This involves symptoms that can persist for weeks or months, including sleep disturbances, mood instability, difficulty experiencing pleasure, and problems with memory or concentration. Delirium tremens is the most severe form of alcohol withdrawal and causes life-threatening symptoms that require immediate medical attention. It typically appears 2-3 days after the last drink but can occur up to a week later. Delirium tremens occurs in about 1%-1.5% of people experiencing alcohol withdrawal. It includes any drinking behavior that increases the risk of physical, mental or social problems. Regularly exceeding recommended alcohol limits can result in alcohol abuse, which causes serious symptoms such as delirium tremens, withdrawal seizures and other life-threatening complications.

• Save

First-Line: Benzodiazepines

• Doctors may prescribe medications to help prevent seizures, ease sleep problems and manage other severe symptoms.
• This action directly reduces symptoms like anxiety, tremors, agitation, and high blood pressure, effectively stabilizing the patient.
• Your medical team needs to know about all substance use to plan safe treatment.
• From sinus infections and high blood pressure to preventive screening, we’re here for you.

DTs can develop in anyone who meets the criteria for heavy alcohol use. For males, that means drinking three or more drinks per day and 15 or more drinks per week. For females, that means drinking two or more drinks per day and eight or more drinks per week. However, DTs becomes more and more likely the more you drink and the longer this continues.

• Save

Inpatient vs. Outpatient Determination

Proper nutrition plus psychological support shorten recovery time while improving quality of life post-withdrawal. These measures shorten recovery time by preventing serious complications that prolong hospitalization or relapse risk. Repeated withdrawals can also increase severity—a phenomenon called kindling—meaning each subsequent detox may last longer with worse symptoms. People who have consumed large amounts of alcohol daily for years tend to experience longer withdrawals. All these factors contribute not only to symptom severity but also how long withdrawal lasts.

• It is essential to be patient, understanding, and non-judgmental, as the recovery process can be challenging and unpredictable.
• Diagnostic criteria for alcohol withdrawal include a history of heavy drinking, recent reduction or cessation of alcohol use, and the presence of two or more specific symptoms, such as tremors, anxiety, insomnia, and nausea.
• This phenomenon, called “kindling,” means that if you’ve gone through withdrawal before, especially multiple times, your next withdrawal episode may be more difficult.
• Detoxing at home can be dangerous, especially for people with heavy alcohol use, past withdrawal symptoms, or medical conditions.

Identifying alcohol use disorder

Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. The severity and duration of withdrawal symptoms can be influenced by factors such as the amount and frequency of alcohol consumption, the presence of underlying medical conditions, and the individual’s overall physical and mental health. In general, withdrawal symptoms tend to peak within 24 to 72 hours and then gradually subside. However, some individuals may experience prolonged withdrawal symptoms, known as post-acute withdrawal syndrome (PAWS), which can last for several months. It is essential to seek medical attention if symptoms persist or worsen over time, as proper treatment and support can help alleviate discomfort and reduce the risk of complications.

With kindling, each withdrawal episode increases the severity of symptoms and further disrupts brain function. This makes future withdrawals more dangerous and difficult to manage. The main symptoms of DTs often take between three to seven days to go away. In severe cases, you may experience some symptoms for weeks to months. Conversely, someone with a shorter drinking history or lighter consumption might have milder withdrawal lasting only a few days. Getting through withdrawal is an important first step, but it’s just the beginning of recovery.

• This is why individualized medical assessment and care are so important during detox.
• The overall trend is toward improvement, even if there are setbacks along the way.
• This may include medication, counseling, and therapy, as well as alternative therapies, such as acupuncture and massage.

Factors Influencing Withdrawal Severity

While there are separate types because they have different primary effects, there’s a lot of overlap between them. For example, most benzodiazepines have a sedative effect in addition to their primary effect. When you suddenly stop drinking, your brain finds itself in a hyperexcitable state without alcohol’s dampening effect. This imbalance causes the physical and psychological symptoms of withdrawal. Your brain essentially needs time to recalibrate and learn to function normally without alcohol.

As with less severe withdrawal, the treatment of choice is benzodiazepines, but these patients generally require higher doses that need to be administered intravenously at frequent intervals or by continuous infusion. Phenobarbital can also be used as an adjunct for patients with difficult-to-control withdrawal symptoms. As noted earlier, the Clinical Institute Withdrawal Assessment-Alcohol revised is not useful for monitoring delirious patients, and a sedation-agitation scale (eg, Richmond Agitation Sedation Scale) can be used instead. The frequency and setting for outpatient monitoring of AWS should be guided Alcohol Withdrawal by symptom severity, risk of complications, and social factors, including reliable social support and a safe home environment. Most patients will require daily evaluations for up to five days after their last drink, but evaluations may increase or decrease in frequency as necessitated by changes in symptom severity.8 These visits can be with any health care professional.

Common Benzodiazepines and Dosing Strategies

Many people can recover with the right treatment, but continued heavy drinking or untreated mental health conditions will only worsen the prognosis. Similar to benzodiazepines and alcohol, phenobarbital enhances the effects of the inhibitory neurotransmitter GABA, but it does so at a different site on the GABA-A receptor. This dual mechanism provides profound central nervous system sedation and is extremely effective at preventing and controlling seizures, making it a strong candidate for managing severe alcohol withdrawal symptoms when other medications fall short. The primary reason benzodiazepines are considered the best medication for alcohol withdrawal is their proven ability to prevent major complications. By stabilizing the central nervous system, they significantly reduce the risk of generalized tonic-clonic seizures and the progression to delirium tremens, a medical emergency with a high mortality rate if left untreated.

• Frequent boluses of diazepam are given intravenously until the patient is calm and sedated.
• If you suddenly stop drinking, it’s like the alcohol side letting go of the rope.
• Managing alcohol withdrawal symptoms is a complex process that requires medical supervision, supportive care, and a commitment to recovery.

Identifying cirrhosis

But severe or complicated alcohol withdrawal can result in lengthy hospital stays and even time in the intensive care unit (ICU). Severe and complicated alcohol withdrawal requires treatment in a hospital — sometimes in the ICU. While receiving treatment, healthcare providers will want to monitor you continuously to make sure you don’t develop life-threatening complications. It’s important to understand that alcohol dependence can develop quickly in heavy drinkers, sometimes after just a few weeks. Withdrawal symptoms can occur with or without a formal diagnosis of alcohol use disorder.