Alcohol Detox Symptoms

Alcohol Detox Symptoms

Long-term alcohol use can lead to physiological dependence. If you try to curb this dependence by suddenly stopping your alcohol use, unpleasant, severe or life-threatening withdrawal symptoms can arise.1 Minor alcohol detox symptoms appear around six to 12 hours after your last drink.2 However, symptoms of alcohol withdrawal have been known to appear days or even 1 week later.2, 3 Symptoms typically peak between 24 and 72 hours after last consuming alcohol, but may linger for weeks in some cases.1, 2

In this article:

Common Alcohol Detox Symptoms

Alcohol withdrawal affects the autonomic nervous system, the central nervous system and overall cognitive function.3 The symptoms of alcohol withdrawal can vary from person to person. Some commonly reported alcohol withdrawal symptoms include:1, 3, 4, 5

  • Irritability, anxiety or nervousness
  • Mood swings. depression and inability to think clearly
  • Fatigue, trouble sleeping and nightmares
  • Sweating and clammy skin
  • Nausea, vomiting and loss of appetite
  • Headache
  • Enlarged pupils
  • Rapid heartbeat and high blood pressure
  • Shakiness and tremors

Severe Alcohol Withdrawal Symptoms

A more severe form of alcohol withdrawal called withdrawal delirium or delirium tremens (DT) may occur, especially in chronic, long-term users. Symptoms of DT include:1, 2

  • Fever
  • Agitation
  • Seizures
  • Hallucinations (seeing or hearing things that are not there)
  • Severe confusion or disorientation

Several predictors can indicate if you are at greater risk of developing severe alcohol withdrawal symptoms. These indicators include:2

  • Having high levels of liver enzymes
  • Dehydration
  • Prior history of developing DT
  • Greater personal age
  • Co-occurring surgical or medical illness
  • Diagnoses of hyponatremia or hypokalemia
  • Brain lesions

Alcohol Withdrawal Timeline for Detox

The alcohol withdrawal timeline can vary from person to person. Generally, alcohol detox takes anywhere from a few days to a few weeks to complete.4 Alcohol detox symptoms can start showing up as early as two hours after the last drink. However, they typically do not appear until 6 to 12 hours later.2, 6

A generalized alcohol withdrawal timeline may look like this:2, 6

  • 6-12 hours following the last drink: Minor withdrawal symptoms may begin to occur. These include:
    • Mild anxiety
    • Difficulty sleeping
    • Headache
    • Upset stomach
    • Heart palpitations
    • Shakiness
  • 12-24 hours: The withdrawal symptoms listed above may start to worsen or increase. You may begin to experience hallucinations, which can be visual, auditory or even tactile in nature.
  • 24-48 hours: Withdrawal seizures may occur at this stage.
  • 48-72 hours: You may experience alcohol withdrawal delirium, characterized by hallucinations, delirium tremens, low-grade fever, high blood pressure and heart palpitations.

In most cases, symptoms resolve themselves within 48 hours but can take longer to dissipate.6 Generally, people are free of detox symptoms within seven days of abstinence from alcohol. However, if withdrawal symptoms appear after one week of ceasing alcohol consumption, this may be due to factors outside of alcohol withdrawal syndrome (AWS).2

Once symptoms are minimal, and you have been free from alcohol for at least three days, you are likely ready for the next phase in recovery, inpatient or outpatient addiction treatment.

Factors that affect the alcohol withdrawal timeline and how long symptoms occur are:1, 3, 4, 5, 6, 7

  • Duration, frequency, and severity of alcohol misuse
  • Overall health
  • History of withdrawal symptoms, seizures, or delirium tremens
  • Co-occurring medical conditions
  • Co-occurring substance use disorders
  • Age at the time of withdrawal (older persons can be more susceptible to AWS)
  • Medical supervision and whether or not medications are used to mitigate withdrawal symptoms

Alcohol Detox Treatment

There are three primary goals of treatment for alcohol detox symptoms:1

  1. Reduce withdrawal symptoms in their intensity, severity and duration
  2. Prevent complications associated with alcohol detox (seizures, delirium tremens, hallucinations, etc.)
  3. Facilitate entrance into addiction treatment to help achieve and maintain abstinence

Inpatient vs Outpatient Alcohol Detox Treatment

Treatment for alcohol detox symptoms can take place in an inpatient or outpatient facility. People with moderate to severe alcohol detox symptoms may need inpatient care at a hospital or other inpatient detox center. There, they receive constant, round-the-clock medical monitoring for signs of serious withdrawal and complications such as DT or hallucinations.1

Those with co-occurring psychosis, suicidal ideations and other psychiatric conditions should also be treated at an inpatient alcohol detox center if possible.3 Other factors that would bar someone from having outpatient treatment for alcohol detox symptoms include:5

  • History of withdrawal seizures
  • High risk of delirium tremens
  • Abnormal lab results
  • Acute illness or chronic medical conditions
  • Lack of social support at home
  • Misuse of other substances

Alcohol detox symptoms can be life-threatening. Thus, inpatient detox treatment is generally the safest option for those detoxing from alcohol. Outpatient treatment can be more cost-effective and may be the best option for people who must remain active in their personal and professional lives outside of treatment.3 But, this may not be possible if your symptoms prove to be anything more than mild.

People with mild alcohol withdrawal symptoms may choose to receive detox treatment at an outpatient treatment center or a physician’s office. If you attend an outpatient detox program, you will need to visit the outpatient center daily for treatment and may be responsible for taking medications at home. It is recommended that you have a supportive person in your life who can monitor you at home and help administer your medications.3

Detox Treatment Methods

Medically supervised treatment for alcohol detox symptoms typically includes a combination of the following:

  • Medical monitoring of heart rate, blood pressure, body temperature and blood levels of different chemicals in your body
  • Supportive medications to ease symptoms of alcohol withdrawal
  • Medical testing and treatment for other medical conditions related to alcohol use
  • Individual, group and family counseling for alcohol use disorder (AUD) or referrals to therapy and support services

Your medical detox team may assess your withdrawal symptoms using the Clinical Institute for Withdrawal Assessment for Alcohol- Revised (CIWA-AR) scale. This assessment will help them determine the severity of your alcohol withdrawal symptoms and whether medication is needed.6, 7

Alcohol Detox Medications

There are several different detox medications your medical team may prescribe.  These help mitigate alcohol withdrawal symptoms and include:1, 3, 4, 5, 6, 7

  • Benzodiazepines: Diazepam, lorazepam and other benzodiazepines may be prescribed to help reduce agitation. They also treat seizures and prevent the progression of withdrawal symptoms. Most doctors prefer using benzodiazepines as the first line of treatment for alcohol withdrawal.
  • Anticonvulsants: Gabapentin, oxcarbazepine and other anticonvulsants can help treat seizures and agitation. They also reduce cravings and prevent withdrawal symptoms from worsening. Anticonvulsants are the second-most effective treatment for alcohol withdrawal, following benzodiazepines.
  • Barbiturates: Barbiturates such as phenobarbital are sometimes used to mitigate symptoms of alcohol withdrawal. However, they have largely been replaced by benzodiazepines. If used, they are typically given only in cases of severe withdrawal. In some cases, they may be given as adjunctive therapy along with benzodiazepines.
  • Acamprosate: Reduces the levels of glutamate in the brain. This can ease withdrawal symptoms and improve sleep quality during withdrawal.
  • Beta-blockers: Atenolol can reduce tremors. They also lower blood pressure and heart rate. However, they do not treat alcohol detox symptoms such as delirium or seizures. Sometimes, beta-blockers are used as an adjunctive treatment for alcohol withdrawal, along with other medications like benzodiazepines.
  • Alpha-adrenergic agonists: Clonidine and other alpha-adrenergic agonists can also help lower heart rate and blood pressure. Clonidine is used more often as an adjunct therapy rather than the first line of treatment for alcohol detox symptoms.
  • Haloperidol: Haloperidol is an antipsychotic medication, sometimes given as adjunctive therapy to help with agitation, a symptom of alcohol withdrawal.
  • Thiamine and folic acid: These vitamins are given to lower the risk of Wernicke encephalopathy, an alcohol-related neurological disease.
  • Magnesium: Because magnesium levels are low during alcohol detox, many medical providers administer magnesium to boost your nutritional health during withdrawal. However, research has not indicated any benefit of magnesium for the treatment of AWS.

Depending on the severity of symptoms, alcohol withdrawal may not require medication, just supportive care. However, thiamine and folic acid are almost always prescribed to optimize nutrition and reduce the risks of long-term complications.4

Find an Alcohol Detox Center

Alcohol detox symptoms can be severe and life-threatening. Some people relapse to stop their symptoms. It is safest and most effective to detox in a medically supervised alcohol detox center, where you will receive medical care and psychosocial support.

If you or a loved one struggles with symptoms of alcohol withdrawal and would like guidance or information about treatment, call 800-996-6135 to get help today.

Resources

  1. U.S. National Library of Medicine. (2021, January 17). Alcohol Withdrawal.
  2. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research, 9(9), VE01–VE07.
  3. Muncie, H., Yasninian, Y., & Oge, L. (2013, November 1). Outpatient Management of Alcohol Withdrawal Syndrome. American Family Physician, 88(9): 589-595.
  4. Diaper, A., Law, F., & Melichar, J. (2014, January 22). Pharmacological Strategies for Detoxification. British Journal of Clinical Pharmacology, 77(2): 302-314.
  5. DeSimone, E., Tilleman, J., Powell, T. (2014, November 17). Treatment of Alcohol Withdrawal Syndrome. S. Pharmacist Journal, 39(11): 38-41.
  6. Gortney, J.S., Raub, J.N., Patel, P., Kokoska, L., Hannawa, M., & Argyris, A. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67-79.
  7. Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial Psychiatry Journal, 22(2): 100-108.
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