What Is Alcohol Withdrawal Syndrome (AWS)?
Alcohol withdrawal syndrome (AWS) refers to a set of physical, mental, and psychological symptoms that can occur when a person who has become physically dependent on alcohol stops drinking.
The risk of experiencing minor or major symptoms with alcohol withdrawal syndrome can depend on how long you have been abusing alcohol, how much you regularly consume, as well as whether or not you have any other illnesses or medical problems.
Alcohol withdrawal symptoms can include:
- heart palpitations
- mood swings
- low appetite
- high blood pressure
A severe form of alcohol withdrawal, known as delirium tremens (DTs), can result in more intense and potentially hazardous symptoms, including:
- loss of consciousness or coma
- tremors throughout the body
- chest and stomach pain
- sensitivity to light, touch, and sound
- rapid mood swings
Delirium tremens occurs in approximately three to five percent of alcohol withdrawal cases. This severe type of withdrawal can be fatal for up to five percent of those who experience it. This risk is reduced when a person is monitored and receives adequate care from medical professionals.
You may be at a greater risk of developing DTs if you:
- have a history of going through alcohol withdrawal
- have other injuries, illnesses, or infections
- have been heavily drinking for more than 10 years
- do not eat an adequate amount of food
What Causes Alcohol Withdrawal?
Alcohol withdrawal occurs when a person who has regularly consumed excessive amounts of alcohol, and has thereby developed a dependence, stops drinking.
Whether you go through withdrawal depends on the amount you drink and how often. Alcohol is a depressant, and drinking heavily can affect the central nervous system (CNS) by suppressing brain excitability.
Over time, as you regularly consume excessive amounts of alcohol, neuroreceptors in your brain become accustomed to your drinking, resulting in dependence. Two neurotransmitters that are particularly affected by alcohol abuse are dopamine and gamma-aminobutyric acid (GABA).
Dopamine is linked to the body’s reward system and regulates feelings of pleasure and energy, as well as cognition, mood, and motor coordination. Drinking alcohol can cause a release of dopamine, resulting in feelings of happiness or euphoria.
GABA, on the other hand, is linked to the feeling of relaxation you may get from drinking. Abusing alcohol can lead to a GABA imbalance, and when you cease drinking, both that imbalance and the halted dopamine production can cause several physical, mental, and psychological withdrawal symptoms.
The increased CNS activity and the excitability that occurs when you stop drinking, too, can also cause symptoms experienced within withdrawal.
Alcohol Withdrawal Syndrome Timeline
Understanding the timeline of alcohol withdrawal can give you an idea of what you can expect during the acute withdrawal phase and afterwards in the following weeks and months.
How Long Does Alcohol Withdrawal Syndrome Last?
The initial detox stage for a person who has become alcohol-dependent typically lasts about a week. However, the length of time you experience symptoms of withdrawal may persist beyond a week and can vary on an individual basis.
Most symptoms may reach their peak 24 to 72 hours after a person has had their last drink, while others may appear within the first 12 hours or persist for longer. While some people report experiencing withdrawal symptoms for just a few days, others may notice ongoing symptoms for some weeks or even months after they have stopped drinking.
In addition, those who develop withdrawal delirium (delirium tremens) may experience symptoms that last one to eight days, most commonly lasting two to three days.
Alcohol Withdrawal Timeline
Stage 1: six to 12 hours
You may begin experiencing some minor symptoms within six to 12 hours after you have stopped drinking.
- stomach pain
- mild anxiety
- heart palpitations
Stage 2: 12 to 24 hours
Symptoms may intensify during this stage. You may also begin experiencing additional symptoms such as:
- nausea and vomiting
- hallucinations or delirium (auditory, visual, and/or tactile)
- high blood pressure
Stage 3: 24 to 72 hour
Alcohol withdrawal syndrome (AWS) typically develops 24 to 72 hours after a person has stopped drinking. It is within this stage that symptoms tend to reach their peak.
These symptoms include:
- withdrawal delirium (or delirium tremens)
- increased heart rate and blood pressure
Stage 4: Weeks after stopping use or longer
Those who experience mild to moderate withdrawal can expect to notice a reduction in their symptoms between five to seven days after they began. However, some people do report experiencing some withdrawal symptoms for weeks or even months after stopped alcohol use. These tend to be more of the psychological symptoms, such as cravings.
Symptoms that persist weeks or longer are more commonly experienced in cases where a person has undergone withdrawal without being treated (i.e. did not receive medical care) or has developed post-acute withdrawal syndrome (PAWS).
Post-Acute Withdrawal Syndrome (PAWS)
While most alcohol withdrawal symptoms will decrease after five to seven days, there are some instances in which a person can experience ongoing effects.
Post-acute withdrawal syndrome (PAWS) refers to a set of ongoing alcohol withdrawal symptoms—such as long-term cravings and overwhelming fatigue—that a person may experience following the acute withdrawal phase.
Additional PAWS symptoms include:
- memory problems
- trouble concentrating
- irregular sleeping patterns
- obsessive-compulsive behaviors
- mood swings
A person may experience these symptoms for a few days at a time, and notice them cyclically months after they have stopped drinking. According to the UCLA Semel Institute for Neuroscience and Human Behavior, about 75 percent of individuals recovering from alcohol abuse may experience some PAWS symptoms.
Alcohol Detox Process
Detoxification refers to the physiological process of your body removing toxins from your system. The safest way to detox is to undergo the process within a medically-supervised setting where professionals can monitor your withdrawal symptoms as they begin, peak, and gradually decline.
A person may choose to detox by either tapering the amount of alcohol they are consuming, or by stopping drinking all at once. Choosing the latter can be more dangerous, resulting in more severe withdrawal symptoms.
It is highly recommended not to let you or a loved one undergo the detox phase alone. Withdrawal from addictive substances can be unpleasant regardless, but detoxing without professional attention and care can be dangerous and risky to both short- and long-term health.
How To Safely Treat Alcohol Withdrawal Syndrome
Your safety, or that of a loved one struggling with alcohol abuse, is of the utmost importance during the withdrawal process. Medically-supervised detoxification that involves 24-hour care from medical professionals is the best way to mediate risks and ensure a person’s safety during this process.
After the initial acute withdrawal phase (typically one week), additional forms of treatment may also be recommended in order to safely treat alcohol withdrawal symptoms.
The following are treatment options available after a medically-supervised detox:
- Inpatient Treatment: Inpatient facilities provide a safe and supervised live-in environment for people to undergo alcohol detox. Within these settings, individuals may receive care from various medical professionals trained to ensure that those recovering from alcohol abuse can safely detox and continue on to receive help to treat their addiction.
- Outpatient Treatment: Depending on the severity of your addiction, you may be able to safely detox on an outpatient basis with a friend or family member on standby to monitor your progress. It is important that you do not detox alone, and have someone who can make sure that your symptoms do not worsen or persist longer than normal.
- Medication-Assisted Therapy (MAT): Some medications may be administered or offered to you during the withdrawal process and further along in your recovery to help ease symptoms that accompany withdrawal and recovery from alcohol abuse. These may include antidepressants, sedatives, vitamins, or medications like naltrexone or acamprosate which can help to reduce cravings.
- Support Groups: Many sobriety programs offer and recommend support groups as part of the 12-step method as a means of helping you connect with others who struggle with alcohol abuse. This can be a therapeutic way to work through your own struggles and take part in meaningful social interactions.
- MedlinePlus — Alcohol withdrawal
- MedlinePlus — Delirium tremens
- National Institute on Alcohol Abuse and Alcoholism — Complications of Alcohol Withdrawal
- New England Journal of Medicine — Recognition and Management of Withdrawal Delirium (Delirium Tremens)
- UCLA Semel Institute for Neuroscience and Behavior — Post-Acute Withdrawal Syndrome