale
    • Headaches
    • Nausea and vomiting
    • Uncontrollable episodes of sudden sweats
    • Tactile disturbances (for example something is crawling on the skin)
    • Tremors (involuntary shaking of the body or hands)
    • Visual disturbances

    The doctor will also check for:

    • Fever
    • Dehydration
    • Irregular heartbeat
    • Hand tremors

    The Timeline Of Alcohol Withdrawal Symptoms

    The timeline depends on the:

    • Time and duration of previous alcohol consumption
    • Number and severity of prior withdrawal attempts

    The symptoms may appear as early as two hours after stopping alcohol intake. Since the onset is so rapid, it is advised to:

    • Pre-plan hospital admission
    • Access to emergency treatment at hand
    • Undertake alcohol abstinence in consultation with a doctor

    It is possible to plan a detox process because the timeline is often predictable.

    Phase 1 

    It usually lasts 6-12 hours after the last drink.

    • Loss of appetite
    • Nausea
    • Sweating
    • Headache
    • Anxiety
    • Shaking of the body
    • Sleep disturbance as insomnia
    • Irregular heartbeat with palpitations

    Phase 2

    Significant and severe symptoms develop over the next 12 to 24-hours. These include confusion, hallucinations, tremor, irritability and agitation.

    Phase 3

    This stage lasts 24 to 48 hours after the last drink. Any seizure activity usually occurs in this stage. The onset of seizures may be early in cases of kindling effect with repeated attempts at quitting alcohol. The rest of the symptoms from earlier phases subside or lessen in severity.

    Phase 4

    The withdrawal symptoms delirium tremens occupy this stage that lasts 48 to 72 hours after the last drink. They reach their peak in about five days, after which they start regressing and disappear by the end of the second week of alcohol stoppage. Fever and high blood pressure levels accompany severe confusion, hallucinations, seizures.


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