Alcohol is the most commonly used drug that exists; most people have had an alcoholic drink in their lifetimes. Although mild to moderate alcohol use isn’t likely to cause dependence, heavy drinking can lead you to develop an alcohol addiction (also referred to as alcohol abuse, alcohol dependence, alcoholism, or alcohol use disorder). And if you have a physical dependence on alcohol, then you’re likely to go through withdrawal if you stop drinking.
Alcohol withdrawal is one of the most dangerous types of withdrawal, and can even cause death in rare cases. Getting the proper treatment is critically important when thinking about walking away from alcohol use, so that you can make sure you’re safe and comfortable. Luckily, all kinds of evidence-based treatments are available to help people start living an alcohol-free life.
What Is Alcohol Withdrawal?
Some substances are physically addictive, which means that our bodies come to depend on them. When we stop ingesting these substances, our bodies go into withdrawal and experience the painful symptoms of detoxifying the substance from the bloodstream. An everyday example of this is caffeine; many of us who are coffee-drinkers know what it feels like to miss our morning cup of joe and find ourselves with a headache during the day.
It’s easy to forget that alcohol is an addictive substance that can have incredibly harmful effects on our physical and mental health. Alcohol withdrawal can be deadly, and often comes with symptoms that are more serious than withdrawing from other drugs, like marijuana or even cocaine. In fact, it’s one of the only drugs that carries with it the serious risk of fatality during the withdrawal period.
If you’ve been drinking heavily or have struggled with alcohol addiction for a long time, it’s common to experience the effects of withdrawal after you stop drinking. It’s crucial to know that you should never try to withdraw from alcohol alone; find a detox or rehab facility that can ensure that you’re safe and comfortable while you’re going through the process of withdrawal.
Why Do People Experience Alcohol Withdrawal?
Alcohol is normalized in our society, but it’s actually a drug that has incredibly harmful effects on our health. Instead of being digested like regular food or drinks, alcohol is quickly absorbed into the bloodstream, which is why it makes us feel so uninhibited when we drink it.
People who take a moderate amount of alcohol into their bodies on the rare occasion aren’t likely to experience symptoms of withdrawal. People who drink heavily over a long period of time, however, become addicted to alcohol—and this addiction literally changes the way their brains work.
Have you ever heard that alcohol is a depressant? What scientists mean by that is that alcohol is a drug that depresses, or holds down, your central nervous system.
When you drink, your brain experiences changes in how two specific neurotransmitters are released: it releases more gamma-Aminobutyric acid (GABA), a chemical that makes you feel calm and euphoric, and less glutamate, which makes you feel excitable and hyper. This is part of what makes you feel “mellow” when you’re drunk.
For heavy drinkers, their brains balance this effect out by releasing less GABA and more glutamate. When they stop drinking suddenly, their brain is suddenly left without that “balancing” force of alcohol—but it takes a while for the brain to catch up. It keeps producing too little GABA and too much glutamate, expecting the alcohol to come in and balance it all out. This makes people going through alcohol withdrawal feel excitable, irritated, shaky, and overstimulated.
If someone’s alcohol addiction is severe, the excitability that this imbalance in neurotransmitters causes can lead to more serious symptoms, like tremors, hallucinations, and even seizures.
Alcohol Withdrawal: Timeline of Symptoms
Your timeline and process of alcohol withdrawal will depend on how much you’ve been drinking and for how long, along with other factors like your weight, what other drugs you’re taking, and how long and how heavily you’ve been drinking.
In general, the physical withdrawal process from alcohol should take less than a week. The following is a general timeline that’s meant to guide you in navigating what you might expect when you quit alcohol. For information that’s specific to your situation, talk to your doctor.
Stage 1: Six Hours After Quitting
You’re likely to experience some mild withdrawal symptoms a few hours after your last drink. Symptoms in this initial stage of withdrawal include:
- Tremors or “the shakes”
- A change in your blood pressure (increase or decrease)
- Sweating
- Rapid breathing
- Vomiting and nausea
- Headaches
- Heightened anxiety
- Irritability
- Insomnia
Although these symptoms are relatively mild and aren’t usually deadly, they are extremely uncomfortable. Many people continue to drink alcohol, even while knowing that alcohol addiction is ruining their life, just to keep these unpleasant withdrawal symptoms at bay.
Stage 2: 12 to 24 Hours After Quitting
About a day after your last drink, you might experience more serious withdrawal symptoms. This includes things like:
- Visual, sensory, or auditory hallucinations (seeing, feeling, or hearing things that aren’t there)
- Mental confusion and foggy thinking
- Possibility of seizures
Only about 3 to 5 percent of people experience serious withdrawal symptoms.
Stage 3: 48 to 72 Hours After Quitting
This is the most severe stage of alcohol withdrawal, and the one that comes with the most serious risks (called “delirium tremens”). Not everyone who withdraws from alcohol will experience these symptoms, but the risks are high. This is why it’s important to be under medical supervision when you are going through withdrawal.
Stage 4: 72 Hours to Several Months After Quitting
You should only get to this stage (called “post-acute withdrawal”) if you don’t receive any treatment for your alcohol withdrawal. Symptoms in this stage of withdrawal include:
- Difficulty sleeping
- Fatigue
- Changes in mood
Again, with proper detox and withdrawal management services, your withdrawal period from alcohol should only last a few days. Most people make a full recovery from alcohol addiction with the right treatment. If you’re finding that you’re still experiencing these types of mental and physical health symptoms even weeks after you’ve quit drinking, talk to your medical provider and ask for help in finding an appropriate treatment program.
Delirium Tremens: When Withdrawal Becomes Fatal
Alcohol withdrawal is unique in that it carries with it the risk of delirium tremens (DT), a serious neurological condition that can be fatal. Around 5 percent of people withdrawing from alcohol suffer from delirium tremens, and this is definitely not a symptom that you should attempt to survive on your own. Most cases of delirium tremens require hospitalization in an intensive care unit to recover.
Delirium tremens is the most serious of the mental and physical effects of withdrawal that some people face. The symptoms include:
- Hallucinations
- Severe confusion
- Seizures
- Cardiovascular collapse
- High blood pressure
- Reduced blood flow to the brain
- Loss of consciousness
- Dehydration
DT is a serious condition, and you can die from it; research shows that 1 in 20 people who get DT end up dying.
DT is specific to withdrawal from alcohol. If you stop drinking abruptly, make sure you detox under medical supervision. Getting proper treatment can lessen your risk of dying from delirium tremens.
Treatment for Alcohol Withdrawal
Thankfully, there is effective treatment available to help make your alcohol withdrawal process as pain-free as possible. Research shows that people who receive appropriate treatment are less likely to relapse down the road of recovery. If you’re thinking about leaving alcohol addiction behind you, make sure you get the necessary treatment.
Detox
It’s important that you don’t try to go through the symptoms of the initial withdrawal period alone. It could be possible that you won’t face any severe withdrawal symptoms, but like we discussed earlier, withdrawing from heavy alcohol use can have serious effects that could become fatal in some cases.
Medically-Supervised Detox
There are medical facilities that are specifically designed to provide qualified supervision for people while they withdraw from alcohol and other drugs. In a medical detox center, physicians are on standby to make sure you’re both safe and comfortable as you’re going through this process.
Remember, delirium tremens is a risk associated with alcohol withdrawal that can lead to death. Although not everyone who withdraws from alcohol abuse will suffer these types of serious effects, it’s not advisable to try to go through alcohol withdrawal on your own. Find an appropriate detox center that can help you.
Use of Medications
In some cases, medications might be prescribed to help you get through withdrawal if your symptoms aren’t manageable on their own. Your prescribing doctor will assess your specific situation to see if medication might be a good choice for you. Many of these medications could also help you deal with the underlying anxiety that may have led you to drink to begin with. Some of these medications include:
Benzodiazepines
These are a type of anti-anxiety medication that can help lower the risk of seizures.
Anticonvulsive Medication
These drugs are used to prevent seizures when someone is going through alcohol withdrawal.
Barbiturates
These are usually only used when benzodiazepines are contraindicated or aren’t proving effective.
Disulfiram
A medication that blocks the enzyme that digests alcohol, resulting in unpleasant effects like vomiting—even when the person drinks a small amount of alcohol.
Naltrexone
Commonly known by the brand name Vivitrol, this medication is an FDA-approved drug that was originally created for people with opioid addiction.
Acamprosate
Thought to rebalance the central nervous system; unlike disulfiram and naltrexone, it doesn’t cause liver damage.
Usually, a medical detox facility will set you up with prescriptions for these medications. You may have to continue to attend a medication-assisted treatment program to continue to receive doses for things like naltrexone injections, however.
Ongoing Treatment and Rehabilitation
Even after you’ve safely gotten through the process of physical withdrawal, your recovery journey isn’t over yet. Addiction is as much mental as it is physical. You might not be physically dependent on alcohol anymore, but the urges to drink are likely still strong if you haven’t gone through treatment. These urges can quickly lead you to relapse if you aren’t surrounding yourself with the right support.
Luckily, there are treatment programs available that meet every need and budget. Here are some of the most common treatment types and levels of care available to you while you’re going through alcohol withdrawal and recovery.
Inpatient Treatment
Many people decide to go into an inpatient treatment program when they are first trying to walk away from alcohol addiction. Although inpatient programs require a large commitment (you will live in the facility, usually for 30 days or more), they are great for people who need structure and stability as they’re first navigating sobriety.
In an inpatient program, your days will be highly structured. You will typically receive several hours of both group and individual treatment during the day, and sometimes participates in additional activities, depending on the rehab. Most inpatient treatment centers use evidence-based treatment methods like Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR). Some may also use 12-Step philosophies and experiential therapy models, like adventure therapy or music therapy.
The program you choose will depend on your specific preferences for treatment, as well as your insurance plan; many inpatient programs accept most commercial insurance plans, but only some will accept Medicaid or uninsured patients.
Partial Hospitalization Programs (PHPs)
Partial Hospitalization Programs, also sometimes called day treatment programs, are the next highest level of care after inpatient treatment. If you choose a PHP, you will attend treatment for 6 to 8 hours during the day, and go home at night. Most programs require treatment five days a week. Typically, the type of treatment offered is similar to inpatient programs: a combination of evidence-based methods with more experiential therapies.
PHPs can be a great choice of treatment for people who need a highly structured program, but aren’t able to make the commitment that inpatient treatment requires.
Intensive Outpatient Programs (IOPs)
Intensive outpatient programs are one step down from the level of structure a PHP provides. The way an IOP is set up is similar to PHPs, but requires less time in treatment each week. IOPs often only include group treatment, although some include individual therapy as well.
Depending on the rehab, the time commitment required can vary widely. Some programs only meet for 6 hours a week, while others meet for 20. Many programs offer treatment hours both during the day and in the evenings. Some have sessions available on weekends.
Intensive outpatient programs have been shown to be very effective in helping people get and stay sober, so don’t dismiss them just because they are less time-intensive than inpatient or partial hospitalization programs. They can be a great option for people who have to work during the day, and are only available for treatment in the evenings.
Sober Living Facilities
If you’re looking to be surrounded by recovery support in every facet of your life, inpatient treatment isn’t your only option. Many people decide to attend a PHP or IOP while residing in a sober living facility. Sober living facilities, also known as halfway homes, are share-houses or apartments where people live together in a recovery community.
These homes aren’t considered treatment, exactly, but they do sometimes provide peer recovery support and coaching. Additionally, many people choose to attend a day treatment program and return “home” to a sober living facility so that they’re never without support. This is a fantastic option for people who don’t feel confident returning to where they previously lived while they were struggling with alcohol addiction.
Outpatient Substance Abuse Counseling and Psychotherapy
Outpatient counseling and psychotherapy is a great resource for everyone, whether or not they’re going through alcohol recovery. For people who are withdrawing and recovering from serious alcohol use, it can be necessary.
Outpatient substance abuse counseling and therapy is usually conducted on an individual basis, although group therapy is also available. It is typically much less intensive than a PHP or an IOP, and clients usually see their counselor once or twice a week.
There are different types of counselors and therapists available. Certified substance abuse counselors don’t have a university degree, but they are specialized in helping people through recovery. However, if you have a co-occurring mental health condition, it will benefit you to look for a licensed therapist. Licensed therapists are Masters- or Doctorate-level mental health practitioners that have trained specifically to help people with mental health issues, including addiction.
Psychiatrists (mental health providers with medical licenses) can prescribe you with psychopharmacological (psychiatric) medication, like antidepressants, if that’s something you require.
Peer Support and Coaching
The most well-known example of a peer support program that helps people with alcohol addiction is Alcoholics Anonymous, or AA. This original 12-step program has helped many people get the support they need to stay sober after they stop drinking alcohol.
AA and other 12-Step groups can also connect you with a peer sponsor—someone you can depend on to support you through the recovery process. Your sponsor’s role is to guide you through the challenges of early sobriety. These groups also often host sober social events, which is important if your social life has always centered around drinking alcohol.
Alcohol Withdrawal Resources
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
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