Alcohol Withdrawal Syndrome and Management


Alcohol Withdrawal Syndrome (AWS): It’s a set of symptoms. Occurs when people stop or reduce drinking alcohol after heavy-drinking periods. So, the body has become dependent on it. This article gives an overview of AWS symptoms. Plus, it explains how to manage them.

Definition of alcohol withdrawal

Alcohol withdrawal is when the body reacts to less alcohol. It starts when an alcoholic has been drinking lots and then stops or decreases. Symptoms can be mild to extreme. This depends on how much they drank and for how long. Detox can take 5-7 days. It is important to get help.

Symptoms may include:

  • Agitation
  • Mood changes
  • Fast heart rate and blood pressure
  • Trembling hands and legs
  • Aches
  • Confusion
  • Restlessness
  • Seeing things that aren’t there

If not treated, this can lead to delirium tremens (DT). DT is a set of signs & symptoms that involve confusion and agitation. Seizures or death can happen if not taken care of.

Risk factors of alcohol withdrawal

The severity of alcohol withdrawal symptoms can vary. If someone stops drinking suddenly, without any preparation or medical help, it could be dangerous. A few factors that can make the situation worse are:

  • Heavy and/or long-term drinking. This can lead to physical dependence on alcohol and make quitting harder.
  • Family history of alcoholism. People with family members who have had alcohol problems can experience cravings and psychological issues related to drinking.
  • Individual health. Mental health problems, diabetes, heart conditions, or high blood pressure can lead to more severe withdrawal symptoms.
  • Age. Older people may have more severe consequences when they stop drinking.
  • Gender. Women often process alcohol differently and can have more extreme withdrawal symptoms.

Symptoms of Alcohol Withdrawal

Alcohol withdrawal symptoms can vary from gentle to severe. In some cases, they can be life-threatening. Know the signs and symptoms if you or someone close to you is an alcoholic and going through withdrawal.

To learn about common alcohol withdrawal symptoms and how to deal with them, read on:

  • Anxiety
  • Tremors
  • Agitation
  • Headaches
  • Nausea
  • Vomiting
  • Sweating
  • Insomnia
  • Hallucinations
  • Seizures

Mild symptoms

Alcohol withdrawal symptoms can appear 24-48 hours after your last drink. They can range from mild to severe. Mild ones may include agitation, anxiety, insomnia, nausea, vomiting, and difficulty concentrating or loud intrusive thoughts. More severe symptoms may involve rapid heart rate, sweating, high blood pressure, trembling hands, and shaky legs. In extreme cases, alcohol withdrawal can lead to seizures or delirium tremens (DTs).

Typical mild alcohol withdrawal symptoms include:

  • Agitation/irritability;
  • Depressed mood/anxiety;
  • Insomnia;
  • Decreased appetite/nausea;
  • Headache;
  • Fatigue/lethargy;
  • Difficulty concentrating;
  • Hand tremors/shaking limbs;
  • Increased sensitivity to sensory stimuli like sound or light.

It is also possible for the individual to experience auditory and visual hallucinations, become disoriented, and lose track of time or environment. If any of these occur, medical help should be sought immediately.

Moderate symptoms

Alcohol withdrawal can happen when someone who has drank a lot for a long time suddenly stops or decreases their alcohol intake. Anxiety, depression, insomnia, sweating, a fast heartbeat, and racing thoughts are all signs of moderate alcohol withdrawal. Other signs may include feeling sick, shaky, and having a headache. In extreme cases, mild hallucinations or delusions can also occur.

Knowing the signs of alcohol withdrawal is important so that any medical help needed can be given right away.

Most people don’t need medical help if they only have mild to moderate withdrawal symptoms. But serious cases may require hospitalization and professional help. Detox centers offer medications to ease things like nausea and anxiety, plus psychological counseling and support groups to help someone with alcohol dependency.

Severe symptoms

Severe alcohol withdrawal can bring a number of serious symptoms. Factors like how much and for how long alcohol was consumed, medical or mental issues, and rehab history can determine how severe the signs will be.

It’s crucial to spot early signs. If not treated, the individual could suffer from:

  • Fever
  • Rapid pulse
  • Dehydration
  • Unstable blood pressure
  • Excessive sweating
  • Convulsions
  • Shaking
  • Hallucinations or delusions
  • Sleeplessness
  • Agitation or fear

If any of these occur, particularly fevers over 101°F, medical help should be sought right away to avoid further complications.

Medical Management

Medical management of alcohol withdrawal includes using meds to reduce severity. Various drugs may be used, such as benzodiazepines, anti-seizure and anti-psychotic meds, based on how severe the withdrawal symptoms are.

Let’s explore the different medications used for alcohol withdrawal management:


Medications used to manage alcohol withdrawal are meant to reduce symptoms, stop relapse, and promote quitting. Doctors usually start with a benzodiazepine to reduce symptoms. Benzodiazepines are a kind of sedative that reduce brain activity and anxiety, and lessen seizure risk. Some common benzodiazepines for alcohol withdrawal are lorazepam (Ativan), chlordiazepoxide (Librium), diazepam (Valium) and oxazepam (Serax).

In addition to benzodiazepines, doctors may prescribe drugs to address certain symptoms. For example, Naltrexone stops cravings by decreasing the need for alcohol. Carbamazepine helps keep people from seizures and delirium tremens. Disulfiram is a deterrent drug that makes people very ill within minutes if they drink alcohol while taking it. Acamprosate is used to decrease craving for alcohol in those who have stopped drinking; it works by bringing neurotransmitter chemicals in the brain back to usual levels after chronic drinking.

It’s important to remember that medications for alcohol withdrawal have side effects which must be monitored:

  • Benzodiazepines can lead to memory loss or thinking problems.
  • Naltrexone can cause liver damage.
  • Acamprosate can cause vomiting, diarrhea, or itching.
  • Disulfiram can cause cognitive issues or breathing troubles.
  • Carbamazepine has been linked to an increased risk of suicidal thoughts or actions and decreased white blood cell counts.

Patients should follow their doctor’s instructions and report any changes immediately.


Detoxification is the initial stage of alcohol withdrawal management. When an individual becomes dependent on alcohol, it is vital to monitor the withdrawal process medically. The objective of detoxification is to lessen withdrawal symptoms and avoid more physical damage in a secure way.

A health care professional with expertise should do the detoxification process in a hospital or rehabilitation center. Depending on the person’s medical and psychological background, they could require 24-hour observation during detoxification. Before attempting to minimize withdrawal symptoms, medical issues caused by alcohol utilization (such as hypertension and seizures) must be handled. During detox, crucial signs such as heart rate, temperature, breathing and blood pressure are monitored regularly.

Detoxification medications involve:

  • Benzodiazepines (Valium or Librium)
  • Barbiturates (Phenobarbital)
  • Anticonvulsants (Mysoline or Dilantin)
  • Antipsychotics (Haldol)

It is also necessary to replenish fluids and electrolytes with an IV line throughout detoxification. Nutrition plays a significant role in recovery after alcohol withdrawal, so proper diet should be taken into consideration during this process. Once detox is stable, medication dosage can be changed if required until stable progress towards sobriety is attained.


Monitoring alcohol withdrawal can help assess and rate the seriousness of withdrawal symptoms. Also, it guides treatment recommendations. Assessments must be done regularly and tailored to the patient. Tests may include:

  • Blood chemistry panel to measure organ function
  • Liver tests (ALT, AST, GGT)
  • Complete blood count (CBC)
  • Urine test
  • Dynamic liver tests
  • ECG
  • Postural hypotension test or tilt table test
  • Ratio between Etg/Etg and creatinine, recommended by SAMSHA
  • Drug screens as needed to rule out other medications affecting alcohol withdrawal symptoms.

Non-Medical Management

When it comes to managing alcohol withdrawal symptoms, non-medical management can be a great solution! This type of management works by changing lifestyle habits, such as nutrition, exercise and reducing stress. Non-medical management also includes support systems like 12-step meetings, peer support and therapy.

Let’s take a look at the various non-medical options for managing alcohol withdrawal symptoms:

Lifestyle changes

Changing your lifestyle is key to reducing alcohol withdrawal symptoms and increasing the chances of lasting sobriety. It can help lessen cravings and make it easier to stay sober.

Some lifestyle changes:

  • Stay away from triggers and stress.
  • See a therapist, join a self-help group, or go to AA.
  • Do something else instead of drinking, like exercise or a hobby.
  • Have a good bedtime routine – don’t stay up late, set an alarm, meditate, and turn off devices before bed.
  • Have supportive people around who understand what you’re going through and will check in often.

Behavioral therapy

Behavioral therapy is a big element of alcohol withdrawal treatment and management. It can help to reduce cravings, improve coping skills, and stop relapse. There exist various types of behavioral therapy for alcoholism and alcohol abuse.

Cognitive-behavioral therapy (CBT) revolves around altering thought patterns and behaviors that tie into alcohol use. CBT educates problem-solving skills, stress control, and recognizing triggers that could lead to over-drinking or relapse.

Motivational interviewing (MI) is a counseling style that helps people with alcohol use disorder distinguish their personal reasons for quitting drinking. MI assists a person to focus on their own goals for sobriety instead of external pressures from family or friends.

Group or family counseling can help you work through feelings about your loved one’s difficulties with alcohol, instruct healthy conflict resolution strategies, grasp positive communication skills, and form healthier relationships with each other and with the alcoholic individual in your life.

Multidimensional family therapy (MDFT) especially focuses on teenagers and young adults battling with drug abuse or addiction as well as psychological issues such as mental health problems, trauma, and relationship issues due to issues in the family environment. MDFT takes the many facets of the individual’s life like peers, school environment into account when creating treatment plans for handling drug abuse issues as well as psychiatric symptoms or disorders that often occur with drug use disorder, like depression or anxiety.

Support groups

Medical help is not the only source of aid – professional and peer-led support groups are also beneficial. These groups can help individuals recovering from addictions, including alcohol withdrawal.

Participants can learn the causes and triggers of their condition, discuss emotions and receive advice on how to stay sober. Other members’ techniques for sobriety can also be identified.

Anonymity, non-judgment and confidentiality are the common principles to be respected. Each group’s duration and frequency may vary. Generally, meetings take place weekly. To gain the most from involvement, regular attendance is important.


To wrap it up, alcohol withdrawal symptoms may be mild or strong and can be medically serious. Medical assessment and treatment is the main way to handle alcohol withdrawal symptoms efficiently. Taking care of acute alcohol withdrawal symptoms can help lessen the danger of major physical and mental health issues. It’s vital to get medical help and care immediately.

Summary of alcohol withdrawal symptoms and management

Alcohol withdrawal is a mix of physical and mental problems that come up when someone who drinks heavily suddenly stops. The signs can vary from mild to extreme, based on how much they drink and how dependent they are. Anxiety, shaking, fast heart rate, sweating, no sleep, nightmares, nausea, being agitated, confusion and seizures are all common signs. In serious cases, delirium tremens can occur.

Management of this includes many things. Medical attention is important to help with the physical and psychological aspects. Medicines like benzodiazepines may be used to make the problems milder. Therapy can help people learn how to stay away from drinking. Self-help groups like Alcoholics Anonymous can help people stay sober in the long run.

Frequently Asked Questions

Common symptoms of alcohol withdrawal include headache, nausea, vomiting, sweating, anxiety, insomnia, hallucinations, seizures, and tremors.

The duration of alcohol withdrawal symptoms can vary from person to person, but symptoms typically peak within 48-72 hours and may last up to a week or more.

Yes, alcohol withdrawal can be dangerous, especially for heavy drinkers. Seizures and hallucinations are potential complications, and delirium tremens (DTs), a severe form of withdrawal, can be life-threatening without medical intervention.


Treatment for alcohol withdrawal may include medication, such as benzodiazepines, to manage symptoms and reduce the risk of complications. In severe cases, hospitalization may be necessary.

The best way to prevent alcohol withdrawal is to avoid excessive alcohol consumption. If you have a history of heavy drinking, talk to your doctor about gradually reducing your alcohol intake to minimize the risk of withdrawal.

In rare cases, alcohol withdrawal can lead to death, particularly in individuals with underlying medical conditions or a history of severe alcoholism. It is important to seek medical attention if you or someone you know is experiencing symptoms of alcohol withdrawal.

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