Alcohol withdrawal

Alcohol withdrawal occurs most often in adults. But it may also occur in teenagers or children.

The more often you drink, the more likely you are to have alcohol withdrawal symptoms when you stop drinking.

You may have more severe withdrawal symptoms if you have certain other medical problems.

Alcohol withdrawal symptoms tend to occur within 8 hours after the last drink, but can occur days later. Symptoms tend to peak by 24 to 72 hours, but may go on for weeks.

Common symptoms include:

• Anxiety or nervousness
• Depression
• Fatigue
• Irritability
• Jumpiness or shakiness
• Mood swings
• Nightmares
• Not thinking clearly

Other symptoms may include:

• Sweating, clammy skin
• Enlarged (dilated) pupils
• Headache
• Insomnia (sleeping difficulty)
• Loss of appetite
• Nausea and vomiting
• Pallor
• Rapid heart rate
• Sweating, clammy skin
• Tremor of the hands or other body parts

Delirium tremens is a severe form of alcohol withdrawal. It can cause:

• Agitation, irritability
• Sudden, severe confusion (delirium)
• Fever
• Seeing or feeling things that aren't there (hallucinations)
• Seizures

Your health care provider will perform a physical exam. This may reveal:

• Abnormal eye movements
• Abnormal heart rhythms
• Dehydration (not enough fluids in the body)
• Fever
• Rapid breathing
• Rapid heart rate
• Shaky hands

Blood and urine tests, including testing for toxins and drugs, may be done. An electrocardiogram (ECG) may also be done.

The goals of treatment are to:

• Reduce withdrawal symptoms
• Prevent complications of alcohol use
• Help you to reduce or stop drinking alcohol

INPATIENT TREATMENT

People with moderate-to-severe alcohol withdrawal symptoms may need to be treated at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens.

Treatment may include:

• Monitoring blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body
• Giving fluids or medicines through a vein (by IV)
• Giving sedatives until withdrawal is complete

OUTPATIENT TREATMENT

If you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. During this process, you will need someone to stay with you and keep an eye on you. You will likely need to make daily visits to your provider until you are stable.

Treatment usually includes:

• Sedatives to help ease withdrawal symptoms
• Blood tests
• Patient and family counseling for alcohol use issues
• Testing and treatment for other medical problems linked to alcohol use

It is important to go to a living situation that supports you in avoiding unhealthy alcohol use. Some areas have housing options that provide a supportive environment for those trying to stay sober.

Total and lifelong avoidance of alcohol (abstinence) is the best treatment for those who have gone through alcohol withdrawal.

More information and support for people with alcohol use disorder and their families can be found at:

• Alcoholics Anonymous -- www.aa.org
• Al-Anon Family Groups/Al-Anon/Alateen -- al-anon.org
• National Institute on Alcohol Abuse and Alcoholism -- www.niaaa.nih.gov
• SMART Recovery - www.smartrecovery.org/
• Substance Abuse and Mental Health Services Administration -- www.samhsa.gov/atod/alcohol

How well a person does depends on the amount of organ damage and whether the person can stop drinking completely. Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months. People who continue to drink a lot may develop health problems such as liver, heart, and nervous system disease.

Most people who go through alcohol withdrawal make a full recovery. But, death is possible, especially if delirium tremens occurs.

Alcohol withdrawal is a serious condition that may quickly become life-threatening.

Call your provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. Call for an appointment with your provider if symptoms persist after treatment.

Go to the emergency room or call 911 or the local emergency number if seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.

If you go to the hospital for another reason, tell the providers if you've been drinking heavily so they can monitor you for symptoms of alcohol withdrawal.

Reduce or avoid alcohol. If you have a drinking problem, it is best to stop drinking alcohol completely. Total and lifelong avoidance of alcohol (abstinence) is the safest approach.

Detoxification - alcohol; Detox - alcohol

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Kelly JF, Renner JA. Alcohol-related disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 26.

Mirijello A, D'Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543 pubmed.ncbi.nlm.nih.gov/25666543/.

O'Connor PG. Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 30.

Updated by: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.