Get Help Today.
You are not alone. We can help you get better.

How to Treat Alcohol Withdrawal

Alcohol withdrawal treatment includes management of symptoms using prescription medications. In fact, the primary goals of treating alcohol withdrawal are to prevent seizures and/or delirium tremens and to moderate discomfort related to autonomic instability. More on the treatment of alcohol withdrawal here,

13
minute read
Reviewed by: Dr. Dili Gonzalez, M.D. Dr. Juan Goecke, M.D.

ARTICLE OVERVIEW: Drinkers who become physically dependent on alcohol will go through a period of withdrawal upon cessation or significantly lowered consumption of beer, wine, or spirits. Typically, most cases of alcohol withdrawal require a watch-and-wait supervision to treat symptoms as they occur. However, in cases of heavy or long-term drinking, medical intervention may be required to prevent very serious conditions: seizures or delirium tremens. In this article, we detail the basic protocol of how to withdraw from alcohol. Then, we invite your questions or comments about withdrawal treatment at the end.

TABLE OF CONTENTS


Why Withdrawal Occurs

According to the National Institute on Alcohol Abuse and Alcoholism, every year, more than 1.5 million people in the United States either enter alcoholism treatment or are admitted to a general hospital because of medical consequences resulting from alcohol dependence. [1] These people, as well as a substantial number of others who try to detox at home, experience alcohol withdrawal. But what is withdrawal? Why does it happen?

Alcohol withdrawal is a clinical syndrome that affects people accustomed to regular alcohol intake who either decrease their alcohol consumption or stop drinking completely. In these people, the central nervous system has adjusted to the constant presence of alcohol in the body and compensates for alcohol’s depressive effects on both brain function and the communication among nerve cells (neurons). Consequently, when the alcohol level is suddenly lowered, the brain remains in a hyperactive, or hyperexcited, state, causing withdrawal syndrome.

Ready for help?
Call us today. You don’t need to face addiction on your own.
1-888-882-1456

How Long Does Alcohol Withdrawal Take?

Alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can last for many days. Symptoms usually peak by 24 – 48 hours and then diminish, but some symptoms persist for weeks. The most dangerous symptoms like delirium or seizures can occur a day or two after initial detox…so EVERY CASE OF ALCOHOL WITHDRAWAL SHOULD BE MEDICALLY SUPERVISED.

Symptoms that persist beyond the period of acute withdrawal (the first week or so of detox) are called “protracted” or “post-acute” withdrawal symptoms, and are usually related to sleeping or mood, disorders.

Symptoms

Many people who go through withdrawal from alcohol manifest a set of predictable, minor symptoms, also called a “syndrome”. Signals of alcohol withdrawal may include any combination of generalized hyperactivity, anxiety, tremor, sweating, nausea, retching, tachycardia, hypertension and mild pyrexia.

The most common effects of withdrawal from alcohol include:

Don’t let your loved one suffer.
Addiction responds to treatment. Call us to get started.
1-888-882-1456
  • Agitation.
  • Anxiety or nervousness.
  • Depression.
  • Difficulty concentrating.
  • Disorientation.
  • Fatigue.
  • Headache.
  • Heightened.
  • Sensitivity to light and sound.
  • Irritability.
  • Jumpiness or shakiness.
  • Mood swings.
  • Nausea.
  • Nightmares.
  • Not thinking clearly.
  • Sweating.
  • Tremors.
  • Vomiting.

NOTE HERE: Delirium tremens is the most intense and serious syndrome associated with alcohol withdrawal, is characterized by severe agitation; tremor; disorientation; persistent hallucinations (sensations and images that seem real though they are not); and large increases in heart rate, breathing rate, pulse, and blood pressure.

While treatable, serious withdrawal episodes may contribute to the development of negative health consequences. THIS IS WHY ALCOHOL WITHDRAWAL NEEDS TO MEDICALLY MANAGED! If you are dependent on alcohol, please seek professional help. There is no shame in asking for help. Alcohol dependence is a medical issue. It is treated medically.

Questions about rehab?
Get confidential help day or night.
  • Access to top treatment centers
  • Compassionate guidance
  • Financial assistance options

Protracted Symptoms

The Substance Abuse and Mental Health Services Administration indicate that a protracted withdrawal syndrome may develop following alcohol withdrawal and can persist for up to 1 year after you stop drinking. Some symptoms may be masked as other health disorders, but are actually caused by delayed brain changes. [2]

The symptoms of protracted alcohol withdrawal include:

Start your
recovery today.
  • Anxiety.
  • Depressive symptoms.
  • Increased blood pressure and pulse.
  • Increased body temperature
  • Increased breathing rate.
  • Sleep disruption.
  • Tremor.

Other symptoms of protracted withdrawal syndrome appear to oppose symptoms of alcohol withdrawal.

These symptoms of protracted withdrawal syndrome include:

  • Decreased energy.
  • Decreased overall metabolism.
  • Lassitude.

The significance of this cluster of symptoms has been debated. For example, protracted withdrawal syndrome could reflect the brain’s slow recovery from the reversible nerve cell damage common in alcoholism. Other experts are hesitant to claim that they even exist at all! Clinically, the symptoms of protracted withdrawal syndrome are important, because they may predispose abstinent alcoholics to relapse in an attempt to alleviate the symptoms.

Timeline

So, what can you expect during an episode of alcohol detox? Here, we’ll cover the first few days and typical symptoms that manifest within that time.

Within 6 to 12 hours after alcohol cessation, the common symptoms include:

  • Headaches.
  • Low-level stress or anxiety.
  • Minor hand tremors.
  • Sleep disturbances.
  • Stomach upset/loss of appetite.
  • Sweating.

From 12 to 48 hours after alcohol cessation, a person may experience:

Ready for help?
Call us today. You don’t need to face addiction on your own.
1-888-882-1456
  • General tonic-clonic seizures.
  • Hallucinations that may involve sight, hearing or touch.
  • Withdrawal seizures.

From 48 to 72 hours after alcohol cessation, the person may have:

  • Delirium tremens (see above for more information).
  • Disorientation.
  • Further hallucinations, mostly involving sight.
  • Increased heart rate, blood pressure and temperature.
  • Sweating.

Main Treatments

Symptoms of alcohol withdrawal can range in severity from mild tremors to massive convulsions or withdrawal seizures. Mild alcohol withdrawal can cause pain and suffering; severe alcohol withdrawal can be life threatening.

The goals of alcohol withdrawal treatment are to:

  1. Relieve the person’s discomfort.
  2. Prevent the occurrence of more serious symptoms.
  3. Forestall cumulative effects that might worsen future withdrawals.

Withdrawal treatment also provides an opportunity to engage persons in long-term alcoholism treatment.

Any person going through alcohol withdrawal should receive a physical examination to detect conditions such as irregular heartbeat, inadequate heart function, liver disease, pancreatic disease, infectious diseases, digestive system bleeding, and nervous system impairment. Vital signs should be stabilized and disturbances of water and nutritional balances corrected.

Mild to Moderate Cases

Before you begin any alcohol detox, seek medical diagnosis. A doctor should follow clinical guidelines to manage withdrawal, such as these outlined in the 2013 article published in the medical journal, Indian Psychiatry. If the person the experience mild to moderate alcohol withdrawal symptoms, they can often be treated in an outpatient setting. If you fit into this category, you will need someone to commit to staying with you. It needs to be someone who can keep an eye on you. [3]

Daily visits to the health care provider are often needed until you are stable. It is important that people who complete alcohol withdrawal can continue care in a living situation that helps support them in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.

The acute treatment for mild cases of alcohol withdrawal usually includes:

  • Blood tests.
  • Person and family counseling to discuss the long-term issue of alcoholism.
  • Sedative drugs to help ease withdrawal symptoms.
  • Testing and treatment for other medical problems linked to alcohol use.

Serious Cases

Clinicians use numerous strategies to manage alcohol withdrawal, mainly relying on medications to help address symptoms. The Veteran’s Association’s withdrawal guidelines are published here, for example. [4] Most often, doctor will first assess you using the Alcohol Withdrawal Scale, outlined in this 2015 article published in the medical journal, Drugs. [5] This is why people with moderate to severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. The person will be watched closely for hallucinations and other signs of delirium tremens.

Treatment may include:

  • Administration of fluids or medications through a vein (by IV).
  • Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body.
  • Sedation using medication called benzodiazepines until withdrawal is complete.

So, should you seek a hospital, or not? ALWAYS SEEK PROFESSIONAL HELP IN ANY CASE OF ALCOHOL DETOX.

Medications that Help

Pharmacological treatment is most frequently employed in moderate to severe alcohol withdrawal. Although more than 150 medications have been investigated for the treatment of alcohol withdrawal, clinicians disagree on the optimum medications and prescribing schedules. The following review describes some medications that have been recognized as potential treatments for alcohol withdrawal:

  • Anti-anxiety drugs like benzodiazepines to reduce anxiety withdrawal symptoms.
  • Anti-seizures drugs like Depakote.
  • Beta-blockers which can slow the heart rate, reduce tremors and sometimes also helping with the craving for alcohol.

If you tell your doctor that you are having a problem with alcohol withdrawal s/he might also help you taper off with a benzodiazepine such as Valium or Librium. Typical detox regimens using these medications are as follows:

  • Diazepam (Valium); 10 mg 3 or 4 times in first 24 hours, then 3 or 4 times daily as needed.
  • Chlordiazepoxide (Librium); 50 mg every 6 hours for four doses, then 25 mg every 6 hours for eight doses.

This NIAAA introduction to Alcohol Withdrawal provides more details about medications to be used during detox. In addition, anyone who receives treatment for abstinence from alcohol should receive 100 mg of thiamine as soon as treatment begins. A magnesium supplement may also help improve general withdrawal symptoms, as well as an oral multivitamin formula that contains folic acid (for a few weeks). [6]

Tapering

Some people can just quit drinking alcohol cold turkey without having significant withdrawal symptoms. Other people, however, may suffer significant withdrawal symptoms when they suddenly stop drinking.

Alcohol withdrawal is potentially fatal, so if the person starts to experience significant alcohol withdrawal symptoms when they stop drinking then it is important to gradually detoxify from alcohol rather than quitting all at once “cold turkey”. They can gradually detoxify from alcohol by tapering off, by using alcohol itself or by using medications.

How to taper your drinking?

It all begins by reducing the number of drinks in a sitting, a day, a week, or whichever time frame works best. Tapering off alcohol is often a one-drink-at-a-time progression. Mixed drinks can be made with greater proportions of mixer to alcohol content or replaced with non-alcoholic drinks to mimic the act of alcohol consumption. If nothing else, drink alternatives like water between drinks because hydration is essential for detox.
In addition to quantity, the specific type of alcohol needs to be considered. Hard liquors, for example, contain higher alcohol-by-volume measures than other beverages. It is recommended when attempting to taper off alcohol that an person should substitute these stronger options for wine or beer — or at least hard liquor with a smaller proof.

Finally, when determining how to taper off alcohol, one must always remember the importance of setting. Users should avoid places where recreational or binge drinking is likely to occur, such as clubs, sporting events, parties, and more. Such a conclusion comes down to personal discretion — nobody knows the people and places that create potentially negative consequences like the person in question. This, of course, is easier said than done if drinking has become the crux of one’s social or romantic relationships. Experts advise surrounding oneself with positive influences whenever possible.


Always remember that if the taper is not working for you or if you are having major withdrawal that it is safest to check into a medical detox because alcohol withdrawal can kill you.


After you complete your taper we recommend that you attempt a period of abstinence from alcohol. Thirty days is a reasonable amount of time to shoot for. This will give your body some time to reset back towards normal and also give you a chance to experience most of the situations where you used to drink without alcohol. Thirty days is just a suggestion; some people may choose a shorter period such as a week and others may opt for something longer such as 90 days. Some people might even find that they like abstinence from alcohol so much that they will opt for permanent abstinence once the trial period is up.

Why Detox In A Clinic?

Appropriate treatment of alcohol withdrawal can relieve the person’s discomfort, prevent the development of more serious symptoms, and forestall cumulative effects that might worsen future withdrawals. Hospital admission provides the safest setting for the treatment of alcohol withdrawal. Severe alcohol withdrawal requires pharmacological intervention. Although wide varieties of medications have been used for this purpose, clinicians disagree on the optimum medications and prescribing schedules.

Relative indications for inpatient alcohol detoxification include:

  • Concomitant medical or psychiatric illness.
  • History of alcohol withdrawal seizures or delirium tremens.
  • History of severe withdrawal symptoms.
  • Lack of reliable support network.
  • Multiple past detoxifications.
  • Pregnancy.
  • Recent high levels of alcohol consumption.

Detox At Home

Management of alcohol withdrawal at home could be considered if the person:

  • Does not have a history of complicated withdrawal.
  • Does not have a history of withdrawal seizures.
  • Has an appropriate support person to monitor them and assist with medication administration.
  • Has stable accommodation.
  • Is experiencing mild withdrawal symptoms after 48 hours.
  • Is medically and psychiatrically stable.

If you have been in an inpatient setting and want to leave early to continue to detox from home, please reconsider. You’ll need to be medically and/or psychiatrically reviewed and cleared as low risk of complications if managed in a home setting.

Safety During Withdrawal

The best and the safety way to stop drinking after you develop physical dependence is under medical supervision. Neurologists, psychiatrists, and general physicians are trained in monitoring alcohol detox and identifying signs of complication and then treating them.

Appropriate treatment of alcohol withdrawal can ease discomfort, prevent the development of more serious symptoms, and put off cumulative effects that might worsen future withdrawals; and because alcohol withdrawal can quickly and unexpectedly take a serious turn for the worse, always seek medical help anytime you need to withdraw from alcohol.

Signs of an Alcohol Problem

To be diagnosed with alcohol use disorder, the persons must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). [7]

To assess whether you or loved one may have alcohol use disorder, here are some questions to ask.  In the past year, have you:

  1. Had times when you ended up drinking more, or longer, than you intended?
  2. More than once wanted to cut down or stop drinking, or tried to, but could not?
  3. Spent a lot of time drinking? Or being sick or getting over other aftereffects?
  4. Wanted a drink so badly you could not think of anything else?
  5. Found that drinking, or being sick from drinking, often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  6. Continued to drink even though it was causing trouble with your family or friends?
  7. Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  8. More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  9. Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  10. Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  11. Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

The presence of at least 2 of these symptoms indicates an alcohol use disorder. The severity of the alcohol use disorder is defined as:

  • Mild: The presence of 2 to 3 symptoms.
  • Moderate: The presence of 4 to 5 symptoms.
  • Severe: The presence of 6 or more symptoms.

Who Uses Alcohol?

According to the 2015 National Survey on Drug Use and Health (NSDUH), 86.4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime; 70.1 percent reported that they drank in the past year; 56.0 percent reported that they drank in the past month. [8]

In 2015, 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month; 7.0 percent reported that they engaged in heavy alcohol use in the past month. Even more, the same report documented that an estimated 15.1 million adults ages 18 and older (6.2 percent of this age group) had alcohol use disorder. This includes 9.8 million men (8.4 percent of men in this age group) and 5.3 million women (4.2 percent of women in this age group). Plus, an estimated 623,000 adolescents ages 12–17 (2.5 percent of this age group) had alcohol use disorder. This number includes 298,000 males (2.3 percent of males in this age group) and 325,000 females (2.7 percent of females in this age group).

However, not everyone who needs help gets it.

About 6.7 percent of adults who had alcohol use disorder in the past year received treatment. This includes 7.4 percent of males and 5.4 percent of females with alcohol use disorder in this age group. About 5.2 percent of youth who had alcohol use disorder in the past year received treatment. This includes 5.1 percent of males and 5.3 percent of females with alcohol use disorder in this age group.

As you can see by these statistics, you do not are the only one facing this problem.

Dependence vs. Addiction

Often the terms alcohol addiction and alcohol dependence are used interchangeably, which can lead to confusion.

Alcohol dependence refers to a physical dependence on alcohol and is characterized by tolerance to alcohol and alcohol withdrawal syndrome. Alcohol withdrawal syndrome can be life threatening and occurs when heavy drinkers stop drinking or drastically cut down their alcohol intake.

There is a fine line between the dependence on alcohol and alcohol addiction. Alcohol addiction is a primary condition characterized by the inability to stop using alcohol despite growing negative consequences. Uncontrollable cravings for alcohol, exceeding self-imposed limits, continued use despite physical, psychological, and social consequences, and an inability to stop drinking once one has started are all behaviors that signal addiction has developed.

Your Questions

We hope that you have found this article useful. If you still have questions about alcohol withdrawal and its treatment, please leave them in the section below. We will do our best to respond to all questions with a personal and prompt response.

Reference Sources: [1] NIAAA: Alcohol Use Disorders: Diagnosis And Clinical Management Of Alcohol-Related Physical Complications: Acute Alcohol Withdrawal
[2] NIAAA: Alcohol Facts And Statistics
[3] NIAAA: Clinical Management Of Alcohol Withdrawal: A Systematic Review
[4] CI2I: Inpatient Alcohol Withdrawal Guidelines
[5] NCBI: Identification And Management Of Alcohol Withdrawal Syndrome
[6] NIAAA: Introduction to Alcohol Withdrawal
[7] APA: Diagnostic And Statistical Manual Of Mental Disorders (DSM–5)
[8] SAMHSA: 2015 National Survey On Drug Use And Health: Methodological Summary And Definitions
HAMS: Harm Reduction For Alcohol
MEDLINE PLUS: Alcohol Withdrawal
NIAAA: Alcohol Facts And Statistics
NIAAA: Alcohol Use Disorder: A Comparison Between DSM–IV And DSM–5
NIAAA: Complications Of Alcohol Withdrawal
NIAAA: Introduction Of Alcohol Withdrawal
NIAA: Treatment Of Alcohol Withdrawal
SA HEALTH: Ambulatory/Home Setting Management Of Alcohol Withdrawal
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.
Medical Reviewers
Dr. Dili Gonzalez, M.D. is a general surgeon practicing women's focused medici...
Dr. Goecke is a medical doctor and general surgeon with personal experience of...

All of the information on this page has been reviewed and verified by a licensed medical professional.

9 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

I have read and agree to the conditions outlined in the Terms of Use and Privacy Policy.

  1. I’m 29 years old and have been drinking 4 tall beers(24oz) steel reserves, and a pint of.skole vodka every night for 3 years straight now. I have not gone without drinking for one night in that time. As of a couple months ago, my hands have.started shaking around noon the next day, followed my anxiety, sweats, and irritability. Also, I dont sleep anymore, i start drinking around 7pm, fall asleep by 10pm, then I usually have a horrible nightmare that wakes me up around 1:30-2:00am and im awake from then on. Sometimes I have extra alcohol stashed away for when I wake up I chug it and fall back asleep for a couple hours. My question is. I’d like to taper off the alcohol with use of meds as well as I suffer from severe depression and anxiety, thats why I drink. I dont have any insurance so treatment is not an option so im going to taper off at home with family support. Will the emergency room help me at all? Will the emergency room give craigslist meds or do I have to go to another clinic of some sort? I know this blog is old but please respond if you can? Im desperate and really need to sleep. Please answer and please e-mail me. Thank you,
    Jeff

  2. helpful article, much-needed article for this generation people, most of them are not aware of alcohol and withdrawal, alcohol is a silent killer and it will keep creating negative thoughts and emotion I quit 6 months and now leading a life in a happy and healthy way. keep sharing with us

  3. Hi – I started a self detox but I felt so bad at the end day one Ive decided by 2 I needed a large gin in the morning – just to lessen the shakes – so now at end of day two I feel fifty per cent better and as its tapered the drinking will be zero I plan by weeks end. The shakes are starting to go so therefore I can produce this on a fidly mobile phone. However of an evening when at work Im having halucination. Porn is coming up in video on the walls and windows and I see a naked group of people cavorting outside (I know you wont laugh). How long do think it may be before they subside? I have several periods of alcohol dependency and Im 54 years of age – I cant go to rehab so would the doctor prescribe any anti – hallucogenics? Regards – Dave

    1. Hi Dave. Call a toll-free Alcohol Helpline on 1-888-675-1820 to find a high-quality alcohol addiction treatment program. This helpline is accessible 24/7 and gives you the chance to speak with trusted treatment consultants who can help you find an alcohol recovery program suited to your individual needs.

  4. Is it advised to taper off alcohol rather than going cold turkey? The withdrawal symptoms / DTs sound terrifying!
    I have been reading articles by the HAMS org and they have recommended a slow taper process rather than quitting and going through the expensive and embarrassing detox route. I have been drinking get at least a pint of whiskey or more a night for about 10 years. Thanks

  5. Hi Noel. I had a hard time understanding your comment, but I believe you say you are being regularly checked by a doctor. That’s good. Maybe your doctor can ferer you to a facility that can treat your problem with alcohol and help you stop drinking for good. All the best, Noel.

  6. im drinkig off and on for 30 jears now for mij fam it is a very teribble time if i doo so as the jears past i lowerd the amound wich resolted in 4 bott 350ml guisness stout still im drunk after such a small amount as an problem drinker u can never know wen i will react the habbet seems tu come from the left side off the brain every treatment helped but ju never know wen a problem acure it can be a song that can bring good or bad mamories counnselers are the wurst nightmare in mij case and stil i hope after 30 jears too come with a solution regulary checked bij docters imhealty littel over weight but ready too and this madness thanks for the opertuaty given too write but hopefully ju can come with a straight answer

  7. Is it possible that my over thinking or this thing that keep popping out of my mind is a sign of depression or mental disorder due to my alcohol addiction? Anyone can answer that i’m just new to alcohol and has been drinking for around couple of months now and I just stopped drinking last week.

Get Help Today.
You are not alone. We can help you get better.
I am ready to call
i Who Answers?