Medically reviewed by Dr Iqbal Mohiuddin MBBS BSc, PGCME Alcohol use disorder is a serious and increasing problem in society. To stop drinking alcohol when you suffer from alcoholism, it’s likely you will experience withdrawal symptoms. The unpleasant sensations that commonly occur during the withdrawal period can entail a struggle, making it ultimately more difficult to stop reverting to alcohol use.
Alcohol use disorder means you will have little control over your behaviour. In many different cases, one might struggle with withdrawal symptoms, depending on your level of addiction of course.
Alcohol Withdrawal Syndrome (AWS) is when a heavy drinker abruptly stops drinking. It will impact someone both physically and mentally. Depending on the level of addiction, you might suffer from things like mild anxiety or things like delirium Tremens, which is a serious condition.
At Rehab 4 Addiction, we are able to signpost you to a variety of organisations offering a medicated alcohol detox. This includes NHS treatment taking place at your local hospital, as well as private detox providers. All treatment providers are either Care Quality Commission (CQC) or Care Inspectorate regulated facilities. All treatment providers adhere to the National Institute for Health and Care Excellence (NICE) guidelines.
Alcohol withdrawal occurs when someone suffering from alcohol use disorder suddenly stops drinking, resulting in symptoms that range from mild to severe during detoxification. In cases of severe long-term alcohol use disorder, it may be fatal. Withdrawal is most common in adults but can also occur in teenagers or children.
While a night of drinking may produce similar initial symptoms, alcohol withdrawal syndrome typically stems from heavy drinking over a long period of time. For some, drinking for months or even weeks then stopping abruptly can cause acute alcohol withdrawal symptoms. For others, years of alcohol abuse can trigger more serious side effects.
Alcohol withdrawal symptoms occur in response to altering neurotransmitters in the brain. When a person drinks, the relaxed, friendly feelings alcohol inspires is actually due to the brain increasing the amount of its chief inhibitory neurotransmitter known as gamma-Aminobutyric acid (GABA). GABA is the neurotransmitter that blocks specific signals in the nervous system, slowing down the brain.
Continuously depressing the central nervous system and altering brain chemistry with alcohol abuse creates a dependency on the substance to feel good again. In addition, over time, someone suffering with alcohol use disorder will need more drinks in one sitting to feel the desired effects, worsening the outcome on their body.
Alcohol withdrawal symptoms are caused by an alteration in this gamma-aminobutyric acid (GABA) receptors. GABA receptors are responsible for maintaining baseline levels in the central nervous system (CNS).
Heavy alcohol use numbs these receptors, which is why those suffering from alcohol use disorder need to consume more drinks over time to feel its effects. When these receptors are numbed, the brain accommodates by shutting down the GABA receptors, leading to CNS over-excitability.
The CNS over-excitability results from the brain’s attempt to maintain equilibrium in the system. Therefore, when heavy alcohol users suddenly cease or slow drinking, the “new” CNS baseline is much higher than normal.
Alcohol withdrawal can be dangerous if you have preexisting conditions like seizures or mental health issues, or if you have previously suffered from alcohol abuse and tried to detox. Withdrawal can be fatal or dangerous for others in cases of mental instability and delirium. It’s thus essential to undergo detox under medically supervised conditions, rather than at home without these safeguards.
The suitability of a home-based detox is determined after an assessent. You must generally be drinking less than 30 units of alcohol per day in order to qualify for a home alcohol detox. The psychiatrist can give you some useful strategies to cut down the amount of alcohol you are drinking so you can begin a home detox.
In many situations, a home-based detox may be a suitable choice.
When an addict decides to go into recovery, the body does not immediately know how to respond to the chemical imbalance. Through years of alcohol dependency, the brain naturally stops producing normal levels of GABA and patients suffering from alcohol withdrawal often feel anxious, shaky and sick.
During the uncomfortable process, doctors may prescribe medications to reduce symptom severity.
Severe and long-term heavy drinkers force their bodies to build a ‘homeostasis’ state, and when alcohol is removed the balance is extremely upset. There are a number of serious and extreme physical sensations that could increase the risk of fatality.
In some cases, improperly handling the detoxification stage can prove fatal, so long-term sufferers of alcohol use disorder should always seek medical help during the process.
Below we have listed the main types of severe withdrawal symptoms which if left untreated could result in death:
It is possible to die from alcohol withdrawal especially if you have a history of epilepsy. Withdrawal delirium can also cause people to inflict self-harm. Other medical conditions associated with alcohol abuse (liver disease, Wernicke-Korsakoff syndrome, gut issues) may cause life-threatening complications for alcohol withdrawal patients.
According to current research, of all patients who are hospitalised and experience withdrawal delirium, less than 4% die. These fatalities are normally due to:
Many alcohol dependents will come across many mental health symptoms during their withdrawal stage. Depression, anxiety, and irritability are some of the most common. However, these are underlying issues most of the time that could have driven one to drink.
A lot of people who have been suffering from anxiety and depression self-medicate with alcohol, which could cause a vicious cycle to happen.
Drinking alcohol might help someone with depression or anxiety in the short term, but binge drinking will lower the serotonin levels in your brain after a few hours, which regulates the feeling of happiness in your brain.
You would feel even worse the next day, and it would push you to drink more, which in turn would exacerbate your mental health issue. After a period of prolonged drinking, your serotonin levels would be at a very low point, which they could develop into clinical depression.
Restlessness and insomnia are some of the other well-known withdrawal symptoms. There are many reasons why one could suffer from insomnia during withdrawal. It might be a direct result of the depression caused by the lack of serotonin in your brain. Many people with depression will struggle with sleeping.
Not only will alcohol lower your serotonin levels, but also that of another chemical in your brain, dopamine. Dopamine is linked to your motivation levels and reinforcing pleasure.
A well-known and frequently documented alcohol withdrawal symptom is what is colloquially called ‘the shakes,’ which is a physical sensation that many who suffer from alcohol use disorder or abuse experience.
The ‘shakes’ are a type of body tremor that cannot be controlled, and they vary in severity from person to person depending on the amount of alcohol consumed, the period of time, and the general health of those suffering from alcohol use disorder.
As a physical symptom that occurs as alcohol is being detoxed through the body, the ‘shakes’ do generally disappear once the withdrawal process is complete.
However, as a sign of stress on the central nervous system, the shakes can become worse if the individual is experiencing high flying emotions or post-alcohol related anxiety.
It is therefore important to remember that those who are anxious about detox and withdrawal, trembling could increase and appear worse.
Shaking will also occur because alcohol abuse has damaged your nerve cells. Alcohol is considered a depressant, by reducing activities in your brain.
Your brain becomes gradually more used to that consistent low level of stimulation as one maintains heavy or frequent drinking.
Once you stop drinking, your brain gets stimulated with more activity than it is ready for. Your nervous system feels overwhelmed, and hyperactivity symptoms like shaking and tremors as a result.
Other withdrawal symptoms are night sweats. This is because the alcohol is being broken down through sweating in your body. Only 10 per cent of the alcohol in your body goes out through your urine.
The rest will be broken down through metabolism working throughout your body. Therefore, after stopping drinking, your body will try and push and sweat all the alcohol out of the body.
Acute Alcohol Withdrawal refers to the common physical symptoms those recovering from alcohol use disorder experience in the first few weeks after abstaining from alcohol. While some symptoms cause discomfort, others can have serious consequences.
The symptoms of acute alcohol withdrawal include:
NICE Guidelines advise that a home-based detox is only recommendable if you are drinking less than 30 units of alcohol per day. This equates to a one-litre bottle of vodka.
If you are drinking more than this amount, then you will be advised to undergo detox at a residential rehab clinic. It’s also possible to taper the amount you drink per day to below 30 units, and then you will be able to undertake a home detox.
If you drink more than 30 units of alcohol per day, then the risks of suffering from life-threatening withdrawal symptoms is more of a risk. For instance, delirium tremens. This is a serious condition, and the symptoms are all of the above, but much worse.
You could possibly die if you decide to suddenly withdraw from alcohol, due to seizure or cardiac arrest. We advise you to find a rehabilitation clinic and do this under the supervision of health professionals, particularly where you are drinking more than 30 units of alcohol per day.
Eventually, withdrawal symptoms worsen with alcohol abuse and detoxification will require an intervention. In cases where symptoms are already advanced, not seeking medical attention can lead to serious complications and even be fatal.
Recovery, once the detoxification period is complete, should not be handled alone. According to a study conducted by the National Library of Medicine, those in recovery who tried to recover on their own displayed unhealthy coping mechanisms that meant they were less likely to reach three years of being sober.
These people were more prone to relapse within 16 years, more so than those recovering from alcohol use disorder who enlisted in outpatient therapy, 12-step programmes, or other counselling.
For more information on inpatient facilities to treat alcoholism, head over to our private rehab clinics page where you will find all you need to know about registering.
The timeline can differ per person. There are many people who could take a while before they feel normal again. Some people will only have symptoms for a few days. This varies per person, but those suffering from alcohol use disorder may experience the below:
One might suffer from mild symptoms like insomnia, anxiety, foggy thinking, abdominal pain, vomiting, no appetite, nausea, fatigue, depression, tremors, heart palpitations, and mood swings.
Most withdrawal symptoms will be; increase in blood pressure, an increase in body temperature/ respiration, an irregular heart rate, cognitive confusion, irritability, sweating, and disturbing moods.
Hallucinations, seizures, fever, agitation, and confusion.
After 3-5 days, most of the alcohol withdrawal symptoms should be gone. If you would like to read more information on how to get help for alcohol detox and rehab, visit our homepage.
Alternatively, you can make an appointment with your GP, who can help you find a free clinic if you cannot afford one.
PAWS refers to Post-Acute Withdrawal Symptoms. Typically, alcohol withdrawal symptoms subside after the first two weeks of abstinence. However, some patients suffer from PAWS for the first year of their recovery.
During this time, Post-Acute Withdrawal patients may experience symptoms like mood swings, lack of energy and motivation, memory issues, balance problems, delayed reflexes, regular nausea and depression. Symptoms typically come in waves, lasting days at a time.
Extended treatment is especially important for patients experiencing PAWS because they are more likely to relapse during the first year as symptoms seem never-ending. However, if patients continue to abstain, symptoms typically reduce and disappear over time.
When diagnosing alcohol withdrawal, doctors start by observing a patient’s appearance and asking questions about their medical history and alcohol consumption.
A toxicology screening with blood and urine tests is also common to determine the amount of alcohol in a patient’s system. After conducting basic tests, doctors often consult the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) to determine a patient’s score and thus the severity of their withdrawal symptoms.
Your doctor may check for physical symptoms of withdrawal like an irregular heartbeat or dehydration and you may receive a toxicology screen to diagnose the amount of alcohol in your body.
The CIWA measures ten key symptoms are:
The Clinical Institute Withdrawal Assessment for Alcohol questions patients about various symptoms including nausea and vomiting, tremors, paroxysmal sweats, anxiety, tactile disturbances, auditory disturbances, visual disturbances, headache and fullness in head, agitation and orientation or clouding of sensorium.
Each category has up to seven options available to describe the symptom prevalence and severity.
A score of 67 is considered the most severe case of alcohol withdrawal, while a score over 20 is considered a severe case where Delirium Tremens becomes possible.
Scores from 16 to 20 are considered moderate level symptoms and scores from 10 to 15 constitute mild symptoms. The test explains scores under 10 typically do not need medications to assist with recovery. [3]
If you have suffered from alcohol use disorder for years, it will take time to see results. The frontal lobe begins to repair itself, and this takes time.
Next, dopamine receptors in your brain will return to normal and no longer fire when you consume alcohol. This makes room for new enjoyable activities in your life, increasing your motivation to maintain a healthy lifestyle.
Eliminating alcohol will normalise serotonin production as well. Serotonin is the chemical responsible for feelings of happiness. Finally, you will learn to adopt new skills and habits in lieu of alcoholism. You can find time to take up new hobbies, gain more knowledge for work, and meet new people.
Patients experiencing minor to moderate alcohol withdrawal symptoms can typically manage symptoms by rehydrating and avoiding high sensory outputs like loud sounds and bright lights. They may also benefit from a sedative prescription to better handle this stressful period.
Patients suffering from strong to severe alcohol withdrawal symptoms should consider further treatment options to ensure a safe and lasting recovery.
These include undergoing a residential treatment programme, working with a specialist to develop a medication-assisted therapy strategy, seeking additional outpatient centres and counselling programmes and possibly moving to a sober living community.
Below we have listed the five most common and efficient treatments for alcohol withdrawal and detox:
Each of our rehab facilities follows the same high standard of care when it comes to treating alcoholism. We offer all-round packages to combat every aspect of your recovery and needs. These include:
Whilst alcohol detox is about purging alcohol from the body, rehabilitation addresses complex psychological and emotional issues giving rise to addiction.
Psychological problems include post-traumatic stress disorder, various anxieties, depression and often latent psychological trauma experienced in childhood. Whilst physical detox may only take 5 to 7 days to complete, psychological recovery lasts for an entire lifetime.
Before alcohol detox is attempted, a ‘substance abuse’ profile and history are drawn up by our admissions team. We may require, with your consent, access to medical records and any other relevant documentation. This may include documents concerning previous attempts at engaging residential or outpatient rehabilitation.
Our alcohol detox programme is open to anyone over the age of 16. All we ask is for your complete commitment to getting and staying sober. If you are not committed to this process your personalised rehabilitation programme is unlikely to succeed and your investment in the process may result in nothing.
When you enter our detox programme you are under 24-hour a day observation by our team of medical experts. You receive support and attention required to make a full recovery.
Rehabilitation centres we refer you to maintain an on-site pharmacy so medications are available on a prescribed basis. Such drugs are capable of fighting off severe withdrawal symptoms such as delirium tremens, seizures, nausea and hallucinations common during alcohol detox.
Following detox, a number of therapies are provided, such as; group therapy, individual therapy and cognitive behavioural therapy. Our commitment to providing effective therapies after detox means you leave the centre with much-needed coping strategies to fight off relapse.
Once treatment is complete, our staff put in place a structured relapse prevention plan including outpatient and community support.
This plan typically includes the involvement of your local Alcoholics Anonymous group or SMART Recovery.
Throughout the detox and rehabilitation process, you will receive meals rich in vitamins and minerals. The food we provide is high in nutrients as this is believed to aid the detox process.
Our detox programme takes place in tranquil settings conducive to relaxation and learning. This means you are in an optimal emotional and psychological state which in turn will help you face the darker side of withdrawal symptoms from a position of strength rather than weakness.
While alcohol withdrawal is serious, it is not something to be afraid of. Learning about alcohol’s harmful effects, choosing to undergo treatment and finding a supportive network allows patients to recover with the resources they need.
In addition to the resources and treatment options above, those recovering from alcohol use disorder should also seek healthier lifestyle choices like a nutritious diet and exercise plan including stress-relieving activities like yoga. In addition to restoring self-connection, these healthier habits can bring those recovering from alcohol abuse disorder a sense of happiness and purpose.
You are not alone in this process and while rehab and detox can appear intimidating or unattainable, it is important to remember that you will be surrounded by a supportive and empathic community, whichever treatment plan you choose.
[2] https://www.ncbi.nlm.nih.gov/books/NBK482134/
[3] https://umem.org/files/uploads/1104212257_CIWA-Ar.pdf
This article was reviewed by Boris MacKay. Boris is our editor-in-chief at Rehab 4 Addiction. He also covers a variety of topics relating to addiction and recovery. Boris is an addiction therapist and assists in the alcohol detox process.
