Alcohol withdrawal can be a fatal condition that may occur in individuals who are heavy or chronic drinkers. It has been estimated that approximately 2 million Americans experience withdrawal symptoms of alcohol annually . These individuals may have started drinking heavily for a few weeks ranging up to as long as many years. Withdrawal will then occur when alcohol consumption is stopped suddenly or significantly reduced. Severe alcohol withdrawal symptoms present as a medical emergency necessitating a visit to the emergency room. It is much more dangerous in people who have existing health conditions such as heart issues, respiratory problems, infections, history of seizures, and other conditions. Although some symptoms may appear mild in the beginning, it is crucial to seek medical care as symptoms can rapidly worsen.
Withdrawal Symptoms of Alcohol: Stages and Timeline
The symptoms of alcohol withdrawal can be divided based on the time of appearance following alcohol cessation  :
6 – 12 Hours After Alcohol Use: Minor symptoms
- Sleep disturbance – difficulty staying or falling asleep, restlessness, night terrors. These are amongst the most common complaints . There is also an increased rate of interrupted breathing during sleep. All these can cause excessive daytime sleepiness that leads to decreased productivity and increased rates of road traffic accidents .
- Anxiety – can be the cause of palpitations and gastrointestinal upset. Anxiety also causes hyperventilation, diaphoresis, and dizziness. Although alcohol has anti-anxiety properties, the long-term use of it can increase levels of anxiety .
- Gastrointestinal upset (nausea, vomiting, diarrhea)
- Diaphoresis (cold sweats)
- Palpitations (heart beats too fast or too hard)
- Anorexia (loss of appetite)
12 – 24 Hours After Alcohol Use:
- Hallucinations may occur – includes visual (imagining seeing objects or people that are not there), auditory (hearing voices in their head), tactile (feeling sensations such as insects crawling on skin). One study reported 10% of patients experience hallucinations 6]. Patients who experience hallucinations tend to be younger, consumed more alcohol, has more life problems related to alcohol usage, and higher rates of recreational drug use .
24 – 48 Hours After Alcohol Use:
- Seizures – are usually generalized seizures that alternate with muscle spasms and contractions . More than 90% of alcohol withdrawal seizures occur in the first 48 hours after the last drink. Less than 3% occurs 5 to 20 days after . Evidence suggests that the risk and severity of seizures increases with the number of previous episodes of withdrawals.
48 – 72 Hours After Alcohol Use:
- Disorientation (confusion regarding when and where they are),
- Hallucinations (usually visual)
- Tachycardia (increased heart rate)
- High blood pressure
- Low grade fever
- Delirium tremens (delirium due to alcohol withdrawal) – this can develop in 1 to 4 days after the start of withdrawal symptoms. It has been found to be fatal in up to 5% of patients . The risk is reduced if adequate medication and support is available.
Other Alcohol Detox Withdrawal Symptoms and Issues
- Wernicke – Korsakoff Syndrome – Although not technically a symptom of alcohol withdrawal, it usually occurs during the same period. It is due to thiamine deficiency which is most common in heavy long-term drinkers. There is severe cognitive impairment, delirium, abnormal gait, and paralysis of certain eye muscles . Most patients are disoriented and agitated. It can have residual and disabling effects. Untreated, patients may progress from stupor (a state of unconsciousness or insensibility), coma, and death.
- Cardiovascular Complications – Heavy drinkers often have heart issues as alcohol can cause damage leading to abnormal heart rhythms . For instance, the “Holiday Heart Syndrome” is when there are episodes of abnormal heart rhythms after an episode of drinking.
- Depression – This is often observed in patients and approximately 15% of heavy or chronic drinkers are at risk of death by suicide  and self-harm. This may be due to the behavioral inhibition and depressive feelings caused by alcohol. Besides the depression from alcohol, life-related issues that developed due to heavy alcohol use are also contributing factors to depression.
- Protracted Withdrawal Syndrome – There is some evidence that this may occur after alcohol withdrawal. It can possibly last up to a year with tremors, insomnia, anxiety, depression and others [10,11].
The withdrawal symptoms of alcohol can be severe and fatal. Rather than performing an alcohol detox process at home, It is best to seek appropriate medical care as rehabilitation centers and emergency rooms are well-prepared to handle these patients. These professionals are skilled at providing the best medical and emotional support needed for the patient’s health and safety.
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