Alcohol Withdrawal: Symptoms, Timeline & Treatment

Instructor: Yolanda Williams

Yolanda has taught college Psychology and Ethics, and has a doctorate of philosophy in counselor education and supervision.

Alcohol withdrawal syndrome is a potentially deadly condition caused by stopping drinking after a prolonged period of heavy alcohol use. Learn more about alcohol withdrawal syndrome, its symptoms, timeline, and treatment.

Introduction and Definition

Tommy is an alcoholic. Every day he drinks at least a fifth of bourbon after work. After getting into a car accident and losing his license, Tommy decides that it is time to stop drinking. He gets rid of all the liquor in his house and quits cold turkey. About five hours after his last drink, Tommy notices that he cannot keep any food down and feels queasy. His hands are shaky, and he is sweaty. Seven hours later, Tommy starts seeing pictures float across the walls. He knows that these are hallucinations and are not real, but they still disturb him. One day after his last drink, Tommy has a seizure. Worried about his health, Tommy goes to the ER. The doctor tells Tommy that he is suffering from alcohol withdrawal syndrome. Tommy is immediately placed in an inpatient treatment center where he can be monitored.

_Alcohol withdrawal syndrome is a condition that occurs in individuals who either discontinue or significantly lower the amount of alcohol that they drink after being heavy drinkers for a long period of time (i.e. weeks, months, or years). When a person who is a heavy drinker suddenly stops drinking, it causes a sudden decrease in blood alcohol levels. This causes the central nervous system to become hyper-excitable, which results in the symptoms associated with alcohol withdrawal. The higher amount of alcohol you drink on a regular basis, the higher your chances are of developing alcohol withdrawal syndrome once you decide to quit drinking.

Symptoms and Timeline

The symptoms of alcohol withdrawal can start two hours after a person has his/her last drink, and can continue for weeks. Symptoms can range from mild (i.e. shaky hands and sweating) to severe (i.e. seizures and delirium). To better understand the symptoms of alcohol withdrawal syndrome, we will look at them as they occur in a timeline.

Five to Twelve Hours

Mild symptoms of alcohol withdrawal usually start about five to twelve hours after the person has the last drink. In Tommy's case, symptoms started five hours after he stopped drinking and included tremors in the hand, sweating, and stomach problems, such as nausea and vomiting. Other symptoms include rapid heartbeat, high blood pressure, mild anxiety, nightmares, night terrors, headaches, confusion, trouble sleeping, and rapid breathing.

Twelve to Twenty-Four Hours

Twelve hours after he stopped drinking, Tommy began to have visual hallucinations. Not all individuals in alcohol withdrawal will experience hallucinations. For those who do have them, hallucinations begin about twelve to twenty-four hours after the last drink. Hallucinations can be visual (seeing pictures float on the wall), auditory (hearing voices) or tactile (feeling that there are spiders crawling on your body). This condition is referred to as alcoholic hallucinosis. Most people who experience alcoholic hallucinosis know that the hallucinations are not real.

One to Two Days

Withdrawal seizures kick in after about one to two days after taking the last drink, though some people experience them as soon as two hours after they stop drinking. Those who have previously experienced detoxification are more likely to experience withdrawal seizures.

Two to Three Days

Delirium tremens occur in about one out of twenty people who experience alcohol withdrawal syndrome. It starts about forty-eight to seventy-two hours after the last drink and usually reaches its peak about four to five days after a person has quit drinking. Symptoms of delirium tremens include confusion, severe anxiety, agitation, seizures, irregular heartbeat, excessive shaking, fever, elevated blood pressure, and hallucinations. The hallucinations associated with delirium tremens are primarily visual and unlike alcoholic hallucinosis, delirium tremens hallucinations are not easily separated from reality. Individuals who have previously had withdrawal seizures or delirium tremens, acute mental illness, liver problems, and advanced age are at an increased risk for delirium tremens. Other symptoms that occur during this time include vivid night terrors, panic attacks, and excessive sweating.

Treatment

The goals of alcohol withdrawal syndrome treatment are to decrease the symptoms of alcohol withdrawal, prevent complications that may arise as a result of alcohol withdrawal, and help maintain alcohol abstinence.

When the symptoms of alcohol withdrawal syndrome are mild, an outpatient setting (i.e. an outpatient alcohol treatment center) may be preferred. Outpatient settings generally require you to have someone who will support you and stay with you throughout the withdrawal process. You will also be required to visit your health care provider on a daily basis.

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