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Alcohol Withdrawal Syndrome: Symptoms, Stages, and Treatment

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Written by Ankith Sagar

Deciding to overcome alcohol addiction is a positive step towards better overall health. This journey, while at times overwhelming, will lead to a happier and more fulfilled life. At Anunitha, understanding the entire process beforehand goes a long way in ensuring de-addiction.

Based on the severity of your addiction, going through this the right way becomes crucial in mitigating the sometimes fatal effects of Alcohol Withdrawal Syndrome. 

What is Alcohol Withdrawal Syndrome?

Alcohol withdrawal syndrome (AWS) is the name for the symptoms that occur when a heavy drinker suddenly stops or significantly reduces their alcohol intake.

These symptoms begin to surface anywhere between 6 hours to a few days after your last drink and continue to affect you for weeks. 

The Science Behind Alcohol Withdrawal Symptoms

The science behind alcohol withdrawal symptoms can be summarized as follows:

  1. Neurotransmitter Imbalance: Alcohol affects neurotransmitters in the brain, particularly gamma-aminobutyric acid (GABA) and dopamine. GABA is tied to relaxation, while dopamine is linked to the body's reward system, energy, enjoyment, and motivation.
  2. GABA Imbalance: Chronic alcohol use causes an imbalance in GABA, which the brain becomes accustomed to. This leads to disrupted neurotransmitter production when alcohol use ends, resulting in withdrawal symptoms.
  3. Dopamine Disruption: Excessive alcohol use also affects dopamine levels. The brain becomes dependent on alcohol for feel-good neurotransmitters. When alcohol consumption stops, dopamine production halts, leading to both physical and psychological withdrawal symptoms.
  4. Central Nervous System Effects: Alcohol is a Central Nervous System (CNS) depressant. Prolonged and excessive consumption interferes with the brain's natural functions and disrupts neurotransmitters that send messages to the CNS.
  5. Physical Dependence: Alcohol withdrawal is a result of physical dependence. When the body and brain require alcohol to function normally, the absence of alcohol triggers withdrawal symptoms.
  6. Withdrawal as a Detoxification Process: Withdrawal symptoms occur during detox, a natural process where the body works to remove toxins and reach a new equilibrium.
  7. Psychological Impact: The change in neurotransmitter activity, particularly GABA, leads to increased anxiety, irritability, and agitation during withdrawal.

These points highlight the complex interplay between alcohol and brain chemistry, explaining why withdrawal symptoms occur and their varied nature.

Symptoms of Alcohol Withdrawal

Alcohol withdrawal symptoms can vary widely in their severity, depending on factors such as the duration and intensity of alcohol use, individual health status, and previous history of withdrawals. These symptoms can start as early as a few hours after the last drink and may last for weeks. They are typically categorized into mild, moderate, and severe symptoms.

Mild Symptoms

  • Anxiety or nervousness
  • Insomnia or difficulty sleeping
  • Nausea or vomiting
  • Tremors (shakiness)
  • Sweating
  • Increased heart rate
  • Headache
  • Loss of appetite

Moderate Symptoms

  • Increased tremors
  • Confusion or clouded thinking
  • Mood swings or irritability
  • Increased blood pressure
  • Rapid heart rate
  • Mild hyperthermia (elevated body temperature)

Severe Symptoms (Delirium Tremens - DTs)

  • Hallucinations (seeing, feeling, or hearing things that aren't there)
  • Severe confusion or disorientation
  • Seizures
  • High fever
  • Severe agitation or anxiety
  • Profound sweating

Additional Considerations

  • Affective Symptoms: Depression and anxiety can be both a cause and a symptom of alcohol withdrawal, complicating the withdrawal process.
  • Autonomic Hyperactivity: Symptoms like sweating, rapid heartbeat, and elevated blood pressure indicate the body's heightened stress response.
  • Sleep Disturbances: Alcohol withdrawal often disrupts sleep patterns, leading to difficulties in both falling and staying asleep.

Stages of Alcohol Withdrawal Syndrome?

Relatively mild symptoms are observed 6-12 hours after the last drink. The symptoms of early withdrawal include headache, mild anxiety, insomnia, small tremors, and stomach upset.

By 24 hours, some people may begin to experience visual, auditory, or tactile hallucinations.

Within 24-72 hours, various symptoms may have peaked and begun to level off or resolve (though some more protracted symptoms may stick around for weeks or longer).

Seizure risks may be highest from 24 to 48 hours after the last drink, requiring close monitoring and seizure prophylaxis. 

Withdrawal delirium (i.e., DTs) may appear from 48 to 72 hours after the last drink.

While these stages are similar for most people, the severity of the addiction dictates how bad withdrawal symptoms can get.

Remember, while most of you may not experience some or most of these symptoms, medical professionals have treatment options for all of them. 

To read more about the symptoms of AWS, you can refer to our blog on Alcohol Withdrawal and Detox. 

What is Post-Acute Withdrawal Syndrome (PAWS)?

Post-acute withdrawal Syndrome (PAWS) refers to a set of persistent withdrawal symptoms that occur after the initial acute withdrawal phase from substances like alcohol. Here's a brief explanation:

  • Duration: PAWS can last for several months or even years after the acute withdrawal phase has ended.
  • periods of relative comfort followed by episodes where symptoms reappear.
  • Impact on Recovery: PAWS can be challenging for individuals in recovery, as the ongoing symptoms can affect daily functioning and increase the risk of relapse.
  • Management: Managing PAWS typically involves long-term support, which can include therapy, support groups, and sometimes medication. Lifestyle changes like regular exercise, a healthy diet, and stress management techniques are also beneficial.
  • Symptoms: Unlike the acute phase, which is primarily physical, PAWS symptoms are often psychological and emotional. They can include mood swings, anxiety, irritability, sleep disturbances, reduced concentration, and cravings for the substance.
  • Intermittent Nature: PAWS symptoms can come and go. Individuals might experience 

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How Is Alcohol Withdrawal Diagnosed?

Alcohol withdrawal is diagnosed through a combination of clinical assessment, patient history, and observation of symptoms. Here's how the process typically unfolds:

  • Patient History and Interview: Healthcare professionals start by gathering detailed information about the individual's drinking habits, including the duration and quantity of alcohol consumption. They also inquire about any past experiences with withdrawal.
  • Observation of Symptoms: The presence of typical withdrawal symptoms following the cessation or reduction of alcohol intake is a key indicator. These symptoms can include tremors, sweating, nausea, anxiety, and agitation.
  • Physical Examination: A physical exam may be conducted to assess overall health and to identify any physical signs of alcohol abuse or withdrawal, such as liver problems or other alcohol-related health issues.
  • Use of Assessment Tools: Tools like the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale are often used. This scale helps quantify the severity of withdrawal symptoms and guides treatment decisions.
  • Laboratory Tests: Blood tests may be performed to check for alcohol and other substances in the system, as well as to assess overall liver function and nutritional status.
  • Evaluation for Co-occurring Disorders: Since alcohol use disorder often coexists with other mental health conditions, a comprehensive mental health evaluation is usually part of the diagnostic process.
  • Monitoring for Severe Symptoms: In cases where severe withdrawal symptoms like seizures or delirium tremens (DTs) are a concern, close monitoring in a medical setting is necessary.
  • Differential Diagnosis: It's important to rule out other medical conditions that might mimic or complicate withdrawal symptoms.

The diagnosis of alcohol withdrawal is critical for determining the appropriate level of care and treatment, whether it's outpatient support, medically supervised detox, or inpatient treatment.

What are the Treatment Options Available for Alcohol Withdrawal Syndrome?

Unless you have a serious health condition or you've had severe withdrawals in the past, you probably won't need more than a supportive environment to help you through. That includes:

  • A quiet place
  • Soft lighting
  • Limited contact with people
  • A positive, supportive atmosphere
  • Healthy food and lots of fluids

If your blood pressure, pulse, or body temperature rises, or if you have more serious symptoms like seizures and hallucinations, seek medical care immediately. Your doctor could suggest inpatient care and drug treatment.

Common medications include benzodiazepines to help treat symptoms like anxiety, insomnia, and seizures. You might also take anti-seizure meds and antipsychotics, along with other drugs. De-addiction centers like Anunitha are well-equipped to handle all the symptoms of AWS in a safe, controlled environment.

When to Seek Medical Help

It's crucial to seek professional medical help if experiencing symptoms of alcohol withdrawal, especially if severe symptoms or a history of severe withdrawal episodes are present. Medical supervision can significantly reduce the risks associated with withdrawal, such as seizures or delirium tremens, through the use of medication-assisted therapy and supportive care.

Tips to Manage Alcohol Withdrawal Symptoms

We wish we could tell you otherwise, but withdrawal symptoms from severe or even moderate alcohol addiction can be quite overwhelming. This is generally the most unpleasant part of your detoxification process. While we haven't found a way to get rid of them entirely, here are some ways we found to make the journey easier.

  • Hydrate with Electrolytes: Drink fluids rich in electrolytes (like sports drinks) to combat dehydration and nausea.
  • Seek Support: Inform close friends and family of your intention to quit; ask for their support.
  • Remember You're Not Alone: Understand that many have successfully navigated through withdrawal and addiction recovery.
  • Use Cold Showers: Take cold showers to help manage strong urges to drink and alleviate some withdrawal symptoms.
  • Avoid Triggers: Steer clear of situations or activities closely linked to your drinking habits, especially in the early stages.

Prevention of Alcohol Withdrawal Syndrome

To prevent Alcohol Withdrawal Syndrome effectively, it's important to approach the cessation of alcohol consumption with caution and a well-thought-out strategy. Here are some key points to consider:

  • Avoid going "cold turkey" if you've been a heavy drinker due to the risk of severe withdrawal symptoms and potential fatality.
  • Gradually reduce alcohol consumption over several days to allow your body to adjust to lower alcohol levels.
  • Consider substituting high-alcohol content drinks (like spirits) with lower-alcohol options (like beer or wine) to ease the reduction process.
  • Seek medical supervision for medication assistance during withdrawal to manage symptoms safely.
  • Inform close friends or family about your plan to quit; support and understanding are crucial during this time.
  • Avoid individuals or environments that encourage drinking to maintain your commitment to reducing alcohol intake.
  • Gradual reduction is the safest method to prevent Alcohol Withdrawal Syndrome, requiring motivation and self-discipline to adhere to set limits.

Trusting Cadabams Anunitha for Alcohol Dependence Treatment

Cadabams Anunitha stands out with its team of psychiatrists skilled in advanced treatment methodologies like Cognitive Behavioural Therapy (CBT), Interpersonal and Social Rhythm Therapy (IPSRT), and family-focused therapy, proven effective for alcohol dependence. With over two decades of experience in tackling complex alcoholism cases, our expertise is recognized and trusted by healthcare professionals.

Our rehabilitation center, Anunitha, combines a comfortable setting with modern infrastructure to offer holistic treatment plans tailored to individual needs. This personalized approach ensures effective rehabilitation while also equipping families with the necessary tools to support their loved ones' recovery journeys.

For assistance with alcohol treatment in India or in case of alcoholism-related emergencies, reach out to our de-addiction helpline at +91 96111 94949. At Cadabams, we treat our patients with the utmost dignity and sensitivity, acknowledging addiction as a disease, not a weakness. We aim to stay relevant to user search trends and common usage without any derogatory intent. For suggestions on improving our content, please contact us at

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1. What are the First Signs of Alcohol Withdrawal?

The first signs of alcohol withdrawal typically include anxiety, shaky hands, headache, nausea, vomiting, and sweating. These symptoms can start as early as 6 hours after the last drink. Insomnia and mild agitation are also common early signs.

2.  How Long Does Alcohol Withdrawal Last?

The duration of alcohol withdrawal varies from person to person. Generally, symptoms start within 6-24 hours after the last drink and can last up to a week. However, some symptoms, particularly psychological ones like mood swings and cravings, can persist for weeks or months in a condition known as Post-Acute Withdrawal Syndrome (PAWS).

3. Can Alcohol Withdrawal Be Fatal?

Yes, alcohol withdrawal can be fatal, especially if it leads to severe symptoms like seizures or delirium tremens (DTs). DTs can include hallucinations, severe confusion, fever, and high blood pressure, and they require immediate medical attention. The risk of fatal complications underscores the importance of seeking medical supervision during the withdrawal process.

4. What Should I Do If I or Someone I Know Is Experiencing Alcohol Withdrawal?

If you or someone you know is experiencing alcohol withdrawal, it's crucial to seek medical attention immediately. Alcohol withdrawal can be dangerous and requires professional supervision, especially if severe symptoms are present. Contact a healthcare provider, visit an emergency room, or contact a detox center. 

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