Alcohol detox symptoms

Alcohol withdrawal syndrome is characterized by central nervous system hyperactivity that occurs when an alcohol dependent individual abruptly stops or significantly reduces alcohol consumption. More about detoxing from alcohol safely in this article.

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Alcohol detox symptoms occur in people who develop physical signs of addiction to alcohol and occur when an alcohol dependent person reduces levels of drinking, or stops drinking altogether. While alcohol withdrawal fatalities are rare, it is possible in very heavy, chronic drinkers. So how can you withdraw from alcohol safely? We review common symptoms of alcohol detox here and present safe options for getting help for each. Then, we invite your questions about alcohol withdrawal or its implications at the end.

When does alcohol detox start?

Onset of alcohol withdrawal is usually between 6- 24 hours after the last drink or following significant reduction in alcohol consumption. In some individuals (usually relatively fit and healthy), the withdrawal syndrome is short-lived and inconsequential, with the acute phase resolving well within five days with minimal or no medical intervention. However, in others it increases in severity over the first 48 – 72 hours of abstinence. In some severely dependent drinkers, withdrawal can occur when the blood alcohol level is decreasing, even if the patient is still intoxicated or has consumed alcohol recently, with a significant proportion of dependent drinkers experiencing the onset of withdrawal symptoms before the blood alcohol level reaches zero.

Alcohol detox: How long?

Usually during alcohol detox, there are 2-6 days of acute withdrawal, with the worst symptoms presenting around the 2nd or 3rd day after the last drink, but this may vary from person to person. Psychological symptoms of alcohol withdrawal, including dysphoria, sleep disturbance and anxiety often persist for 1-2 weeks after drinking cessation and can continue for months. Protracted alcohol  withdrawal symptoms may persist for at least 1 year.

Symptoms of alcohol detox

The signs and symptoms of alcohol withdrawal may be grouped into three major classes (autonomic, gastrointestinal and cognitive and perceptual changes), and may be uncomplicated or complicated withdrawal.  The following are the “uncomplicated” withdrawal symptoms that may occur:

Category I: Autonomic hyperactivity

  • fever (generally <38 Celsius degrees)
  • hypertension
  • sweating
  • tachycardia
  • tremor

Category II: Gastrointestinal symptoms

  • anorexia
  • diarrhea
  • dyspepsia
  • nausea
  • vomiting

Category III: Cognitive and perceptual changes

  • anxiety
  • disturbed sleep, vivid dreams
  • poor concentration
  • psychomotor agitation

Severe alcohol detox symptoms

Some of the more severe withdrawal symptoms that very heavy or long term, chronic drinkers may expect during detox can include:

  • dehydration and electrolyte disturbances
  • delirium
  • hallucinations or perceptual disturbances (visual, tactile, auditory)
  • seizures

Seizures may occur 6 – 48 hours after the last drink is consumed in heavily alcohol dependent individuals, and can occur even if the blood alcohol level is high (e.g. greater than 0.10 g%) in severely dependent drinkers. Alcohol withdrawal delirium usually occurs 48 – 96 hours after the last drink is consumed but may take up to seven days to appear. The delirium usually lasts for 2 – 3 days, although can persist for several days.Hallucinations may appear within the first 24 hours and in some cases last up to three days; however they can resolve within 24 – 48 hours. Some patients may also experience paranoia, psycho-motor disturbances, abnormal affect and other delusions.

PAWS alcohol detox symptoms

The protracted withdrawal syndrome which may develop after acute withdrawal includes symptoms associated with detox that persists beyond the typical time course. These symptoms include:

  • anxiety
  • depressive symptoms
  • increased breathing rate, body temperature, blood pressure and pulse
  • sleep disruption
  • tremor

Other protracted withdrawal symptoms appear to oppose symptoms of acute alcohol withdrawal. These symptoms of PAWS include:

  • decreased energy
  • decreased overall metabolism
  • lassitude

Alcohol detox side effects

Alcohol withdrawal management can occur in a variety of settings, ranging from hospital inpatient, community residential (e.g. specialized detoxification unit) to ambulatory services (outpatient or home-based detoxification services). The withdrawal setting should be carefully selected for each individual person. The choice of withdrawal setting requires a comprehensive clinical assessment and discussion (with your family) regarding the advantages and disadvantages of each approach.

Furthermore, people attempting alcohol withdrawal are vulnerable to psychological stress. Treatment is more effective in an environment that is quiet, non-stimulating, and non-threatening. Easy availability of alcohol and other drugs reduces the likelihood of treatment completion. Factors to be considered in determining the most appropriate withdrawal setting for an individual include:

  • likely severity of alcohol withdrawal and occurrence of severe withdrawal complications (seizures, delirium, hallucinations)
  • use of other substances: individuals who report heavy use of other drugs (e.g. benzodiazepines, psychostimulants, opiates), may be at increased risk of withdrawal complications and generally require close monitoring and supervision (e.g. community residential unit)
  • concomitant medical or psychiatric conditions: patients with significant co-morbidity may require hospital admission until medically cleared. Patients may be able to be ‘step-down’ to less intensive withdrawal settings to complete withdrawal once medically stable.
  • social circumstances, the availability of a safe environment and ‘home’ supports
  • outcome of prior withdrawal attempts: repeated failure at ambulatory withdrawal may be an indication for referral to a residential detox unit
  • patient preference and availability of resources

Alcohol detox and its complications are among the most visible consequences of alcoholism. These types of syndromes arise directly from adaptations made within nerve cell communication systems that are targets of alcohol in the brain. Acute withdrawal symptoms and complications, including seizures, hallucinations, and delirium tremens, represent medical emergencies. Some complications may be permanently disabling. In addition, the distress associated with acute and protracted withdrawal presents an ongoing motivation to relapse to alcohol use in recently detoxified patients. Thus, the early stages of sobriety represent a period of risk at many levels. Supportive counseling should be provided to maintain motivation, provide strategies for coping with symptoms, and reduce high-risk situations.

Question about alcohol detox

Alcoholism is a serious, worldwide problem that is tearing up families and destroying lives. If you, or someone you know is coping with this kind of situation, you should know that you’re not alone, and there is a way out of it. So, please, if you have any more questions regarding alcohol detox, or comments and experiences to share, please post them in the comment section below. We will be happy to address them as quickly as we can.

Reference sources: Medline Plus: Alcohol withdrawal
NIAAA Publications: Complications of alcohol withdrawal
NCBI: Acute withdrawal, protracted abstinence and negative affect in alcoholism
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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