Alcohol Withdrawal Syndrome

Alcohol withdrawal syndrome (AWS) refers to unpleasant symptoms that take hold when long-time drinkers quit suddenly. AWS happens most often in adults, but teenagers can experience problems too. 

Common symptoms of alcohol withdrawal include anxiety, shaking, hallucinations, and seizures. Because AWS can be life-threatening, anyone with alcohol dependence should get help to quit.

If you have AUD, alcohol detox is often the first step toward better health. 

During detox, alcohol is processed out of your body, and you may experience mild to severe withdrawal symptoms. While these symptoms often ease after the first couple weeks, the overall timeline depends on the severity of your dependence on alcohol.

Getting through withdrawal is not something to do on your own. It is a complex time that people experience with varying intensity levels. Symptoms of withdrawal can change rapidly, and in cases of severe alcohol dependence, withdrawal can be a potentially dangerous process. 

As a result, medical detox is recommended for safety. When you detox with the care and support of medical professionals, they can help you manage the experience with medications and other treatments.

What to Expect During Medical Detox

By working together with a medical professional in a recovery setting, you can focus on getting better and moving forward in your life.

Medical detox is designed to help you transition from alcohol abuse to sobriety in a safe and controlled manner. Since AWS tends to progress in stages, the treatment you’ll need changes as your symptoms change. 

This table can help you understand a typical process.

An alcohol detox program is designed to provide medications and support before life-threatening problems start. Enrolling in a program like this means a reduced risk of issues like seizures. However, the careful monitoring a program like this provides ensures you can get quick help if problems appear.

Medications for Alcohol Withdrawal 

Various medications may be used to reduce uncomfortable symptoms during detox from alcohol. These medications can help to balance an individual’s biochemistry and reduce the risk of complications. 

Typically, medications for alcohol withdrawal include benzodiazepines, barbiturates, gabapentin, and clonidine. Naltrexone, acamprosate, and disulfiram are options for prolonged alcohol abstinence.

Benzodiazepines

These drugs are commonly called benzos, and they are frequently used to manage withdrawal symptoms. They are often a top choice for alcohol withdrawal to soothe nerves and calm the central nervous system.

The goals of benzodiazepine treatment include the following:

• Controlling AWS symptoms
• Improving vital signs (like temperature, heart rate, and blood pressure)
• Preventing seizures

Some benzos are short-acting, and some are long-acting. Long-acting benzodiazepines, such as Valium and Librium, are generally used for alcohol detox. Doctors look for a treatment amount that helps patients feel somewhat sedated but still arousable.

Barbiturates

Some people with AUD don’t respond to benzodiazepines, and their symptoms intensify during withdrawal. Barbiturates work on a slightly different binding site in the brain and may work when benzos do not.

The goal of barbiturate therapy is to reduce unpleasant or life-threatening symptoms. These medications can be delivered with benzos like Valium or Librium, or they can be given alone. Since some barbiturates can last in the body for up to 140 hours, they can deliver long-term relief.

Gabapentin

This partial opioid medication is a sedative with anti-seizure properties, making it a good choice for AWS. Research suggests the drug can reduce alcohol cravings too, so it might be beneficial as a take-home medication until the person can enter an AUD treatment program.

Opioids like gabapentin do come with addiction risks, so they’re not always ideal for people with an addiction history. However, if people don’t respond to therapies like benzodiazepines or barbiturates, gabapentin could be a good option.

Clonidine

Clonidine is a beta blocker that can reduce high blood pressure, fast heart rates, and excessive sweating. While clonidine doesn’t help with seizures, and high doses can mask some important seizure markers, it can help people feel more comfortable as they transition to sobriety. Typically, clonidine is used alongside other therapies, such as benzodiazepines.

Acamprosate

At the end of an alcohol detox program, people have achieved sobriety. However, they remain at a high risk of relapse until completing an AUD treatment program. Acamprosate can work as a bridge from detox to treatment.

Acamprosate’s action isn’t well-defined, but researchers think that it works on GABA receptors and makes alcohol less rewarding. It’s particularly helpful, researchers say, for people who have achieved a short period of sobriety, such as a detox program enrollment.

Disulfiram

This medication is also used to help people move from a detox program to long-term sobriety. It works by blocking alcohol’s breakdown within the body. Even a tiny sip of alcohol can make people feel very sick, leading to fewer cravings and relapse risks.

Disulfiram doesn’t directly address alcohol cravings. However, with time, it can help people to redefine their relationship with alcohol.

Naltrexone

Naltrexone is another medication option that could promote long-term sobriety. While this drug was originally designed to address opioid abuse, researchers say it can also reduce alcohol cravings and relapse risks.

Naltrexone administration rarely begins until seven to 10 days of detox have passed, as it can stimulate symptoms of withdrawal.

Why Medications for Alcohol Detox Matter

By working with a treatment professional, you can take medications to manage cravings, reduce stress, and reduce your reliance on drinking.

Alcohol is a depressant, and you may have been relying on it for months, years, or decades. During that time, your brain and biochemistry became dependent on alcohol. When you stop drinking, it takes a period of time for your body to adjust to its absence. 

This period is what is commonly called withdrawal. During withdrawal, you may have a mixture of symptoms that can range from mild to severe. The symptoms may be physical as well as psychological. 

For some people, withdrawal is not a huge deal. For others, it is extremely severe and painful. It can even be life-threatening.

Treatment professionals are skilled at helping you manage pain and focus on your recovery process. They can ensure you stay safe and are able to focus on therapy during this time.

What Doctors Look for During Detox 

Alcohol withdrawal symptoms are different for each individual. They can change quickly and often catch people off guard if they are not familiar with the stages of alcohol detox. Due to this, it is important to work with a medical treatment provider who can guide you through the process.

During the first 24 hours after taking a drink, there are generally mild symptoms. These may include headaches, loss of appetite, nausea, irritability, restlessness, and difficulty sleeping. 

More severe symptoms can include seizures, hallucinations, and tremors. 

A condition called delirium tremens can include several symptoms, such as increased heart rate, elevated blood pressure, and breathing problems. Hand tremors known as the shakes may increase. A person experiencing this may feel extremely disoriented and uncontrollably restless.

It is estimated that 5 to 10 percent of people experience seizures during withdrawal. If these seizures are not properly treated, one in three of these people will continue to experience more severe symptoms associated with delirium tremens.

A seizure during withdrawal could result in permanent injury or even death. To avoid this, it is essential to seek medical support that may include the use of medications to manage withdrawal symptoms. 

Even after serious withdrawal symptoms have subsided, some people develop PAWS or post-acute withdrawal syndrome. This syndrome can include low energy, anxiousness, and difficulty sleeping. These symptoms may continue for several months or longer.

Again, medical assistance can help to effectively treat PAWS. Alcohol withdrawal doesn’t have to be painful. With the right support, you can effectively get through it with minimal discomfort.  

Why Attempting Alcohol Detox at Home Isn’t a Good Idea

While it may be tempting to detox from alcohol at home, it is not a good idea. You need medical support to ensure your safety and reduce the likelihood of relapse.

If you suddenly stop drinking, it can trigger severe withdrawal symptoms. If delirium tremens occur, the results can be incredibly serious, even deadly. It isn’t worth the risk to attempt this on your own at home.

With medical detox, you’ll be supported in a medical setting. You will likely receive medications to stabilize the withdrawal process, preventing severe withdrawal symptoms and ensuring your safety throughout the process. 

Relapse to alcohol use is also much more likely if you attempt to detox on your own. When withdrawal symptoms set in and you experience cravings for alcohol, you’re likely to simply drink again to make these negative effects disappear. With medical detox, you’ll have support to help you continue with the withdrawal process.

How to Know When You Need Help With Alcohol Withdrawal

If you have mild alcohol abuse patterns, you likely don’t need medical detox, and you can simply cut back on your drinking with therapeutic support.

If you or someone you love is struggling with alcohol, you can use the CAGE substance abuse screening tool to get a sense of the severity of the problem. 

The CAGE survey involves four screening questions that can help you determine if you should seek help:

• Have you ever felt you should reduce how much you drink?
• Have you felt irritated if people criticize or comment on your drinking?
• Have you ever felt guilty about drinking?
• Have you ever drank first thing in the morning?

If you answer “yes” to one or more of the questions, it is an indication that you may have an alcohol abuse issue. Talk to a treatment provider or your doctor about the place alcohol has in your life and how best to proceed toward a healthier future. 

If you have a history of chronic and high levels of alcohol abuse, you need medical support during alcohol withdrawal. Talk to a professional to determine what is appropriate for your situation.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More