Alcohol Withdrawal

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Anyone who has ever drunk an excessive amount of alcohol is familiar with the immediate effects of alcohol withdrawal. A hangover is a very mild form, mainly due to loss of fluid and electrolytes. For those who have become dependent on alcohol, withdrawal is much more severe, even life threatening.

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Alcohol withdrawal syndrome

Seriousness and extent of symptoms depends on how long alcohol abuse has lasted, how much alcohol is consumed on a daily basis, and whether or not the patient has previously had alcohol withdrawal. Kindling is the phenomenon where someone who has repeatedly undergone alcohol withdrawal has more severe symptoms. This occurs even when the usage hasn’t markedly increased. Just by having undergone withdrawal previously, the syndrome is made worse.

The general stages of withdrawal (time to onset from last drink):

Minor symptoms (6 to 12 hours)
Headache, mild anxiety, insomnia, nausea, excessive sweating, loss of appetite, trembling.
Medium symptoms (12 to 24 hours)
Hallucinations – these may be visual, audio, or even tactile. These usually resolve within 48 hours.
Major symptoms (24 to 48 hours)
Seizures – tonic-clonic, may require emergency response. In some cases, these can start as soon as a few hours after cessation of alcohol.
Alcohol withdrawal delirium - can range from mild to severe (48 to 72 hours)
Also called delirium tremens, these are characterized by visual hallucinations, rapid heartbeat, sweating, tremor, disorientation, and agitation. These usually peak at about 5 days. Episodes of delirium tremens have a fatality rate of one to five percent.


Medications are used to treat the symptoms of alcohol withdrawal. These include antipsychotics to control hallucinations and agitation, anti-anxiety medications (which can also help with tremor and insomnia) such as Valium or Xanax, and blood pressure medications like Clonidine.

Sometimes, alcohol will be used in a measured and controlled way to reduce the severity of withdrawal. This can be administered through an IV along with fluid replacement and vitamins. Thiamine is a critical nutrient that is depleted in alcoholics and sometimes withdrawal will be withheld for a day while the vitamin is given to allow levels to build up.

Medications are sometimes given on an outpatient basis, but for serious cases inpatient monitoring is necessary to handle severe symptoms as they turn up.

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