Definition

Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking alcohol.

Alternative Names

Detoxification - alcohol; Detox - alcohol

Causes

Alcohol withdrawal occurs most often in adults. But, it may also occur in teenagers or children.

The more you drink regularly, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking.

You may have more severe withdrawal symptoms if you have certain other medical problems.

Symptoms

Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 to 72 hours, but may go on for weeks.

Common symptoms include:

• Anxiety or nervousness
• Depression
• Fatigue
• Irritability
• Jumpiness or shakiness
• Mood swings
• Nightmares
• Not thinking clearly

Other symptoms may include:

• Sweating, clammy skin
• Enlarged (dilated) pupils
• Headache
• Insomnia (sleeping difficulty)
• Loss of appetite
• Nausea and vomiting
• Pallor
• Rapid heart rate
• Sweating, clammy skin
• Tremor of the hands or other body parts

A severe form of alcohol withdrawal called delirium tremens can cause:

• Agitation
• Fever
• Seeing or feeling things that aren't there (hallucinations)
• Seizures
• Severe confusion

Exams and Tests

Your health care provider will perform a physical exam. This may reveal:

• Abnormal eye movements
• Abnormal heart rhythms
• Dehydration (not enough fluids in the body)
• Fever
• Rapid breathing
• Rapid heart rate
• Shaky hands

Blood and urine tests, including a toxicology screen, may be done.

Treatment

The goal of treatment includes:

• Reducing withdrawal symptoms
• Preventing complications of alcohol use
• Therapy to get you to stop drinking (abstinence)

INPATIENT TREATMENT

People with moderate-to-severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens.

Treatment may include:

• Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body
• Fluids or medicines given through a vein (by IV)
• Sedation using medicines until withdrawal is complete

OUTPATIENT TREATMENT

If you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. During this process, you will need someone who can stay with and keep an eye on you. You will likely need to make daily visits to your provider until you are stable.

Treatment usually includes:

• Sedative drugs to help ease withdrawal symptoms
• Blood tests
• Patient and family counseling to discuss the long-term issue of alcoholism
• Testing and treatment for other medical problems linked to alcohol use

It is important to go to a living situation that helps support you in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.

Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through alcohol withdrawal.

Support Groups

The following organizations are good resources for information on alcoholism:

• Alcoholics Anonymous -- www.aa.org
• Al-Anon Family Groups/Al-Anon/Alateen -- al-anon.org
• National Institute on Alcohol Abuse and Alcoholism -- www.niaaa.nih.gov
• Substance Abuse and Mental Health Services Administration -- www.samhsa.gov/atod/alcohol

Outlook (Prognosis)

How well a person does depends on the amount of organ damage and whether the person can stop drinking completely. Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months. People who continue to drink a lot may develop health problems such as liver, heart, and nervous system disease.

Most people who go through alcohol withdrawal make a full recovery. But, death is possible, especially if delirium tremens occurs.

When to Contact a Medical Professional

Alcohol withdrawal is a serious condition that may rapidly become life threatening.

Call your provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. Call for an appointment with your provider if symptoms persist after treatment.

Go to the emergency room or call the local emergency number (such as 911) if seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.

If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

Prevention

Reduce or avoid alcohol. If you have a drinking problem, you should stop alcohol completely. Total and lifelong avoidance of alcohol (abstinence) is the safest approach.

References

Finnell JT. Alcohol-related disease. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 142.

Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.

Mirijello A, D'Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543 pubmed.ncbi.nlm.nih.gov/25666543/.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.