There are different symptoms and stages of alcohol withdrawal, depending on the following patient characteristics4:
- The duration of alcohol use (long-term vs. short-term user)
- The amount of alcohol use (how “heavy” the drinking history is)
- How abruptly alcohol was discontinued
The stages of alcohol withdrawal, which increase in severity1, and consist of the following;
- Minor withdrawal symptoms (“hangover” symptoms)
- Occurs 6-12 hours after cessation of alcohol.
- Alcoholic hallucinosis – visual, auditory and tactile hallucinations
- Occurs 12-24 hours after cessation of alcohol.
- Alcohol withdrawal seizures
- Occurs 24-48 hours after cessation of alcohol.
- Delirium tremens – delirium, psychosis, seizures and coma
- Occurs 48-72 hours after cessation of alcohol.
It’s important to note that someone who uses alcohol does not necessarily progress through these stages from 1 to 4. The longer you drink, the heavier you drink, and the more abruptly you discontinue drinking simply places you at a higher risk of experiencing a higher stage; particularly stages 3 and 4. This, therefore, places you at a higher risk of a serious withdrawal symptom and even death.
What Causes the Symptoms?
Alcohol has a depressive effect on the central nervous system, meaning that it slows it down. This causes impaired coordination, slurred speech, and a staggering gait. In higher doses, it even causes coma and death.4
With long-term alcohol use, the body adjusts to the intake of alcohol and the same amount of alcohol no longer produces the desired effect. This is called tolerance. Thereafter, there is a subsequent imbalance in brain chemistry, causing abnormal and excessive firing of neurons in the brain when alcohol is withheld.4 This abnormal firing of neurons can cause severe aforementioned symptoms such as hallucinations or seizures. Without the depressive effects of alcohol, this “excited” state can be unbearable to withstand.
Signs and Symptoms
The symptoms of alcohol withdrawal can range from mild to severe, as we have mentioned previously.
Mild withdrawal symptoms, or a “hangover,” often include1:
- Tremors or “the shakes”
With sustained/long-term alcohol use, withdrawal then includes:
- Tachycardia or palpitations
More severe withdrawal symptoms can be downright terrifying, and these include stages 2, 3 and 4; hallucinations, seizures and delirium tremens (or “DTs”) respectively.
Delirium tremens is a potentially fatal complication of alcohol withdrawal. It occurs within 48 to 72 hours after the last drink. It is a rapid onset of confusion, altered consciousness, vivid hallucinations and possibly withdrawal seizures. DTs can occur in up to 10% of alcoholics that go through the withdrawal process. Delirium tremens has a mortality rate of nearly 35% when not treated, making alcohol one of the most dangerous substances to detoxify from. It is absolutely essential that delirium tremens is managed in an inpatient, hospital setting (Trevisan, Boutros, Petrakis & Krystal, 1998).