If you drink heavy amounts of alcohol for weeks, months, or years, you may have mental and physical symptoms when you stop or cut back. This is called alcohol withdrawal. About half of all people with alcohol use disorder go through it.
For men, heavy drinking is defined as five or more alcoholic drinks in a day or 15 or more per week.
For women, heavy drinking means four or more drinks on any day or eight or more drinks per week.
Symptoms of alcohol withdrawal can range from mild to serious and can sometimes be life-threatening. If you drink only once in a while, you're unlikely to have withdrawal symptoms. But if you've gone through alcohol withdrawal once, you're more likely to go through it again.
Alcohol Withdrawal Causes
Alcohol has what doctors call a depressive effect on your system. It slows down your brain function and changes the way your nerves send messages back and forth.
Over time, your central nervous system adjusts to having alcohol around. Your body works hard to keep your brain in a more awake state and your nerves talking to one another.
When the alcohol level in your system suddenly drops, your brain stays in this overactive state. That's what causes withdrawal symptoms.
Alcohol Withdrawal Symptoms
When you stop or cut back on your usual amount of alcohol, you could have:
- Headaches
- Mood changes
- Feelings of being easily irritated or "on edge"
- Anxiety
- Confusion
- Trouble falling asleep or staying asleep
- Rapid heart rate
- Higher blood pressure than usual
- Shaking
- Increased sweating
- Upset stomach
- Hallucinations (seeing things that aren't there)
- Seizures
Delirium tremens (DTs) can also happen when you stop drinking large amounts of alcohol. Changes in your brain activity can result in a range of serious symptoms, such as:
- Trouble thinking clearly
- Trouble focusing
- Not knowing where you are or what date it is
- Trouble speaking and understanding others
- Feeling quick to anger or violence
- Acting in a way that's unusual for you (for instance, not filtering what you say to others)
- Unusually slow movements
- Decreased facial expressions
- Apathy (lack of interest in things you usually care about)
DTs can be fatal. Getting treatment as soon as possible is essential.
When does alcohol withdrawal start?
Everyone is different, but generally speaking, mild symptoms often start 6-12 hours after your last drink.
How long does alcohol withdrawal last?
Symptoms are often at their worst between 24 and 72 hours after you stop drinking. But some may linger for weeks or even months.
Alcohol withdrawal timeline
How your body responds once you stop drinking can range from mild to serious. It partly depends on how much you usually drink and how long you've been having that amount.
About six hours after you stop drinking. You might start having early symptoms such as:
- Anxiety
- Shaky hands
- Headache
- Nausea
- Vomiting
- Insomnia
- Sweating
About 12-48 hours after you stop drinking. More serious symptoms can start during this timeframe. They may include hallucinations (seeing things that aren't there). These often start about 12-24 hours after you stop drinking. Seizures may happen within the first 48 hours after you stop.
About 24-72 hours after you stop drinking. Only about 1%-1.5% of people with alcohol withdrawal will have DTs. If so, they may start around this time. They can continue for several days and are often at their most intense four to five days after your last serving of alcohol.
Alcohol withdrawal stages
Not everyone experiences alcohol withdrawal the same way. To figure out which stage you're in, your doctor could ask you to fill out a questionnaire called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). It's a list of 10 symptoms that you'll score on a scale of 0 to 7, based on how much they bother you. Then your numbers are added up to find out which of these three stages you're in:
- Mild: You can probably recover on your own with rest and support.
- Moderate: Certain medications may help make you more comfortable. Your doctor will likely also want to keep a close eye on you.
- Severe: You may be at risk for more serious complications. Your doctor could suggest a short-term detox program where you stay overnight. That way, you can get more support and stronger types of medication.
Diagnosing Alcohol Withdrawal
There's no one specific test that proves you're going through alcohol withdrawal. Your doctor will confirm that based on a few different factors including:
- Your symptoms
- Your general health
- Your alcohol use and how recently you stopped drinking. They'll also want to know if you've ever gone through withdrawal before.
Your doctor may decide to order different tests, such as blood work or a heart test. These results can help them learn how alcohol has affected your body and identify any infections, injuries, or other health issues that need treatment.
It may feel hard to talk honestly to your doctor about your alcohol use. Remember that their goal is to help you get healthy, not judge you. Once they understand your drinking history, they'll be better able to suggest treatments that could help you.
Alcohol Withdrawal Treatment
As your body gets used to no alcohol, different treatments can make you more comfortable and keep your symptoms from getting worse.
In mild cases, a supportive environment may be enough to help you. That could likely include:
- A quiet, calm place to rest
- Healthy food and lots of fluids
- Check-ins with your doctor
- Counseling with a therapist (may involve one-on-one, group, or family sessions)
- Support groups, such as Alcoholics Anonymous or Women in Sobriety
Moderate cases may need short-term medications to lessen symptoms. Your doctor will probably also want to see you more regularly.
Inpatient treatment
A severe case of alcohol withdrawal can lead to complications, some of which can be life-threatening. To prevent this, your doctor may suggest a treatment program where you stay overnight. That way, you can get 24-7 support for your mental health and physical symptoms.
Treatment at an inpatient treatment program often includes:
Detox. For two to seven days, doctors may manage your withdrawal with medications.
Learning to change. Trained specialists will help you better understand your habits and patterns of behavior and how to commit to new ones. This could include everything from anger management classes to nutrition advice.
Counseling. This may involve one one-on-one sessions with a social worker or therapist to help you deal with mental health issues or past traumas. At some point, it may be helpful to include your partner or family, too.
Managing your health. Doctors will monitor your symptoms and risk for alcohol withdrawal complications. They'll also help manage any ongoing health issues you have.
Continuing care. Once you leave an inpatient program, you'll be connected to resources you can continue to use, such as support groups or doctors or therapists in your area.
Alcohol withdrawal medication
Benzodiazepinesare often the first treatment doctors suggest for alcohol withdrawal. These sedatives help rebalance your brain chemicals. Benzodiazepines can also reduce your risk of delirium tremens.
Chlordiazepoxide (Librium) is often prescribed for alcohol withdrawal. Other types include:
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam
You can take these medications by mouth, or your doctor may give you a longer-acting version of one of these drugs by IV in the hospital.
You might also receive other medications along with benzodiazepines.
Gabapentin for alcohol withdrawal
Anti-seizure drugs such as gabapentin and carbamazepine can help reduce your craving for more alcohol. Studies show that gabapentin can also help improve your sleep and mood, which may make you less likely to relapse.
Antipsychotics for alcohol withdrawal
These medications aren't for everyone but could help lessen severe DT symptoms, such as hallucinations and aggression. If you're given this type of medication, you'll need to be closely monitored.
Clonidine for alcohol withdrawal
When used along with beta-blockers,clonidine may help get your heart rate or blood pressure back down to healthy levels.
Alcohol withdrawal and vitamin supplements
When you're going through withdrawal, it's common to be low in vitamins and minerals that your body needs to stay healthy, such as:
- Folate
- Vitamin B6
- Vitamin B12
- Vitamin C
- Magnesium
- Zinc
You're more likely to be deficient if alcohol was making up 30% or more of your daily calories.
Sometimes, your nutrition levels will improve once you start eating healthy foods again. If not, your doctor may suggest that you start taking a supplement. Follow their advice exactly.
Managing Alcohol Withdrawal
If you're getting through alcohol withdrawal at home, here's what can help.
Be prepared.Talk to your doctor or a drug treatment specialist about what to expect. Ask whether any medications are right for you.
Find your support system. Identify a family member or friend who you can reach out to for emotional support. You could also join a support group, such as Alcoholics Anonymous. If your symptoms make you so uncomfortable that you want to give up, a support person can help remind you that your body is getting rid of toxins and changing back to how it's supposed to function.
Take care of yourself. Eating healthy foods, trying to get exercise, and getting enough sleep can help reduce some withdrawal symptoms, such as mood swings. If you take prescription medication, continue to take it as directed.
Manage your stress. While it's easier said than done, keeping your stress under control can reduce your symptoms and curb any alcohol cravings. Try to spend time in places that feel calming to you. You also could focus on doing relaxing activities, such as:
- Reading
- Listening to music
- Taking a bath
- Meditation
- Exercise
- Getting a massage
Keep yourself distracted. You may find it hard to focus for long periods. That's not uncommon. Instead, try to occupy yourself with short activities, such as watching a movie, going for a walk, playing a video game, or window shopping.
Remove all alcohol from your home. You don't want to be tempted. Get rid of all beer, wine, and liquor, as well as any products that contain alcohol, such as rubbing alcohol and vanilla extract. If throwing everything away feels too hard, give it away to a friend or family member.
Avoid people who may encourage you to drink. For now, it may be easier to skip meeting your "drinking buddies" and avoid gatherings that have a focus on drinking.
Stay hydrated and snack smart. Drink plenty of fluids. You don't have to stick to water. Try seltzer, virgin cocktails (mocktails), fruit juices, or kombucha. Keep in mind that fruit juice and kombucha may be high in sugar.
For snacks, choose foods that are high in carbohydrates, such as pretzels, crackers, or apples, which can help satisfy cravings.
Thiamine for alcohol withdrawal
Thiamine (vitamin B1) helps your body break down food for energy. it also serves a lot of other important functions, such as keeping your nervous system healthy. Many people who go through alcohol withdrawal no longer have enough thiamine in their body. This can quickly become a medical emergency. If your doctor feels you're at risk, it will be important for you to have a thiamine supplement by IV for several days.
Alcohol withdrawal diarrhea
Over time, alcohol use can damage the lining of your gastrointestinal tract, leading to diarrhea (loose stools), which can cause other issues, including:
- Dehydration
- Imbalanced electrolytes (minerals) in your blood
- Not being able to absorb enough nutrients from the food you eat
Once you stop drinking and all the alcohol is out of your system, your diarrhea should start to get better.
Your doctor may also suggest that you follow the BRAT diet for a while. BRAT stands for:
- Bananas
- Rice
- Applesauce
- Toast
These foods can help firm up your stools while giving your bowels a chance to rest.
Can You Prevent It?
Some people try to avoid withdrawal symptoms by cutting back on alcohol instead of giving it up all at once. Tapering is a slower process. Over weeks or months, you'll have smaller or fewer drinks until you reach a point where you don't have any at all.
Some people think tapering can be a safer way to finally get your heavy alcohol use under control. But even if you try it, you may still have withdrawal symptoms.
Talk to your doctor or an alcohol treatment specialist before you try tapering. They can help you understand what to expect and help you come up with a safe plan.
Alcohol Withdrawal Complications
As you go through alcohol withdrawal, let your doctor know how you're feeling, both physically and mentally. This will help them understand how they can help you.
Alcohol withdrawal fatigue
You're not alone if you feel exhausted after you quit drinking alcohol. Your energy should return once your brain chemicals are back to their normal levels. Until then, try to be patient with yourself. It can also help to:
- Follow your doctor's advice.
- Talk to a therapist or share how you feel in a support group. You may feel better knowing others are going through the same thing.
- Try to stick to a daily routine, even if it's not your usual one. You might make a to-do list to stay on track.
- Celebrate the small things. You're getting healthier and that's the most important part.
Alcohol withdrawal itching
When you stop drinking, it can affect even your skin. Your doctor will want to know if you have any mild itching, numbness, a pins-and-needles feeling, or burning. If untreated, it may get worse. Itching is also linked to hallucinations from alcohol withdrawal.
Alcohol withdrawal seizure
Your risk of having a seizure is highest within the first 12 hours after stopping or reducing alcohol. You're also at a higher risk if you have a history of epilepsy, hypoglycemia, or an electrolyte imbalance.
A seizure can be a medical emergency. Make sure that others with you during this time know to call 911 right away.
If you're with someone who is having a seizure:
- Try to stay calm.
- Stay close by. Move any objects away that could harm them.
- Check for a medical bracelet. It could give more details about their health.
- If they're lying down, turn them on their side. Make sure their mouth is pointing towards the ground.
- If the seizure is over before help arrives, stay with them as they start to recover.
Alcohol withdrawal psychosis
Severe delirium tremens can cause psychosis, which is a disconnect from reality. You could see, feel, or hear things that aren't there. You could also feel paranoid, like others are lying to you or trying to hurt you. Issues with your memory and thinking clearly are also common.
The early warning signs of psychosis include:
- Not sleeping well
- Feeling more anxious than you usually do
- Feeling "off" or not like yourself
- Starting to hear or see things
Call your doctor right away if you notice any of these symptoms. The sooner you start treatment (which often includes both medication and therapy) the better your outcome.
Relapse
Alcohol withdrawal can be uncomfortable and tough. You may reach a point where you start drinking again just to relieve your symptoms. It can be helpful to plan ahead how you'll handle a relapse. For instance, you might write a list of reasons why you want to stop drinking alcohol and read it.
Relapses happen. What's important is how you move forward. Talking with a loved one or therapist about why it happened and what you can do differently next time can be a good next step.
Takeaways
After you stop drinking heavy, regular amounts of alcohol, your nervous system needs time to adjust. That can cause uncomfortable physical and mental symptoms, which can sometimes be life-threatening. Get support from your doctor, friends, and family when you're ready to stop drinking. That way, they can help you manage the discomfort and respond quickly in case of a medical emergency.
Alcohol Withdrawal FAQs
How much does rehab cost?
The average cost is $13, 475, according to the National Center for Drug Abuse Statistics. But it can vary a lot based on the type of program you use. For instance, some 30-day inpatient programs cost $5,000, while others may cost $20,000. Similarly, 90-day rehab programs can range from $12,000 to $60,000.
These costs may seem high, but don't let that stop you from seeking help. There are ways you can afford rehab even if you don't have insurance. For instance, ask if a program offers:
- A sliding scale (which means you're allowed to pay only what you can afford)
- Grants
- Scholarships
- Charity care
- Payment plans
Contact your state's mental health/substance use agency for more guidance on how to afford rehab.
