The symptoms of alcohol withdrawal make quitting drinking especially difficult and are usually what foil most people’s plans to get sober. Many alcoholism articles do not go into a detailed discussion of these symptoms and do not really let people know what to expect. When an alcoholic person is prepared for what may come when trying to get sober, he or she can get the support from family and friends that is so crucial to recovery. It is in everyone’s best interest to be as well informed about withdrawal symptoms as possible.
Withdrawal symptoms usually start six to twelve hours after the person’s last drink. They are usually moderate symptoms at first, with more severe symptoms occurring 24 to 48 hours after the last drink. If the person has made several attempts at quitting drinking, withdrawal symptoms may get worse at each attempt.
People with alcohol addictions do best when they have the support of doctors or therapists while they are trying to get sober. People in rehab facilities or in treatment programs have higher success rates than people who are trying to quit on their own, partly because the withdrawal symptoms can be so overwhelming.
Heavy alcohol use, as with all heavy drug use, causes physical changes in the brain. These changes occur as the brain adapts to high amounts of the drug being constantly present in the body. In the case of heavy alcohol use, the brain produces more of certain neurotransmitters to counteract alcohol’s depressive effects. The brain becomes used to producing elevated levels of these neurotransmitters, but when there is no alcohol in the system, these chemicals stay in the system, causing psychological and physical effects.
- Persistent feelings of unease, fear, or tension even when there is no cause
- Some alcoholics also have panic attacks.
Anxiety is one of the most common withdrawal symptoms in alcoholics. In the absence of any alcohol after months or years of heavy drinking, high levels of epinephrine causes a heightened state of awareness. This in itself causes many people to feel anxiety, but the person often becomes more anxious because they are afraid of the other withdrawal symptoms they are experiencing. Symptoms of withdrawal are scary and difficult to deal with, especially when the person is alone, or if they are in a public place when the symptoms begin.
- Feelings of hopelessness and sadness
- May precede alcoholism, causing the person to self-medicate by drinking
Many people with alcoholism also have chronic untreated depression. As many as 40% of alcoholics are depressed, and most of the time the depression triggers the heavy drinking that eventually leads to alcoholism. Many alcoholics use alcohol as a way to dull their sadness and depression. This is called self-medication. Quitting drinking takes away the “medicine,” and combined with the fear of withdrawal and of having no way to cope with sadness and hopelessness, people trying to get sober often become even more depressed.
Depression that is caused by withdrawal is often a result of imbalances in dopamine and serotonin which are two of the neurotransmitters that are commonly elevated in alcoholics. Depression symptoms often last six weeks or more, which often triggers cravings for alcohol. Some people need a depression medication to help them with their feelings and to lessen the urge to drink.
- Irritability, nervousness, and overexcitement
- due to high levels of epinephrine in the central nervous system
Excessive epinephrine in the brain and body occurs when an alcoholic stops drinking. In the absence of alcohol, the alcoholic person may experience irritability, shakiness, nervousness, and jumpiness as a result of elevated epinephrine levels. This is because epinephrine is the chemical released to elicit the fight-or-flight response in times of stress. Too much epinephrine causes the person’s responses to problems and physical discomfort to be unpredictable.
- Only about 5% of alcoholics develop this symptom
- Can result in death, so medical attention is crucial
Delirium tremens or DTs is a severe symptom of alcohol withdrawal that usually occurs in people who have been drinking heavily for many years and who have made many attempts to quit drinking. DTs cause hallucinations, violent shaking, paranoia, panic, and confusion. DTs usually occur three to ten days following the person’s last drink. A person experiencing DTs should be taken to a hospital for treatment because the risk of death from DTs is about 15-20%. Doctors usually use medications such as sedatives to ease the symptoms and keep the person from dying.
The body, like the brain, also adapts to heavy alcohol use causing physical symptoms during withdrawal. Some of these symptoms are the effects of elevated levels of neurotransmitters, but others occur because of other ways the body changes in heavy drinkers.
- Inability to sleep caused by interruptions in brain’s natural sleep processes
- Usually lasts about one month
Chronic alcohol users often pass out instead of going to sleep normally. Frequent, heavy alcohol use affects the thalamus, the area of the brain that is responsible for producing sleep hormones and proteins. After years of this behavior, the brain stops producing the protein that is needed to get to sleep causing many people in recovery to experience insomnia for up to a month after their last drink.
The elevated levels of epinephrine in the system cause recovering alcoholics to sweat profusely. The body is also trying to get rid of the toxins that have built up from years of drinking heavily. Many of these toxins exit the body through sweat.
Sweating usually gets worse at night. It is important to remember to drink plenty of water, since the sweating may contribute to dehydration.
Other Physical Symptoms
- Nausea and vomiting
- Pale, clammy skin
The severity of symptoms depends on how severe the addiction is. People who have been drinking heavily only a short amount of time will not have the severity of symptoms that a person addicted to alcohol for many years will have. About half of people will have symptoms that are mild to moderate, but everyone trying to get sober will benefit from medical attention and a doctor’s supervision. Some symptoms can have complications, while some can simply make the recovering person turn back to drinking for relief.