Alcohol use disorder (AUD) is a major health concern across the globe, and is the seventh leading cause of death and disability. There are a staggering 8 million people with AUD in the United States with about half a million cases of severe withdrawal requiring medical supervision.
Acute alcohol withdrawal symptoms begin after a person has stopped drinking. Typically, acute symptoms are an indication that the person consumed enough alcohol over an extended period of time to result in damage to the central nervous system, brain and liver. This type of heavy drinking leads to severe withdrawal and will need a medically supervised detox. People experiencing acute withdrawal symptoms should never attempt to manage their detox at home due to the dangers involved.
Definition of Acute Alcohol Withdrawal
Acute alcohol withdrawal occurs when a person suddenly stops drinking after a period of heavy alcohol use. Symptoms may include tremors, sweating, nausea, anxiety, insomnia, increased heart rate and seizures.
Heavy and long-term alcohol use can lead to physical and psychological dependence, which can be accompanied by serious withdrawal symptoms if suddenly stopped.
It is important to note that alcohol withdrawal can be dangerous and potentially life-threatening. Medical assistance is always recommended for those experiencing acute alcohol withdrawal.
Acute Alcohol Withdrawal – Physical & Emotional Symptoms
Alcohol withdrawal symptoms typically begin within 8 hours after your last drink and can range from mild to severe. Common symptoms include anxiety, sweating, nausea, shakes, insomnia and increased heart rate.
In more severe cases, delirium tremens is possible, presenting with confusion, visual and auditory hallucinations and seizures.
Symptoms of alcohol withdrawal happen because alcohol is a central nervous system depressant. Interestingly, alcohol affects neurotransmitters in the brain and heavy alcohol use eventually causes homeostasis occurring only when alcohol is present, not the other way around.
Therefore, when one suddenly stops drinking, overactivity of the central nervous system results leading to severe withdrawal symptoms.
Symptoms indicating a person is experiencing acute alcohol withdrawal syndrome include:
- Shakiness, convulsions, seizures, delirium tremens (DTs)
- Chills, sweating, clammy, pale skin
- Depression, anxiety, stress, anger, volatility, mood swings
- Depersonalization, confusion, hallucinations, psychosis
- Loss of appetite, weight loss/gain, nausea/vomiting
- Sleep disturbances, restlessness, fatigue
- Increased blood pressure, rapid heart-rate
- Dilated pupils, sensitivity to light
If you are experiencing any of these symptoms after you stop drinking, it is important to seek medical help to ensure your safety. With medical supervision, withdrawal can be managed safely and effectively.
Post-Acute Withdrawal Syndrome (PAWS)
While acute withdrawal refers to the body’s process of healing, a second set of symptoms, known as post-acute withdrawal syndrome (PAWS) occurs when the brain starts working to rebalance itself after a period of active addiction.
These symptoms are more psychological and emotional in nature. Depending on how much the person was drinking and for how long, this phase of withdrawal can begin a few weeks to a few months into recovery.
PAWS is not permanent but is responsible for a large number of relapse cases, even among those who are engaged and committed to their recovery.
Whether or not PAWS is mild or severe, it is a phase the brain needs to go through in order to heal. The brain is working to correct the chemical imbalances caused by addiction.
When does PAWS occur? Symptoms get triggered through stress or by people, places or things that remind the person of their alcohol use. Symptoms are more frequent during the early stages of abstinence and will decrease as one moves further into recovery.
Here are some of the most common symptoms:
- Urges and cravings
- Mood swings, irritability, hostility
- Foggy thinking, memory issues
- Lack of motivation, difficulty focusing
- Sleep disturbances, fatigue, insomnia, vivid dreams
- Poor fine motor coordination
- Depression, anxiety, stress, panic
To help reduce the likelihood of relapse, it’s important for people in recovery to be made aware of the uncomfortable but temporary symptoms of PAWS so they are prepared.
Alcohol Withdrawal Timeline
Alcohol withdrawal symptoms typically begin 6-14 hours after the last drink as the person’s blood alcohol level starts to decrease. Once detox begins, the symptoms can last from 5 to 14 days, depending largely on how much and how long the person has been drinking as well as other factors such as history of withdrawal symptoms, age and underlying health conditions.
0 to 72 hours after the last drink:
- Insomnia, restlessness
- Fever, nausea
2-5 days into detox:
- Hallucinations, paranoia
- Confusion, disorientation
- Delirium tremens
5-14 days into withdrawal:
- Brain fog, nervousness
- Depression, mood swings
Management of Alcohol Withdrawal
It isn’t clear why some people suffer more severe withdrawal symptoms than others, but some evidence shows that it may be related to one’s genetic predisposition.
Signs and symptoms of withdrawal can develop when one stops drinking after as little as a few weeks of heavy use. Acute alcohol withdrawal is linked to blood-alcohol concentrations high enough to develop tolerance.
The management of alcohol withdrawal focuses on alleviating symptoms. Medication-assisted treatment (MAT) is used to control shakes and risk of seizure and helps prevent more severe symptoms. Vital signs are constantly monitored and IV fluids and supplements may be given.
IV is preferred due to the stomach issues that are present in the first couple of days of detox. Many alcoholics are malnourished and require nutritional support. Patients considered to be at high risk for complications will usually be monitored in the intensive care unit
Treatment for Alcohol Dependence and Alcohol Withdrawal Symptoms
Alcohol withdrawal can be a difficult process and it is important to seek medical attention. Treatment for alcohol withdrawal typically includes both medical and psychological approaches.
Medical treatment typically includes medications to reduce symptoms, such as benzodiazepines and anticonvulsants. These medications can help reduce anxiety, tremors and hallucinations and can also help to reduce the risk of seizures.
Psychological treatment may include cognitive-behavioral therapy, which can help to identify triggers for drinking and can provide techniques to help people cope with cravings. This can only happen for people who are through the worst of their detox.
Other treatments may include nutritional counseling, support groups and lifestyle changes. It is important for individuals to find the treatment that works best for them and to receive the right level of medical and psychological care.
Risk of Relapse During Withdrawal
The risk of relapse during alcohol withdrawal is a major concern for those struggling with alcohol addiction. Withdrawal symptoms can be severe and so uncomfortable that many individuals turn to drinking to relieve the distress. Cravings and intense urges to drink can be overwhelming and difficult to resist,
To avoid relapse during this stage, it is very important for individuals to seek professional help and treatment, such as medically supervised detox and therapy to help manage the uncomfortable symptoms and cravings and provide the necessary support to fight the urge to use so one can start their journey towards recovery and abstinence.
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