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What is Alcohol Withdrawal Syndrome (AWS)?

Alcohol dependence and addiction are increasing and pervasive problems. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in inpatient alcohol rehab settings. Alcohol withdrawal syndrome ranges from mild to severe. The severe, complicated effects of alcohol withdrawal may present with alcohol-induced psychosis, seizures, or delirium tremens, which can be life-threatening [1].

Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal (AW). These happen due to alcohol-induced imbalances in the brain, which result in excessive neuronal activity if the alcohol is withheld.

Dependence on alcohol is associated with both physiological symptoms such as tolerance and withdrawal and behavioral symptoms such as impaired control over drinking. It usually manifests when an alcohol-dependent individual develops withdrawal symptoms after stopping alcohol, either due to family pressure, self-motivation, or difficulty in procuring alcohol.

How Long Does Alcohol Withdrawal Last
A medically-assisted withdrawal helps prevent serious complications, keeps track of a patient’s health condition, and relieves any painful effects.

According to the National Center for Biotechnology Information (NCBI) [2], alcohol dependence is one of the most common psychiatric disorders, second only to major depression. Approximately 14% of the general population has a lifetime history of alcohol dependence. The Alcohol Withdrawal Syndrome (AWS) is one of the most common presentations of Alcohol Dependence Syndrome. AWS is a cluster of symptoms that happens in alcohol-dependent people after cessation or reduction in heavy or prolonged alcohol use.

The clinical presentation varies from mild to severe and the onset of symptoms typically occurs a few hours after the last alcohol intake. The most common manifestations are tremor, restlessness, insomnia, nightmares, paroxysmal sweats, tachycardia, fever, nausea, vomiting, seizures, hallucinations (auditory, visual, and tactile), increased agitation, and tremulousness. These symptoms involve disturbances in a wide range of neurotransmitter circuits that are implicated in the alcohol pathway and reflect a homeostatic readjustment of the central nervous system (CNS).

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Signs of Alcohol Withdrawal 

Alcohol withdrawal can encompass many signs and symptoms. But what are the first signs of alcohol withdrawal a person may experience? 

Craving for a Drink

A period of daily drinking over multiple days can eventually produce alcohol dependence. When the body becomes dependent on alcohol, the brain sends messages that encourage the person to continue to drink, to satisfy the dependence. One of these messages may be: “I need a drink” or “I want a drink” or “I could use a drink” or “It’s time for a drink”. The thought just enters into the mind, if the person takes a drink then the thought leaves them, if the person postpones the drink, then the thought will get stronger.

Tremors

Fine hand tremors. This is a classic and often troubling symptom of alcohol withdrawal and one of the first signs of alcohol withdrawal. The person dependent on alcohol notices a fine tremor in their hands. The tremor is most noticeable when holding objects such as drinking glasses or toothbrushes. Hand tremors often occur upon wakening due to the time between the last drink and time spent in bed. The dependent person may require a drink of alcohol to stop the hand tremor.

Alcohol Withdrawal Symptoms 

The symptoms of alcohol withdrawal relate proportionately to the level of alcohol intake and the duration of the person’s recent drinking habit.

Not everyone who quits drinking alcohol experiences withdrawal symptoms, but many people who have been drinking for a long period of time, drink frequently, or drink heavily, will experience some withdrawal symptoms if they stop using alcohol suddenly.

There are several mild to moderate psychological and physical symptoms you might experience when you stop drinking.

Psychological Symptoms

  • Anxiety
  • Bad dreams
  • Depression
  • Difficulty thinking clearly
  • Fatigue
  • Feeling jumpy or nervous
  • Irritability or becoming excited easily
  • Rapid mood swings
  • Shakiness

Physical Symptoms

  • Clammy skin
  • Elevated blood pressure
  • Headache
  • Alcohol induced Insomnia
  • Loss of appetite
  • Nausea and vomiting
  • Paleness
  • Rapid heart rate or palpitations
  • Sweating, especially the palms of your hands or your face
  • Tremor in your hands

Severe symptoms are potentially much more dangerous, and are deserving of in-depth description:

Delirium tremens (DTs): “DTs are much more serious than the “alcohol shakes”—5% of patients who experience DTs die from metabolic complications. DTs, which present within 2 to 4 days of the last drink (and can last up to 3 to 4 days), 

The symptoms of delirium tremens include:

  • Agitation
  • Confusion (which can be severe)
  • Dangerous changes in blood pressure
  • Excessive sweating
  • Fever
  • Hallucinations
  • Heart arrhythmia (irregular heartbeat)
  • Rapid changes in mood
  • Seizures
  • Sensitivity to touch, light, and/or sound
  • Tremors

The symptoms of DT may get rapidly worse and can be fatal. A person with delirium tremens needs to be hospitalized until the symptoms can be controlled.

Seizures: Grand mal seizures can occur in up to 25% of alcoholics undergoing withdrawal. If alcohol-related seizures do occur, they generally do so within 1 day of cessation of alcohol intake but can occur up to 5 days later.

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Alcohol Withdrawal Timeline 

The timeline of withdrawal from alcohol begins as soon as the level of alcohol in the blood comes down and the effects of intoxication begin to wear off. Alcohol withdrawal symptoms can begin to show up as early as 2 hours after having the last drink.

Alcohol withdrawal symptoms usually show up in various stages. The following is the timeline for the common symptoms of alcohol withdrawal:

6 hours

Minor withdrawal symptoms usually begin about six hours after your last drink. A person who has a long history of heavy drinking could have a seizure six hours after stopping drinking.

These first symptoms of withdrawal include:

  • Decreased appetite
  • Headache
  • Heart palpitations
  • Insomnia
  • Mild or moderate anxiety
  • Shaking
  • Upset stomach
How Long Does Alcohol Withdrawal Last
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12 to 24 hours

A small percentage of people going through alcohol withdrawal have hallucinations at this point. They may hear or see things that aren’t there. While this symptom can be scary, doctors don’t consider it a serious complication.

This stage of alcohol withdrawal includes the previous symptoms plus the following moderate symptoms:

  • Confusion
  • Excessive sweating
  • Fast heart rate (more than 100 beats per minute)
  • Fever
  • Increased systolic blood pressure
  • Mild tremor
  • Moderate anxiety
  • Rapid, shallow breathing

24 to 48 hours

Minor withdrawal symptoms usually continue during this time. These symptoms may include headache, tremors, and stomach upset. If a person goes through only minor withdrawal, their symptoms usually peak at 18 to 24 hours and start to decrease after four to five days.

48 hours to 72 hours

Some people experience a severe form of alcohol withdrawal that doctors call the delirium tremens (DTs) or alcohol withdrawal delirium. A person with this condition can have a very high heart rate, seizures, or a high body temperature.

72 hours

This is the time when alcohol withdrawal symptoms are usually at their worst. In rare cases, moderate withdrawal symptoms can last for a month. These include rapid heart rate and alcohol-induced psychosis (seeing things that aren’t there).

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PAWS

PAWS (Post-Acute Withdrawal Syndrome) refers to the long-term side effect of alcohol abuse, potentially challenging and affecting a person’s life. Symptoms might continue years after withdrawal and initial detox. That is why it is highly recommended to continue treatment after the initial seven-day detox.

These symptoms include:

  • Hostility
  • Irritability
  • Anxiety & Depression
  • Mood swings
  • Low levels of energy
  • Fatigue
  • Insomnia
  • Inability to focus
  • Lack of sex drive
  • Chronic pain

These symptoms are mainly psychological and have been known to continue for months or years after alcohol cessation. They tend to ‘come and go’ in waves or episodes, and can be triggered by specific circumstances, memories, smells, or people.

What Happens During Alcohol Withdrawal & Detox? 

Detox is a safe, medically supervised setting where someone can safely detox from alcohol and other substances while getting the proper medical treatment needed to guarantee the most comfortable detox experience possible. The staff will provide 24/7 care and supervision while the body, especially the liver, clears itself from alcohol. They will also be ready and able to intervene in the event of a serious medical emergency as a result of alcohol withdrawal.

As the person enters detox, he or she will undergo a professional medical evaluation. Here, a medical professional will assess the severity of the alcohol withdrawal symptoms in addition to the physical and mental health. Professionals will work closely with the client to develop an individualized detox plan to effectively meet the clients’ needs. 

The whole body, including the liver, will start detoxing. The liver was at the focus of attention when a person was drinking, as it filters and processes the fluids ingested during the day. This means that the liver will start to detox once alcohol consumption is stopped. 

How Alcohol Detox Helps

The alcohol detox stage is the first step in alcoholism treatment. During this time, alcohol is completely flushed from your body. Withdrawal symptoms typically subside within approximately 1-2 weeks after starting detox; however, this could take longer depending on the severity of your alcohol use disorder. From there, you will be able to focus on other aspects of the recovery process such as different activities, therapies, counseling sessions, and support options.

Some people are apprehensive to quit drinking because they’re nervous about the withdrawal symptoms experienced during alcohol detox. While some people may only be affected by minor effects of alcoholism, others may face extreme pain. Withdrawal symptoms can change quickly and aggressively, which is why it’s important to detox under the care of medical professionals. Treatment professionals at a rehab facility will be able to help you manage your pain with different medications. This allows you to focus on your recovery and get better.

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Alcohol Withdrawal Treatment

Medically-assisted Detox

Detox is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of alcohol withdrawals.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for alcohol use disorder and mental health disorder are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

Integrated Mental Health Care

Alcohol affects mental health, so people may use it to self-medicate undiagnosed disorders. Rehab centers typically provide mental health screenings, diagnoses, and integrated treatment for co-occurring disorders. In addition, holistic and therapeutic approaches are often used to treat recovering addicts with these conditions.

Behavioral Therapies

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) can improve addicts’ behavior. CBT targets negative and maladaptive thought patterns as it promotes positive emotions and beliefs, while DBT helps clients address conflicting impulses so they can make healthy choices. Both therapies treat substance abuse and mental health disorders. Therapy also empowers clients to identify, avoid and mitigate cues that trigger drug cravings.

Individual and Group Counseling

Addiction and mental health counseling occur in both individual and group settings. One-on-one treatment sessions may address unresolved trauma, unconscious conflicts, and specific struggles, while group sessions often involve training in life skills, stress management, conflict resolution, and social connections. Group counseling also gives clients the chance to share their thoughts and experiences to develop social support, which is essential for lasting recovery

How long alcohol withdrwal last?” is a question that many misusers of alcohol may have. If you have apprehensions to quit drinking because you’re nervous then talk to one of our addiction specialists. Please, do not try to detox on your own because the detox process can be painful and difficult without medical assistance. If you or someone you know regularly exceeds these recommended daily limits or is experiencing effects of alcohol withdrawal, it is important to intervene early. We Level Up NJ has addiction specialists that are standing by to help. 

How Long Does Alcohol Withdrawal Last
When alcohol detox is treated in an inpatient rehab facility, different medications may be used to help reduce uncomfortable withdrawal symptoms.

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Sources:

[1] NCBI – https://pubmed.ncbi.nlm.nih.gov/29912213/

[2] NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606320/