What Is Alcohol Withdrawal?

Alcohol withdrawal syndrome (AWS) is a medical term for the symptoms that occur when someone who uses alcohol over a prolonged period discontinues or significantly reduces their alcohol intake. Typically, those who experience alcohol withdrawal have an alcohol use disorder (AUD). This is because their body has already developed a tolerance and dependency on alcohol.

More than 1.5 million people in the United States enter outpatient or inpatient alcohol treatment due to the medical consequences of alcohol dependence.

Someone with an AUD is likely physically dependent on the substance. This means that the brain and central nervous system have gotten used to the constant presence of alcohol in the body. Due to this, the central nervous system has created a mechanism to compensate for alcohol’s depressive effects on brain function. Therefore, when the amount of alcohol consumed is suddenly lowered, the central nervous system and the brain remain in a hyper-excited and hyperactive state, which is what causes the main symptoms of alcohol withdrawal syndrome.

Why Does Alcohol Withdrawal Occur?

Our brains require a special balance of chemicals called neurotransmitters to function properly. Alcohol has a strong impact on a few key neurotransmitters responsible for a wide range of bodily functions, particularly dopamine, serotonin, and gamma-aminobutyric acid (GABA):

  • Dopamine – This is the “feel-good” chemical that tells your brain what feels good and motivates you to repeat “feel-good” behaviors.
  • Serotonin – This is the regulatory chemical that helps maintain balance in moods, among other bodily functions. It is a key neurotransmitter treated for conditions like depression or anxiety.
  • GABA – This is the “relax” chemical, or more specifically, the one that reduces the speed at which the brain sends signals out, which results in feeling calm or sedated.

These three neurotransmitters play a significant role in regulating our mood and managing emotions. Minor shifts in their balance can lead to a variety of symptoms like drowsiness, loss of motor skills, euphoria, and dysphoria. Alcohol, being a neurotoxin, disrupts the balance of these neurotransmitters in the brain, and its effects are what is referred to as intoxication.

The most notable way alcohol affects these neurotransmitters is by increasing the production of dopamine and serotonin, resulting in the familiar “feel-good” or “happy” feeling, which, over time, can lead to addictive behaviors.

When alcohol is frequently misused, the brain must adapt and adjust to the influx of neurotransmitters created by chronic alcohol use. It usually does this by reducing the natural production of neurotransmitters and becoming physically dependent on alcohol to provide them instead. Furthermore, when the brain adapts to this chronic alcohol use, the amount of alcohol consumed eventually no longer provides the same effect, leading one to drink more to feel the same effect (known as tolerance).

Therefore, when someone then reduces or completely stops using alcohol after becoming so dependent on it, they begin to experience withdrawal symptoms, as the brain no longer has the proper balance of neurotransmitters or the proper resources to produce them.

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Who Is At Risk For Alcohol Withdrawal Syndrome?

Misusing alcohol, including binge drinking and heavy alcohol use, puts you at risk for alcohol withdrawal syndrome. Typically, people who develop an AUD are at higher risk for alcohol withdrawal syndrome. Furthermore, the risk of developing an AUD, which can lead to AWS, depends on how often, how quickly, and how much alcohol someone consumes.

Other factors that increase the risk of developing an AUD include:

Keeping these risk factors in mind can help you be aware of your drinking habits and prevent alcohol misuse.

How Much Do I Have To Drink To Experience Withdrawal?

There is no defined amount when it comes to the amount of alcohol needed to experience withdrawal. Experiencing alcohol withdrawal symptoms depends on the following factors:

  • The drinking amount: Symptoms are more likely to appear in people who regularly drink heavily.
  • The length of time you’ve been drinking: If you’ve been drinking for a long time or from a young age, your body begins to build a tolerance and gets used to having it in its system. Therefore, if you stop drinking, your body will react with withdrawal symptoms.

There is no set formula for how long it takes or how much you need to drink to develop an alcohol dependence. Experiencing alcohol withdrawal means you have an alcohol dependence.

Alcohol Withdrawal Timeline And Symptoms

Within six hours of your last drink, mild symptoms of alcohol withdrawal may begin to appear. If you notice your symptoms do not progress or get worse within 24–48 hours, you will likely recover from withdrawal without risk. However, depending on the amount of alcohol typically consumed and the duration of alcohol use, the timeline of symptoms may vary.

Alcohol withdrawal symptoms tend to peak 24–72 hours after ingesting your last drink but may last for weeks. During the withdrawal, you may see a broad range of symptoms beginning to appear, including:

  • Tremors
  • Anxiety
  • Jumpiness
  • Mood swings
  • Cloudy thinking
  • Fatigue
  • Agitation or irritability
  • Loss of appetite

  • Nausea
  • Vomiting
  • Headache
  • Clammy skin
  • Craving for alcohol
  • Elevated blood pressure
  • Insomnia
  • Heart palpitations

More moderate to severe symptoms, which usually appear during peak withdrawal time of 24–72 hours after your last drink, may also include hallucinations and seizures.

The most severe and dangerous form of alcohol withdrawal is called delirium tremens (DT),  in which withdrawal symptoms are much stronger. You may experience severe confusion, high blood pressure, fever, high heart rate, and abnormal heart rhythms for a week or longer.

Diagnosing Alcohol Withdrawal

Diagnosing alcohol withdrawal is done by a medical professional, who will take a history and perform a thorough physical exam. Depending on the symptoms and their severity, the healthcare provider can clinically diagnose the alcohol withdrawal as mild, moderate, or severe using the CIWA-Ar tool.

The CIWA-Ar, short for the Clinical Institute Withdrawal Assessment for Alcohol-Revised, is a common assessment tool used by providers to monitor ten key withdrawal symptoms to assess what stage of withdrawal someone is in. The CIWA-Ar scale measures the severity of the following symptoms:

  • Nausea and vomiting
  • Headache
  • Auditory disturbances
  • Agitation

  • Sweating
  • Visual disturbances
  • Tremors
  • Impairment of the senses

Based on the score, which illustrates the severity of withdrawal, healthcare providers can determine what treatment is appropriate.

Throughout your withdrawal of alcohol, clinicians will continue to use the CIWA-Ar to monitor your signs and symptoms and determine if your alcohol withdrawal is worsening or getting better. They can then determine the proper treatment and therapy.

Treatment For Alcohol Withdrawal

The goals of treating alcohol withdrawal are to reduce symptoms, prevent complications, and help reduce or stop alcohol intake.

While mild alcohol withdrawal symptoms can be managed outside the hospital, such as at an outpatient center, people who are without a support system, have a history of withdrawal seizures, have co-occurring psychiatric problems, have a history of misuse of other substances, or have suicidal ideations, should make sure to be monitored and treated in the hospital.

Supportive therapies, such as intravenous fluids and electrolyte replacement, may be given to someone experiencing mild to moderate withdrawal symptoms. People going through alcohol withdrawal may also be given something known as a “banana bag” (called this due to its yellow color), which contains fluids with dextrose (sugar) and vitamins such as multivitamins, folate, and thiamine.

Someone experiencing more severe alcohol withdrawal may need to be closely monitored. They will likely receive the same therapies mentioned for mild to moderate withdrawal, as well as medications known as long-acting benzodiazepines, which can help manage symptoms and prevent the risk of seizures or developing DT.

How Long Does It Take To Detox From Alcohol?

The severity and duration of detox from alcohol withdrawal varies based on many factors and can contribute to the different alcohol detox stages.

The initial detox stage of alcohol withdrawal usually takes about one week. However, you may find that your symptoms continue for longer, even up to a few weeks to months.

Within the first eight hours, you can expect to experience the initial stage of detox and withdrawal from alcohol with mild withdrawal symptoms.

After approximately 24–72 hours, you can anticipate your withdrawal symptoms to peak. This will most likely be the most uncomfortable stage and the time in which it’s most important to be monitored.

After about 5–8 days, you’ll notice the intensity of symptoms start to decrease.

After this first week is over, you may experience some residual withdrawal symptoms, specifically those affecting mood, for up to a few weeks.

Medication For Alcohol Withdrawal

In cases of severe alcohol withdrawal, your healthcare provider may prescribe some medications to help with the symptoms and prevent dangerous outcomes.


Benzodiazepines are a class of sedative medications that can treat anxiety and control seizures. This is typically the drug class of choice for alcohol withdrawal, as long-acting benzodiazepines may reduce the chance of recurrent withdrawal symptoms or seizures.

Some recognizable names of benzodiazepines used in alcohol withdrawal include:

  • Chlordiazepoxide (Librium)
  • Clorazepate (Tranxene)
  • Diazepam (Valium)
  • Oxazepam (Serax)

It is important to follow your healthcare provider’s recommendations regarding any prescription medications.


Providers may recommend using other seizure medications to manage withdrawal symptoms during severe alcohol withdrawal, either instead of or in combination with benzos. This class of drugs may be used to treat mild, moderate, or severe alcohol withdrawal.

These may include:

  • Carbamezpine (Tegretol)
  • Gabapentin (Neurontin)
  • Oxcarbazepine (Trileptal)
  • Valproic acid (Depakene)

Your healthcare provider will determine the right treatment plan for you.


Although rarely prescribed today, barbiturates are another class of sedative drugs that can treat the seizures associated with alcohol withdrawal in people who may be resistant to benzodiazepines.

Dangers Of Alcohol Withdrawal

As mentioned, peak withdrawal symptoms begin at the 24–72 hour mark. If you are not monitored or treated properly, you may enter severe withdrawal, including experiencing DT.

Aside from the dangerous risks of withdrawal symptoms, there are co-occurring health problems that frequently present in someone withdrawing from alcohol, including:

  • Gastritis
  • Liver disease
  • Cardiac problems
  • Pancreatitis
  • Electrolyte imbalances
  • Vitamin deficiencies

By seeking detox treatment, you can get the care and support you need to withdraw from alcohol safely.

Outlook For Alcohol Withdrawal Syndrome

The outlook, or prognosis, for someone experiencing alcohol withdrawal syndrome depends on whether they can completely stop drinking and if they have sustained any organ damage from previous drinking and/or withdrawal, such as liver, heart, or nervous system diseases.

Typically, most people who finish alcohol withdrawal make a full recovery. Still, certain symptoms may last for months while the brain and central nervous system recalibrate and recover from alcohol addiction, including insomnia, mood swings, and fatigue.

Can You Prevent Alcohol Withdrawal?

The safest way to prevent alcohol withdrawal is to avoid drinking alcohol altogether. If you do drink, make sure to monitor yourself and take note of your drinking habits. If you or a loved one has a drinking problem, contact a medical professional or an addiction treatment center to get resources and help to stop drinking.

Find Alcohol Detox Services Today

Alcohol withdrawal is a serious condition that can lead to death if not treated or monitored properly. If you think you are experiencing severe alcohol withdrawal or DT, call your doctor or seek emergency services as soon as possible.

If you or a loved one struggle with alcohol misuse and are afraid you may experience alcohol withdrawal, contact a treatment provider today to learn more about your rehab and detox options.