Alcohol Withdrawal Syndrome - Symptoms, & Treatment | Rehab Guide

Alcohol Withdrawal

Alcohol Withdrawal

alcohol withdrawal

To stop drinking safely, you must follow medical advice to safeguard yourself from the potentially life-threatening complications of alcohol withdrawal.

Alcohol, while a legal drug and widely used by most of the population, is one of the most dangerous substances to withdraw from where dependency has developed.

Rehab guide specialises in the provision of professional inpatient alcohol detox. Here, we explain the benefits of undergoing a medical detox and what you can expect to experience if you are planning on quitting alcohol at home.

What is alcohol withdrawal?

Alcohol withdrawal syndrome is a condition that develops in alcohol-dependent individuals. Effects of substance abuse can range from a mild set of symptoms to severe life-threatening symptoms.

The severity of the symptoms you experience while withdrawing will depend on:

  1. How much you have been drinking and how long you have been drinking dependently for
  2. The method of  detox that you choose to undertake
  3. Your overall physical and mental health, and your medical history

For example: If you are in relatively good health, have a mild dependence, have never previously undergone detox and can reduce your alcohol intake to zero over a number of days, then you will experience fairly mild symptoms.

If on the other hand, you have a heavy dependency,  are in poor health, have previously undergone an alcohol detox or have experienced delirium tremens or alcohol seizures, then withdrawal symptoms are likely to be severe. These are all indicators for potentially life-threatening complications developing.

Alcohol withdrawal symptoms should not be confused with a hangover. A hangover, while can be extremely unpleasant, is a temporary condition associated with occasional excessive consumption, not alcohol dependency.

The CIWA-Ar Alcohol Withdrawal Scale

It is complicated to precisely assess the degree of severity of withdrawal and associated risk, but the most widely accepted is this guide: Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar).

Some symptoms are evident immediately; others may take hours or even a few days to develop. It is, therefore, important for doctors to continue assessment throughout the withdrawal period at intervals dictated by the CIWA-Ar score.


  • Nausea, dry-retching, vomiting
  • Hand tremor
  • Anxiety, irritability, agitation, aggression
  • Sensory disturbances (itching, burning, numbness)
  • Heightened sensitivity to sound (possibly auditory hallucinations)
  • Sensitivity to light (possibly visual hallucinations)
  • Headaches
  • Disorientation
  • Palpitations, raised blood pressure, bouts of sweating
  • Night terrors
  • Delirium tremens
  • Seizures (ranging from mild to full-blown grand mal epileptic seizures).

The highest score on the CIWA-Ar scale is 67; scores under 15 can usually be managed without medication; scores over 15 require varying doses of benzodiazepine tranquillisers, usually Chlordiazepoxide (Librium)

The course of medication is usually declining doses of Chlordiazepoxide over a 10 day period. (4)

Who gets alcohol withdrawal symptoms?

Individuals who have an addiction to alcohol or who binge drink on a regular basis and can’t gradually cut down are at high risk.

Alcohol withdrawal is induced by the abrupt ceasing of alcohol, where the body and brain have become accustomed to having alcohol present in the bloodstream.

Alcohol is a depressant drug in liquid form. It has a sedative effect on the brain, essentially slowing the brain and body down. In a person who drinks heavily for a prolonged period of time, the brain adjusts its chemistry to compensate for the effects of alcohol.

Alcoholism definition

The brain copes with the constant repeated exposure to alcohol by producing natural chemicals that act as a stimulus. When this happens, the individual becomes tolerant to alcohol as the chemicals released by the brain neutralise alcohol’s sedative effects.

The brain becomes used to producing larger and larger quantities of serotonin, norepinephrine and dopamine in response to frequent alcohol consumption and increased consumption as it desperately seeks balance through adjustment.

In a brain that has become alcohol dependent and undergone critical changes to adapt to excessive exposure to alcohol, abruptly stopping alcohol or reducing consumption too quickly can send the brain into critical overdrive. When this happens, the individual’s life is at significant risk (1)

Symptoms of withdrawal result from the brain being suddenly overstimulated when it has become used to being suppressed and slowed down by alcohol. An alcohol-dependent brain takes time to readjust to being without alcohol safely.

When alcohol dependency has developed the brains neurotransmitters speed up their signal transmission in an attempt to still function under the influence of alcohol’s slowing properties. Removing alcohol abruptly or too quickly gives the brain’s neurotransmitters no time to readjust, they continue to fire on all cylinders, creating feelings of heightened anxiety, tremors and insomnia (2)

Alcohol withdrawal MUST be controlled in an alcohol-dependent person to keep them safe and minimise effects of withdrawal and associated risks.

Alcohol withdrawal timeline

The levels of dependence and the length of time you have been drinking will have a considerable impact on the severity of withdrawal symptoms you experience.

How long withdrawal lasts vary significantly from person to person and can be very hard to predict, especially in a heavy drinker. However, there is a pretty accurate withdrawal timeline in which specific symptoms will likely present.

Signs of alcohol withdrawal & side effects

Tremors (shakes) – Tremors, more commonly referred to as “the shakes usually start within 5 to 10 hours after the last alcoholic drink. Typically, the tremors peak between 24 and 48 hours. They can range from mild shaking in the hands to full body tremor. The tremors are also usually accompanied by some of, or all of the following symptoms:  anxiety,  headache,  sweating, intense alcohol cravings, nausea and vomiting, diarrhoea, high blood pressure, feeling jittery and jumpy, irritability, restlessness, insomnia, nightmares and vivid dreams (1)
Delirium tremens (DT’s) – Delirium tremens (also referred to as the DT’s) usually begin within 2-3 days after the last alcoholic drink. DT’s can remain a risk in a heavily alcoholic dependent drinker for more than a week. Delirium tremens is considered extremely dangerous and can cause acute withdrawal that can become life-threatening if not promptly medically treated. Symptoms of DT’s include a dramatic increase in blood pressure, high temperature, rapid onset of confusion, disorientation, hallucinations, loss of consciousness, heart palpitations and rapid heart rate (1)

Alcohol hallucinosis – Withdrawal hallucinations can present visually, auditory or both (seeing and/or hearing things that are not there). The visions may include talking to or seeing a person that is not there, or seeing and/or hearing objects move or fall. Needless to say, alcohol hallucinosis can be very frightening, both for the person that is experiencing them and for those that are trying to care for them. The symptoms of alcohol hallucinosis usually start within 12 to 24 hours after the last alcoholic drink. Alcoholic hallucinations can last for up to 2 days. Hallucinations can be very dangerous as the individual may do something while hallucinating that puts their life or the life of another in danger (1)

Alcohol seizures – Generally considered the most dangerous of all the withdrawal symptoms, seizures can start from 6 to 48 hours after stopping drinking. The risk of a seizure happening peaks at around 24 hours. Alcoholic fits can lead to choking on vomit, tongue swallowing, alcohol blackout, respiratory arrest and brain damage if left untreated, especially when there are multiple or lengthily seizures. Alcohol seizures are a medical emergency, and immediate treatment should be sought (1)

Most withdrawal symptoms last on average for 5 to 7 days, although in some individuals they can last (or come and go) for a number of weeks. Undergoing a medical detox reduces the chances of PAWS (post-acute withdrawal syndrome) developing and minimises the severity of the symptoms. The medication used during a medical detox reduces the effects of symptoms to a level that the patient is comfortably able to cope with.

Alcohol Withdrawal Scale

How to get help for alcoholism today

There are various medically backed methods of withdrawing from alcohol safely. There are also methods that are not recommended medically and are considered extremely risky.

Medical alcohol detox – This method of withdrawal is usually carried out within a clinical environment such as alcohol rehab, detox clinic or hospital. The alcohol is substituted with an approved pharmaceutical depressant medication which is then reduced over a period of days until it is safe for the individual to stop completely. Medical detoxes are usually carried out on an inpatient basis. This is so the patient can be continually monitored. A comprehensive rehabilitation programme is then strongly recommended to be undertaken straight away for the best long term outcome.

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Alcohol reduction programme – This is a method carried out in the community and can be done with or without medical and therapeutic support. It is a method that carries minimal success rate due to the individual experiencing intense alcohol cravings. Most individuals who have alcohol use disorders have become so as they cannot control their alcohol intake. It stands to reason that this method will only work for the minority.

Cold turkey alcohol symptoms – Quite simply, it is not safe and is the method that is most likely to cause short term and long term complications. Cold turkey withdrawal, is the abrupt cessation of all alcohol with no medical intervention or support. It is the method that causes the most deaths.

Rehab Guide understands that many suffering from alcoholism may be tempted to try the ‘cold turkey’ withdrawal method. For those that have been attempting to reduce their intake and failed, this can seem the only viable way of getting sober.

If you have been trying to reduce your alcohol intake and have failed, or are considering attempting alcoholic cold turkey, we urge you to call and speak with one of our addiction experts for free and confidential advice first!

Withdrawal medication

The effects of withdrawal symptoms can be reduced and successfully managed using certain approved pharmaceutical medications. However, it should be noted that these medications can be hazardous in the hands of those who are not medically trained.

Alcohol withdrawal medication is administered most commonly within an inpatient environment, and occasionally they are administered at home during what is commonly referred to as a ‘home alcohol detox’.

The detox medication that is most likely to suit you should only be decided and prescribed by a qualified doctor who has access to your full medical history.

NICE – The UK’s National Institute for Health and Care Excellence, recommends two withdrawal medications that can be used in most cases of medically assisted detox. These medications are Chlordiazepoxide (Librium) and Diazepam (valium) (3)

Other approved medications are sometimes used off label where necessary and when deemed in the patients best interest. People who abuse alcohol are prone to vitamin deficiencies, notably of vitamin B-1 (thiamine), vitamin B-3 niacin and folic acid, along with losses in the minerals zinc and magnesium. Both chlordiazepoxide and diazepam are controlled drugs and should never be self-administered during withdrawal. Self-administration of these powerful sedative drugs increases the risk of complications and the risk of developing a secondary addiction the detox medication (3)

Alcohol help

If you or a loved one are alcohol dependent and want to stop drinking, you must take medical advice and enlist as much support as you can. Stopping drinking needs to be pre-planned to be successful.

Your local drug and alcohol services can offer free alcohol withdrawal symptoms, NHS support and treatment in the community and attending local AA meetings. Many people in AA gain a powerful motivation to avoid relapse. (5)

Inpatient alcohol detoxes can be accessed privately and are available immediately. 

Rehab Guide ensure that all of our patients are afforded the highest levels of medical and therapeutic care for the duration of their treatment and beyond. Our withdrawal treatment plans are designed to help you stop drinking and stay stopped, long after you leave the treatment environment.

Withdrawing from alcohol in one of our CQC registered detox centres, you will be continually monitored by medical professionals to ensure you are receiving the best possible alcohol withdrawal treatment at all times. The qualified counsellors and therapists will also be on hand at all times to offer high levels of therapeutic and emotional support.

Alcohol detox should always immediately be followed by a bespoke rehabilitation programme; this minimises the chances of alcoholic relapse and enables healing on a mental, physical, emotional and social level.

For more information on coping with alcohol withdrawal, inpatient alcohol detox and our individualised rehab programmes and for alcohol help, call and speak with one of our experts today!






  1. Harvard health
  2. Neuroscience -Pathways to alcohol dependence
  3. NICE



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