It is ironic that alcohol is a depressant, but when an alcoholic stops drinking, they may experience depression as a withdrawal symptom. Alcohol has a depressive effect on the human body, slowing down brain functions and altering how nerves communicate with one another. If an individual has an alcohol use disorder, these individuals have had high enough levels of alcohol in their body that their central nervous systems have adjusted accordingly. When their alcohol level suddenly drops, the brain experiences a nervous, excited “keyed-up” state. This brain state is what causes the most common withdrawal symptoms.

Symptoms of alcohol withdrawal can be intense enough for hospitalization or mild enough to only include symptoms like shaking hands. The severity of an individual’s symptoms can depend on the user’s addiction patterns. For instance, how much alcohol they consume daily and for how long plays a role in determining the severity of withdrawal symptoms.

Mild Alcohol Withdrawal Symptoms

When the body not only expects but begins to need, alcohol in order to function, withdrawal symptoms can surface as early as six hours since the last amount of alcohol consumed. At this point, an alcoholic may experience milder symptoms, including:

Anxiety
Shaky Hands
Headache
Nausea
Vomiting
Insomnia
Cold Sweats

Severe Withdrawal Symptoms

Although unpleasant, these are not the worst symptoms to expect. In fact, intense and sometimes life-threatening symptoms can also surface. One of the most severe symptoms is hallucinations, or sensory perception, such as a visual image or a sound, that occurs in the absence of an actual external stimulus. Hallucinations may last anywhere from twelve to twenty-four hours after the last drink. Additionally, an alcoholic may experience a seizure during the first two to three days after stopping their alcohol consumption.

These seizures are not to be confused with the alcoholic-specific symptoms of delirium tremens, often referred to as DTs. DTs can begin as early as two days after the last consumption of alcohol. Severe symptoms of DTs include vivid hallucinations and delusions. Alcohol withdrawal delirium is one of the most serious forms of alcohol withdrawal and can cause sudden and severe problems in the brain and nervous system. Although around half of alcoholics experience withdrawal symptoms when they stop drinking, only 3-5% will experience DTs. With only 5% of those in recovery experiencing DTs, an estimated 50,000 – 70,000 individuals develop DTs each year in the United States alone.

What Causes Delirium Tremens

First off, alcohol withdrawal delirium only affects people with a history of heavy alcohol use. Heavy drinkers may develop this condition if they:

Abruptly stop drinking
Reduce their alcohol use too quickly
Do not eat enough when reducing alcohol use
Have a head injury
Are already sick or have an infection

Additionally, an individual is more at risk for alcohol withdrawal delirium if they have:

Consumed alcohol heavily for a long time
History of alcohol withdrawal
History of alcohol withdrawal delirium
Have other health problems related to addiction or alcoholism
History of seizure disorder or other brain damage

Signs of Alcohol Withdrawal DTs

DTs require a medical diagnosis, in which doctors assess the symptoms of shaking, confusion, high blood pressure, fever, hallucinations, and delusions. DTs affect the physical body both behaviorally and psychologically. Behaviorally, the body will be restless and irritable. Psychologically, the individual will experience delirium and hallucinations. Other common symptoms include:

Fast heart rate
Tremors
Anxiety
Dilated pupils
Insomnia
Seizures
Shallow breathing
Confusion
Heavy sweating

These symptoms usually occur within three days among alcoholics stopping or decreasing alcohol use. Sometimes other symptoms may take a week or more to appear. These symptoms may include:

agitation or irritability
anxiety
chest pain
confusion
delirium (an extremely disturbed state of mind)
delusions (irrationally believing things that are untrue)
excessive sweating
excitement
eye and muscle movement problems
fatigue
fear
fever
hallucinations (seeing or hearing things that aren’t there)
increased heart rate or breathing rate
increased startle reflex (an exaggerated reaction to unexpected stimuli)
involuntary muscle contractions
nausea
nightmares
restlessness
seizures
sensitivity to light, sound, or touch
stomach pain
sudden mood changes

When making a diagnosis, a doctor will usually review the alcoholic’s medical history and ask about the symptoms they are experiencing. They may also conduct a physical exam. Some of the physical symptoms that a doctor will look for include:

Hand tremors
Irregular heart rate
Dehydration
Fever

Toxicology Tests for Alcohol Abuse

Some doctors may also perform a toxicology screen test in order to determine how much alcohol is in one’s body. Toxicology screening is usually done with urine or blood samples, and can also indicate if there are other substances in the body. There are other tests that may be used to determine an individual’s dependency on alcohol and the severity of withdrawal symptoms to follow. These tests could include:

Blood magnesium level: Evaluating an individual’s blood magnesium level, or serum magnesium level, can be done with a blood test. Low magnesium levels can indicate alcoholism or severe alcohol withdrawal since normal magnesium levels are necessary to keep the heart functioning properly.

Blood phosphate level: This is also evaluated with a blood test. Low phosphate levels may also indicate alcoholism.

Comprehensive metabolic panel: This is a blood test that requires fasting. Atypical results could indicate alcoholism. It can also provide doctors information about patients’ overall health, including liver and kidney functioning.

ECG: An ECG, or an electrocardiograph, checks for abnormalities in the electrical activity in your heart. Some alcoholics going through withdrawal experience heart palpitations or arrhythmias, which can help evaluate heart health and the severity of withdrawal.

EEG: An EEG, or electroencephalogram, helps detect electrical abnormalities in the brain. EEGs may be used to evaluate people undergoing severe alcohol withdrawal, especially in those who are prone to or are experiencing seizures.

Withdrawal Assessment Scale

The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) is a series of questions used to measure alcohol withdrawal. This test is used by doctors to diagnose alcohol withdrawal and to determine the severity of symptoms. The scale measures the following ten symptoms:

Agitation
Anxiety
Auditory disturbances and visual delusions
Clouding of sensorium (the inability to think clearly)
Headache
Nausea
Paroxysmal sweats, or sudden, uncontrollable sweating
Tactile disturbances
Tremors
Visual disturbances
Vomiting

Alcohol Withdrawal Timeline

According to guidelines from the American Family Physician, withdrawal can be divided down into four stages with distinct symptoms. Every alcoholic is different so withdrawal timelines may differ. Alcohol withdrawal symptoms can begin as early as two hours after an individual’s last drink, but they typically start between six hours to twenty-four hours after the last alcohol consumption. Below is an alcohol withdrawal timeline outlined:

Stage 1: 6 – 12 hours after last drink

The first stage of alcohol withdrawal usually sets in 6 to 12 hours after the last drink. These minor withdrawal symptoms can include:

Anxiety
Insomnia
Nausea
Loss of appetite
Sweating
Headache
Increased or irregular heart rate

Stage 2: 12 – 24 hours after last drink

Alcoholic hallucinosis may occur 12 – 24 hours after the last drink and may continue for up to 48 hours. It can involve the following types of hallucinations:

Tactile hallucinations, such as having a sense of itching, burning, or numbness that is not actually occurring
Auditory hallucinations or hearing sounds that do not exist
Visual hallucinations, or seeing images that do not exist

It is important to note that it is rare for alcoholics going through withdrawal to experience hallucinations more than 48 hours after their last drink.

Stage 3: 24 – 48 hours after last drink

Withdrawal seizures are most typically experienced 24 – 48 hours after the last drink.

Stage 4: 48 – 72 hours after last drink

Alcohol withdrawal delirium sets in 48 – 72 hours after the last drink. Most symptoms will typically climax around five days after they begin and they will start to decrease 5-7 days after.

Treatment and Rehabilitation

Treatments for Alcohol Withdrawal Delirium may include:

Intravenous fluids
Anticonvulsants to prevent or stop seizures
Sedatives to calm agitation and treat anxiety
Antipsychotic medications to prevent hallucinations
Medication to reduce fever and body aches
Treatment for other alcohol-related conditions
Alcohol Rehabilitation to help you stop drinking

It is necessary to get professional treatment because alcohol withdrawal delirium can be fatal. Doctors may suggest seeking treatment in a hospital so that a healthcare team can monitor the individual’s current condition and manage any complications. In these cases, it may take weeks for alcoholics to feel fully functional again, making it even more important to establish a solid rehabilitation plan.

Rehabilitation, or recovery, as we like to call it at Boardwalk Recovery Center, is a long-term treatment plan intended to alleviate alcohol addiction and set up a successful sober life.