When Does Alcohol Withdrawal Start? – 7 Facts to Know

Before beginning to learn about alcohol withdrawal, let’s have a look at alcohol consumption on a global basis. As per the 2018 reports of the World Health Organization, the total amount of pure alcohol consumed per person globally is almost equal to 6.2 liters. Scary, right? Even scarier is that unrecorded consumption accounts for 26% of global consumption.

1. Alcohol Consumption: A Global Issue

For centuries, alcohol has been a significant part of people’s lives. Although moderate intake of alcohol can be beneficial, excessive and irresponsible drinking can lead to adverse effects.

The regular or episodical drinking of alcoholic beverages, which contain ethanol1, is referred to as consumption of alcohol.

Drinks, including beer, wine, and spirits, are all various forms of alcohol, and societies worldwide have ingested them for centuries. Moderate consumption of alcohol has been linked with certain potential health benefits. However, immoderate drinking has a wide range of detrimental effects.

Usually specified as up to one drink per day for women and up to two drinks per day for men, moderate alcohol intake has been linked to probable cardiovascular advantages, such as lowering the risk of coronary heart disease. Certain studies also suggest that modest alcohol intake may have a scant positive impact on some attributes of cognitive function in older adults.

However, excessive drinking can cause consequential harm to individuals as well as society. Temporary effects of excessive alcohol intake include defective judgment, motor skills, and coordination, causing accidents and injuries. Chronic alcohol abuse can lead to critical health issues like liver damage, cardiovascular diseases, neurological problems, and an elevated risk of various cancers.

Excessive drinking of alcoholic beverages can also contribute to social issues, including violence, family disruption, and other criminal activities. Alcohol addiction and dependency can lead to a cycle of personal and financial problems for affected individuals, affecting their work, relationships, and overall lifestyle.

To address all these issues, governments and health organizations promote sensible drinking guidelines and initiatives to raise awareness of the risks linked with alcohol intake. Public health campaigns often concentrate on stopping underage drinking, assisting those struggling with alcohol addiction, and lowering the number of alcohol-related accidents and incidents.

To summarize, the consumption of alcohol is a complex and multidimensional topic.

While moderate alcohol intake may have some potential health amenities, excessive or irresponsible drinking can lead to serious health, social, and economic consequences. Responsible drinking practices, along with education and support, play vital roles in promoting a healthier relationship with alcohol and reducing the negative impacts of the consumption of alcoholic beverages on individuals and society.

2. What Actuates Alcohol Abuse?

alcohol abuse
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A combination of several individual, social, and environmental factors typically leads to alcohol abuse. Although each person’s path may vary, some common reasons play a part in the onset of excessive consumption of alcohol. The factors are listed as follows:

Traditions, cultural etiquette, and social acceptance of alcohol can play a crucial role.2 Drinking alcohol is a common activity in many societies, and many people can be introduced to alcohol at a very tender age during family gatherings, celebrations, or events.

During early adulthood, many people, due to peer pressure, fall under the influence and may start drinking to fit in within a circle or to be a part of a certain group. Many people also begin drinking alcohol to cope with stress, anxiety, or other emotional disorders, as it provides a sense of relief for the time being.

Evidence suggests that sometimes genetic factors also lead to alcohol abuse. People with a long family history of alcohol abuse are more likely to develop a similar pattern of behavior. Individuals with chronic mental disorders such as depression, anxiety, or trauma may see alcohol as a medication to eliminate emotional pain.

The desire to experiment with alcohol and curiosity about its effects can also lead to alcohol abuse. A permissive environment and easy access to alcohol can foster its abuse as well. Major traumatic events or life changes can stimulate alcohol abuse as a coping mechanism for emotional turmoil.

It is essential to know that not everyone trying to experiment with alcohol will develop an alcohol abuse problem. However, the blend of all these factors can contribute to excessive alcohol ingestion.3

Identifying the signs of abuse early and seeking medical help when required can avert the increase of the problem and boost the chances of a successful recovery. Support groups, counseling, and treatment programs are available to help people address alcohol abuse and regain control of their lives.

3. What is Alcohol Withdrawal?

alcohol withdrawal
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The set of psychological and physiological symptoms that occur when a regular alcohol consumer suddenly stops or consequentially lowers their intake is termed alcohol withdrawal. It is a complex and dangerous process as the body tries to adapt to functioning without alcohol.

Alcohol mainly affects the central nervous system and prolonged or excessive drinking can lead to dependency on the substance. With alcohol dependency, one’s body adapts to the presence of alcohol, and the abrupt removal can cause a variety of symptoms.

The severity can vary from individual to individual, depending on several factors, including the amount and duration of consumption or underlying medical conditions. Moderate withdrawal symptoms include nausea, anxiety, mood swings, and headaches. However, in extreme cases, people may experience hallucinations, seizures, and a critical condition called delirium tremens (DTs).

Rapid heartbeat, hallucinations, severe confusion, fever, and serious tremors recognize DTs. DTs usually occur 2-3 days after the last intake and require urgent medical attention as they can be critical if not treated properly.

Alcohol withdrawal is best controlled under medical supervision, especially for those who have a history of irresponsible, heavy, and prolonged use of alcohol. Medical professionals can provide proper treatment procedures and supportive care to affirm the safety and comfort of the patient during the process.

Certain withdrawal symptoms are treated with the help of medications. For example, Benzodiazepines are generally used for alleviating anxiety, managing DTs, and preventing seizures. Additionally, hydration, supportive care, and emotional health are essential to assist people through difficulties during a withdrawal period.

People may face challenges during the recovery period after the acute withdrawal phase. Identifying and addressing the underlying causes that play a part in alcohol use, taking part in therapy sessions or counseling, and joining support groups are important to maintain long-term abstinence and prevent a recurrence.

To summarize, alcohol withdrawal is a serious condition that requires medical attention and proper management. Seeking professional help is vital for a safe recovery from alcohol dependence.

4. Alcohol Withdrawal Symptoms

alcohol withdrawal symptoms
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When a person who has been drinking alcohol habitually abruptly stops or remarkably reduces their alcohol ingestion, it leads to alcohol withdrawal.

The signs and symptoms of alcohol withdrawal can differ in severity based on the level of dependence on alcohol, the quantity and duration of alcohol ingestion, and individual differences. Usually, these symptoms commence within hours to a few days after the last drink and include:

Mild symptoms occur 6-12 hours after the last drink and generally include headaches, sweating, anxiety, irritability, mood swings, tremors, and insomnia. Some people might also have experienced gastrointestinal distress, such as vomiting, nausea, and loss of appetite. 

The sudden withdrawal can lead to an increased heart rate and blood pressure. In more severe cases, neurological, visual, or palpable hallucinations may occur during the first 24-48 hours. There are also occurrences of seizures within 2 days after the last drink was ingested.

As mentioned earlier, DTs or Delirium tremens are a critical form of alcohol withdrawal that can prove to be a risk factor to one’s life. The symptoms that characterize DTs are agitation, hallucinations, severe confusion, rapid heartbeat, extreme tremors, and fever. DTs usually begin 2-4 days after the last drink, and consulting a medical professional is vital.

Certain psychological symptoms such as anxiety, depression, and mood swings are conventional during alcohol withdrawal and can remain throughout the process.

Alcohol withdrawal can be dangerous and life-threatening, especially in more critical cases. It is best treated under medical supervision to guarantee patient safety and well-being. Medical professionals can identify and address the severity of symptoms and underlying causes and help manage them properly.

Medical management can determine the suitable level of care needed and provide support during this difficult time. After the acute withdrawal stage, carrying on with appropriate treatment and support, such as counselling or participation in support groups, can play a key role in maintaining long-term soberness and averting retrogression.

5. Progression of Alcohol Withdrawal

progression of alcohol withdrawal
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Usually, alcohol withdrawal follows an expected development, but the graveness and stretch of symptoms can differ from person to person, depending upon multiple factors, such as the amount of consumption, dependence on the drink, and any previous medical conditions. The stages are described as follows:

5.1. Early Withdrawal

This phase occurs 6-12 hours after the last drink is consumed. During this phase, mild symptoms like anxiety, headaches, tremors, sweating, insomnia, and irritability may come into view. These signs usually signify that the human body is trying to adjust without the presence of alcohol.

5.2. Peak Withdrawal

This phase appears 1-3 days after the last drink, and the symptoms become more intense during this stage. The signs that occur are increased anxiety, elevated blood pressure, and heart rate, nausea, vomiting, hallucinations, and seizures. Delirium tremens4 or DTs are a severe form of alcohol withdrawal and can occur during the peak phase.

5.3. Late Withdrawal

Other than certain psychological symptoms, such as depression, mood swings, and anxiety, that continue to persist, the intensity of symptoms begins to decrease 3-5 days after the last drink. It is important to continue monitoring and offering support to patients during this phase, as there are still chances of complexities.

5.4. Post-Acute Withdrawal

This phase primarily occurs weeks to months after the last drink is consumed. Some people may face post-acute withdrawal syndrome or PAWS, which comprises the continuation of psychological symptoms like insomnia, anxiety, depression, and mood swings. This phase can last for weeks or months after the acute withdrawal stage.

It is essential to know that not everyone experiences all stages of alcohol withdrawal syndrome, and the duration and intensity can differ from individual to individual.

For people with a long history of alcohol abuse or those who have been through withdrawal previously, there is an increased risk of severe symptoms such as DTs. Seeking medical help during the withdrawal phase is important for proper management of the symptoms.

6. Diagnosis of Alcohol Withdrawal Syndrome

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The diagnosis of alcohol withdrawal syndrome comprises an inclusive evaluation of a person’s medical history, drinking patterns, and the presence of symptoms. Doctors, nurses, or addiction specialists play an important role in diagnosing and properly managing the syndrome. The process usually includes:

The doctor will thoroughly evaluate the medical history, including information about the person’s drinking practices, the frequency and quantity consumed, any past experiences of withdrawal, and any existing medical or mental health conditions. A detailed physical examination is conducted to assess the individual’s overall health and look for any alcohol-related complexities.

The medical professional will identify the presence of various symptoms and determine their severity. Common symptoms include tremors, anxiety, depression, rapid heartbeat, increased blood pressure,  seizures, and other physiological and psychological distresses.

In certain cases, the Clinical Institute Withdrawal Assessment for Alcohol or the CIWA-Ar scale is implemented to quantify the intensity of the symptoms. This helps doctors determine the proper level of treatment and care required.

Blood tests may also be conducted to measure levels of alcohol in the blood, evaluate liver function, and check for potential complications due to alcohol. The healthcare professional will rule out diseases that may demonstrate similar signs of alcohol withdrawal, such as metabolic disorders or neurological conditions. 

Once the diagnosis is made, the medical expert will develop a customized treatment plan based on the patient’s needs. Treatment procedures may involve supportive care, hydration, medications, and psychological assistance.

In more severe cases, medical detoxification under supervised circumstances is essential to ensure the person’s safety and overall health during the withdrawal process. Treatment such as counseling, therapy, and participation in support groups is important to acknowledge the underlying issues and advocate sustained recovery from alcohol abuse.

7. Treatment

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The treatment procedure for alcohol withdrawal generally comprises a blend of medical and psychological involvements to guarantee the safety and ease of the person during the entire process and assist in their long-term restoration from alcohol abuse.

For people with high dependency on alcohol or those on the brink of developing life-threatening symptoms, medical detoxification can be essential. This involves supervised withdrawal in a coordinated environment, where medical experts can manage signs, implement medications to eliminate discomfort and lower the risk of complications such as DTs or seizures.

Medications like benzodiazepines5 may be prescribed to control withdrawal symptoms like anxiety, agitation, and seizures. Other medications can help address cravings and reduce the risk of regression during the early stages of rehabilitation.

Hydration, nutrition, and monitoring crucial symptoms are important parts of supportive care during withdrawal. Sufficient support guarantees that the person’s physical requirements are covered throughout the process.

Therapy, counseling, and participation in support groups play a key role in the treatment of alcohol withdrawal syndrome. These involvements help individuals identify and address underlying issues contributing to alcohol use, learn coping skills, and develop strategies for maintaining abstinence in the long term.

Developing a comprehensive and personalized long-term rehabilitation plan is essential for prolonged soberness from alcohol. This plan can include continuous therapy, participation in support groups, and addressing any coexisting mental health conditions.

Inciting positive changes in quality of life, such as regular exercise, a healthy diet, and stress-reduction techniques, can assist the individual’s recovery journey and improve their overall well-being.

  1. Mann, Laura B., and John D. Folts. “Effects of ethanol and other constituents of alcoholic beverages on coronary heart disease: a review.” Pathophysiology 10.2 (2004): 105-112. ↩︎
  2. Fairbairn, Catharine E., and Michael A. Sayette. “A social-attributional analysis of alcohol response.” Psychological bulletin 140.5 (2014): 1361. ↩︎
  3. Storey, ElizabethL, et al. “Desialylated transferrin as a serological marker of chronic excessive alcohol ingestion.” The Lancet 329.8545 (1987): 1292-1294. ↩︎
  4. Ferguson, Jeffrey A., et al. “Risk factors for delirium tremens development.” Journal of general internal medicine 11 (1996): 410-414. ↩︎
  5. Lader, Malcolm. “Benzodiazepines revisited—will we ever learn?.” Addiction 106.12 (2011): 2086-2109. ↩︎

Last Updated on by Sathi Chakraborty, MSc Biology


Sathi Chakraborty, MSc Biology

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