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Alcohol withdrawal syndrome

What does alcohol withdrawal mean?

Alcohol withdrawal is a term used to describe the symptoms that occur when a person suddenly stops drinking after long and intense alcohol use. The condition is also known as alcohol withdrawal syndrome.

People who go through alcohol withdrawal often live with a chronic alcohol addiction, sometimes referred to as alcoholism.

Approximately every second alcoholic person develops alcohol withdrawal symptoms when alcohol consumption is severely reduced or stopped. Symptoms usually appear between six and 24 hours after the last drink or when drinking has been severely reduced.

Most people who have been withdrawn from alcohol have mild symptoms and include anxiety, restlessness, headaches, and craving for alcohol. However, about one in five people who have been withdrawn from alcohol have more severe symptoms and may include hallucinations, seizures, or even delirium.

There is a fixed catalog of criteria on which the diagnosis is based. This requires a thorough medical history and physical examination. Further examinations will be carried out to assess alcohol dependence and to check for possible complications. Treatment includes sedatives and a careful follow-up of the affected person.[1],[2],[3],[4],[5],[6],[7],[8]

Anyone who thinks they are going through alcohol withdrawal can try Ada to find out more about their symptoms.

What causes alcohol withdrawal?

Withdrawal symptoms are caused in alcoholic people by stopping or greatly reducing their alcohol consumption. It is known that alcohol addiction is caused by a combination of genetic, psychological, and social factors.

In general, alcohol decreases the general activity of the brain. If a person drinks large amounts of alcohol regularly, it can eventually lead to one Imbalance between activating and inhibiting nerve tracts to lead. When regular alcohol consumption is stopped, the brain becomes overactive. This leads to the typical symptoms of alcohol withdrawal.[1],[6],[7]

However, only about every second person who is alcoholic develops withdrawal symptoms with greatly reduced or discontinued alcohol consumption.

Some of the factors that make this more likely include:[1]

  • the amount of beverages consumed per occasion,
  • the presence of alcohol-related complaints,
  • the degree of physical dependence,
  • how much the body has got used to alcohol and consequently needs it.
  • no more than 24 hours have passed since the last drink.

The genes may play a role in the development of alcohol withdrawal and its severity. However, this is still being researched.[1]

What are the symptoms of alcohol withdrawal?

Symptoms of alcohol withdrawal can occur when a person suddenly stops drinking or suddenly reduces it significantly after prolonged and heavy drinking.

The symptoms:[1],[6],[7],[8]

  • only occur in about one in two people living with an alcohol addiction when they suddenly stop drinking.
  • typically occur between six and 24 hours after the last drink or when there has been a severe reduction in alcohol consumption.
  • can be divided into two types: physical and mental.
  • are rather easy for most of those affected.
  • are more serious in about every fifth person affected and can lead to hallucinations, seizures or even delirium.
  • The more severe the withdrawal, the longer the symptoms last.

Symptoms of alcohol withdrawal include:[1],[2],[6],[7],[8]

Slight withdrawal

  • Start: six to 36 hours after the last drink.
  • The following symptoms last a day or two:
    • anxiety
    • agitation
    • Restlessness
    • sleep disorders
    • Vary
    • increased sweating
    • fast heartbeat
    • a headache
    • Cravings for alcohol
    • Loss of appetite
    • nausea
    • Vomit
    • high blood pressure

Alcohol hallucinosis

  • Start: six to 48 hours after the last drink.
  • The symptoms last a day or two:
  • can occur with or without symptoms of mild withdrawal
    • usually visual hallucinations - people often see insects or animals in the room
    • Audible or tactile hallucinations can also occur.
    • Affected people mistakenly hear something or perceive contact with an imaginary object.

Epileptic seizures from withdrawal

  • Start: twelve to 48 hours after the last drink.
  • can occur with or without symptoms of mild withdrawal
  • occur in ten to 30 percent of alcohol withdrawal cases
    • Seizures that affect the entire body - these can occur singly or in clusters of two or three.

Withdrawal delirium

  • Start: 48 to 96 hours after the last drink.
  • also called delirium tremens
  • medical emergency
  • occurs in one to four percent of people with alcohol withdrawal who are in a hospital
    • Disturbance of attention and cognition
      • rapid onset
      • changeable course of the disease
  • sometimes accompanied by:
    • Hallucinations
    • agitation
    • fever
    • greatly accelerated heart rate
    • high blood pressure
    • profuse sweating.

If you are unsure whether these symptoms apply to you, start a symptom analysis.

How is alcohol withdrawal diagnosed?

There is a fixed set of criteria on which the diagnosis of alcohol withdrawal is based. This requires a thorough medical history and physical exam. More tests will be done to assess underlying alcohol addiction, check for possible complications, and rule out other medical conditions. [1],[6],[7]

The procedure for diagnosing and evaluating alcohol addiction includes:[1],[6],[7]


  • Heavy alcohol consumption in the past
    • previous withdrawal syndromes
    • previous attempts at treatment
  • other drugs that are being taken
  • mental illness
  • social situation and support
  • physical symptoms.

physical exam to clarify:

  • the severity of the withdrawal syndrome
  • additional or alternative diseases
  • long-term effects in alcohol addiction.

Laboratory tests

  • Blood tests
    • In particular, examination of the liver and kidney function as well as the blood sugar level and the serum alcohol concentration
  • Testing for drugs in the urine
    • especially checking for benzodiazepines, cocaine, and opioids

Further investigations

  • Electrocardiogram (EKG) - recommended for the elderly.

Imaging examinations

  • CT scan - only required:
    • in people who are having an epileptic seizure for the first time
    • if the withdrawal is different from previous withdrawal syndromes
    • when mental changes are not typical of withdrawal syndrome
    • when head trauma is likely.

How is alcohol withdrawal treated?

Alcohol withdrawal requires both short-term and long-term treatment. The short-term therapy aims to treat the physical and psychological symptoms that occur in the context of withdrawal.

The aim of treatment is to alleviate symptoms, identify and correct possible metabolic disorders, and treat other possible complications.

Long-term treatment focuses on helping a person maintain abstinence and manage the underlying alcohol addiction.[2],[3],[6],[7],[8]

Short-term therapy includes:[2],[3],[6],[7],[8]

  • Supportive measures - monitoring and regular clinical reassessment
  • This includes monitoring vital parameters such as heart rate and blood pressure, as well as repeated monitoring of the blood sugar level and blood alcohol concentration.
  • Intensive care unit admission can be considered for people:
    • who are over 40 years old
    • with concurrent illnesses
    • with a history of problematic withdrawal
    • that do not respond well to treatment
    • who have unstable vital signs
    • who have severe metabolic disorders
    • who have other complications.
    • Metabolic imbalances should be corrected.

Intravenous infusions

  • This is necessary for all people with alcohol withdrawal.
  • Fluid is given through an intravenous line.

Nutritional supplement

  • This should be done through an intravenous line initially, as gastrointestinal absorption is restricted and there is a risk of vomit entering the airways and choking the person.
  • includes the administration of:
    • Thiamine (vitamin B1)
    • Glucose
    • Folic acid
    • Multivitamins

Safe area

  • It should be a quiet and protected place.
  • Temporary physical restraint may be necessary in people with withdrawal delirium to prevent them from harming themselves and others.
  • Any restraint should be removed as soon as the sedatives begin to work.


  • Benzodiazepines
  • These are necessary for all people with alcohol withdrawal to relieve their anxiety and avoid complications.
    • The treatment acts like a sedative and reduces the person's neural overactivity.
    • Benzodiazepines should never be taken long-term because of the high risk of becoming dependent.

Can you prevent alcohol withdrawal?

Withdrawal from alcohol only occurs after long-term consumption of large amounts of alcohol and can therefore be prevented by generally avoiding alcohol or at least by severely restricting alcohol consumption.

People who are alcoholic should turn to specialized treatment facilities to successfully manage their condition.

In people who develop symptoms of alcohol withdrawal, it is important to start treatment as early as possible to avoid serious medical conditions or complications.[7]

What is the prognosis for alcohol withdrawal?

People who have been withdrawn from alcohol may be under for a few months Trouble sleeping or minor signs of an overactive nervous system, such as a fast heartbeat, restlessness or sweating.

Half of the people manage to stay abstinent for a year. Long-term treatment for the underlying alcohol addiction in a specialized treatment facility can reduce the likelihood of relapse.[7]

What are the complications of alcohol withdrawal?

Alcohol hallucinosis, epileptic seizures, and delirium (see above) are typical complications of alcohol withdrawal. Other complications are:[1],[2],[6],[7]


  • This can be a short-term consequence of too high a dose of medication.

Disturbed electrolyte balance

  • low magnesium levels
  • low levels of potassium
  • low sodium levels

Increased likelihood of dying

  • With appropriate treatment, this rarely occurs.
  • other complications due to chronic alcohol addiction.

Anyone who thinks they are going through alcohol withdrawal can try Ada to find out more about their symptoms.

  1. UpToDate. “Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis” - Status: 06 November 2019 ↩↩↩↩↩↩↩↩↩

  2. UpToDate. “Management of moderate and severe alcohol withdrawal syndromes” - Status: 06 November 2019 ↩↩↩↩↩

  3. UpToDate. “Ambulatory management of alcohol withdrawal” - Status: 07 November 2019 ↩↩↩

  4. Medscape. “Alcohol Toxicity” - Status: 06 November 2019 ↩

  5. Medscape. “Alcoholism” - Status: 06 November 2019 ↩

  6. Medscape. “Withdrawal Syndromes” - Status: 06 November 2019 ↩↩↩↩↩↩↩↩↩

  7. BMJ Best Practice. “Alcohol withdrawal” - Status: 06 November 2019 ↩↩↩↩↩↩↩↩↩↩↩

  8. Anvil. “Alcohol use disorder” - Status: 06 November 2019 ↩↩↩↩↩