Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.A.D.A.M.

Causes, incidence, and risk factors

Alcohol withdrawal occurs most often in adults, but it may occur in teenagers or children.

The more you drink every day, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking.

You may have more severe withdrawal symptoms if you have certain other medical problems.

Symptoms

Alcohol withdrawal symptoms usually occur within 5 - 10 hours after the last drink, but can occur days later. Symptoms get worse in 48 - 72 hours, and may persist for weeks.

Common symptoms include:

• Anxiety or nervousness
• Depression
• Not thinking clearly
• Fatigue
• Irritability
• Jumpiness or shakiness
• Mood swings
• Nightmares

Other symptoms may include:

• Clammy skin
• Enlarged (dilated) pupils
• Headache
• Insomnia (sleeping difficulty)
• Loss of appetite
• Nausea and vomiting
• Pallor
• Rapid heart rate
• Sweating
• Tremor of the hands or other body parts

A severe form of alcohol withdrawal called delirium tremens can cause:

• Agitation
• Severe confusion
• Seeing or feeling things that aren't there (hallucinations)
• Fever
• Seizures

For more information on this severe form of alcohol withdrawal, see: Delirium tremens.

Signs and tests

Your health care provider will perform a physical exam. This may reveal:

• Abnormal eye movements
• Abnormal heart rhythms
• Not enough fluids in the body (dehydration)
• Fever
• Rapid breathing
• Rapid heart rate
• Shaky hands

Blood and urine tests, including a toxicology screen, may be done.

Treatment

The goal of treatment includes:

• Reducing withdrawal symptoms
• Prevent complications,
• Therapy to get you to stop drinking (abstinence)

INPATIENT TREATMENT

People with moderate-to-severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens.

Treatment may include:

• Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the body
• Fluids or medications through a vein (by IV)
• Sedation using medication called benzodiazepines until withdrawal is complete

OUTPATIENT TREATMENT

If you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. You will need someone to commit to staying with you during this process,k and who can keep an eye on you. Daily visits to your health care provider are needed until you are stable.

Treatment usually includes:

• Sedative drugs to help ease withdrawal symptoms
• Routine blood tests
• Patient and family counseling to discuss the long-term issue of alcoholism. See: Alcoholism
• Testing and treatment for other medical problems linked to alcohol use

It is important that the patient goes to a living situation that helps support them in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.

Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through withdrawal.

Support Groups

See: Alcoholism support group

Expectations (prognosis)

How well a person does depends on the amount of organ damage and whether the person can stop drinking completely. Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months. People who continue to drink a lot may develop health problems such as liver and heart disease.

Most people who go through alcohol withdrawal make a full recovery. However, death is possible, especially if delirium tremens occurs.

Calling your health care provider

Alcohol withdrawal is a serious condition that may rapidly become life threatening.

Call your health care provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. Call for an appointment with your health care provider if symptoms persist after treatment.

Go to the emergency room or call the local emergency number (such as 911) if seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.

Prevention

Reduce or avoid alcohol. If you have alcoholism, you should stop drinking completely.

References

1. O’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.
2. In the clinic. Alcohol use. Ann Intern Med. 2009 Mar 3;150(5). [PubMed: 19258556]
3. Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501. [PubMed: 19168210]

Review Date: 3/20/2011.

Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.