What is alcohol withdrawal syndrome (AWS)?
Alcohol withdrawal syndrome (AWS) is the name for the symptoms that occur when a heavy drinker suddenly stops or significantly reduces their alcohol intake.
With AWS, you may experience a combination of physical and emotional symptoms, from mild anxiety and fatigue to nausea. Some symptoms of AWS are as severe as hallucinations and seizures. At its most extreme, AWS can be life threatening.
The signs and symptoms of AWS may appear anywhere from 6 hours to a few days after your last drink. These usually include at least two of the following:
- tremors
- anxiety
- nausea
- vomiting
- headache
- an increased heart rate
- sweating
- irritability
- confusion
- insomnia
- nightmares
- high blood pressure
The symptoms may worsen over 2 to 3 days, and some milder symptoms may persist for weeks in some people. They may be more noticeable when you wake up with less alcohol in your blood.
The most severe type of withdrawal syndrome is known as delirium tremens (DT). Its signs and symptoms include:
- extreme confusion
- extreme agitation
- a fever
- seizures
- tactile hallucinations, such as having a sense of itching, burning, or numbness that isn’t actually occurring
- auditory hallucinations, or hearing sounds that don’t exist
- visual hallucinations, or seeing images that don’t exist
- excessive sweating
- increased heart rate
- high blood pressure
- fast respirations
If you have severe AWS symptoms, it’s a medical emergency. Call for help or go to the emergency room. A high fever, hallucinations, and heart disturbances are all reasons to seek immediate help.
What causes alcohol withdrawal syndrome?
(Video) Alcohol Withdrawal Syndrome Overview
What causes alcohol withdrawal syndrome?
Excessive drinking excites and irritates the nervous system. If you drink daily, your body becomes dependent on alcohol over time. When this happens, your central nervous system can no longer adapt easily to the lack of alcohol. If you suddenly stop drinking or significantly reduce the amount of alcohol you drink, it can cause AWS.
People who have an addiction to alcohol or who drink heavily on a regular basis and are not able to gradually cut down are at high risk of AWS.
AWS is more common in adults, but children and teenagers who drink excessively may also experience the symptoms. You’re also at risk for AWS if you’ve previously had withdrawal symptoms or needed medical detox for a drinking problem.
The
- 1.5 ounces of distilled spirits or liquor, including gin, rum, vodka, and whiskey
- 5 ounces of wine
- 8 ounces of malt liquor
- 12 ounces of beer
Binge drinking is the most common form of heavy drinking. For women, it’s defined as four or more drinks in one sitting. For men, it’s defined as five or more drinks in one sitting.
Your doctor will review your medical history, ask about your symptoms, and conduct a physical exam. Some signs your doctor will look for include:
- hand tremors
- an irregular heart rate
- dehydration
- a fever
Your doctor may also perform a toxicology screen, which tests how much alcohol is in your body.
The Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) is a series of questions used to measure AWS. Healthcare professionals may use this test to diagnose AWS. It can also be used to determine the severity of your symptoms. The scale measures the following 10 symptoms:
- agitation
- anxiety
- auditory disturbances
- clouding of sensorium, or the inability to think clearly
- headache
- nausea and vomiting
- paroxysmal sweats, or sudden, uncontrollable sweating
- tactile disturbances
- tremor
- visual disturbances
It’s important to note that the Clinical Assessment mentioned above may be unreliable because it is subjective in nature. According to a
Questions a medical professional may ask include:
- Who am I?
- What day is this?
- Does it feel like there is a band around your head?
- Do you feel sick to your stomach?
- Do you feel bugs crawling under your skin?
Treatment for AWS depends on how severe your symptoms are. Some people can be treated at home, but others may need supervised care in a hospital setting to avoid potentially dangerous complications such as seizures.
The first goal of treatment is to keep you comfortable by managing your symptoms. Alcohol counseling is another important treatment goal. Your doctor’s treatment goal is helping you stop drinking as quickly and safely as possible.
Home care
Mild symptoms of AWS can often be treated at home. A relative or friend must stay with you to monitor your condition. Their job is to make sure that if you develop any worsening of symptoms, they get you to a hospital or call 911 immediately.
They should also make sure you attend your counseling appointments and visit the doctor regularly for any routine blood tests that may be ordered. You may also need tests for alcohol-related medical problems.
If your home environment is not supportive for staying sober, talk with your doctor. Your doctor may be able to connect you with shelter programs for people recovering from alcohol addiction.
Hospitalization
If your symptoms are more severe, you may need to stay in the hospital. This is so your doctor can monitor your condition and manage any complications. You may need to get fluids intravenously, or through your veins, to prevent dehydration and medications to help ease your symptoms.
Medications
Symptoms of AWS are often treated with sedatives called benzodiazepines. The most prescribed benzodiazepine is chlordiazepoxide, which is only available as a generic in the United States.
Other benzodiazepines that might be prescribed are:
- lorazepam (Ativan)
- alprazolam (Xanax)
Benzodiazepines carry a Food and Drug Administration
In addition, vitamin supplements may be given to replace essential vitamins that are depleted by alcohol use. Once withdrawal is complete, additional medications and supplements may be needed to address complications and nutritional deficiencies that occur because of chronic alcohol use.
Most people with AWS fully recover. If you’re otherwise healthy and can stop drinking and get treatment, the outlook is usually good. However, sleep disturbances, irritability, and fatigue may continue for months.
If AWS has advanced to delirium tremens, it can be fatal. If you begin experiencing severe symptoms of AWS, it’s important to seek immediate medical attention. The sooner you begin treatment, the better your chances are of preventing life threatening complications.
The best way to prevent AWS is to avoid regular heavy drinking. If you already have alcohol use disorder, it’s important to seek counseling and medical care as soon as possible. The goal is to safely and gradually decrease your dependence on alcohol so that you can resume your daily life.
Q:
What nutrition advice can you provide for people recovering from alcohol addiction?
Anonymous patient
A:
This depends on the individual and the results of laboratory tests that their doctor may order. In general, blood work will test serum magnesium, and replacements will occur if indicated. Vitamins such as thiamine and folic acid will need to be supplemented. In addition, the doctor may add a daily multiple vitamin. The person should also try to eat three well-balanced meals per day and drink enough water to remain hydrated.
Timothy J. Legg, PhD, PsyD, CAADC, CARN-AP, MACAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
FAQs
What happens to your body when you stop drinking? ›
Up to 24 hours after you stop drinking
Early symptoms will be mild. They may include anxiety, hand tremors and shakes, sweating and headaches. As time goes on, alcohol cravings will grow and a feeling of fatigue and depression could begin.
The most severe manifestations of withdrawal include delirium tremens, hallucinations, and seizures. These manifestations result from alcohol-induced imbalances in the brain chemistry that cause excessive neuronal activity if the alcohol is withheld.
What symptoms will I have if I stop drinking alcohol? ›Alcohol withdrawal can be dangerous and even deadly without the right treatment, especially if you've been drinking heavily over a long period of time. Symptoms of alcohol withdrawal include anxiety, tremors, sweating, and nausea. More severe symptoms include fever, mental confusion, and seizures.
What happens when you stop drinking a lot of alcohol? ›Symptoms/outcomes you may see
Onset of withdrawal symptoms which may include hand tremors, retching, excessive sweating, restlessness and anxiety. Withdrawal symptoms continue. Alcohol cravings, reduced energy and feeling low or depressed are common. Sleep is likely to be disturbed.
Overall benefits of three weeks without alcohol
Clear skin. More energy. Improved gym performance. Reduced anxiety and improved mood.
For men, heavy drinking is typically defined as consuming 15 drinks or more per week. For women, heavy drinking is typically defined as consuming 8 drinks or more per week.
What are 4 of the withdrawal symptoms? ›...
Symptoms can include:
- not being able to sleep.
- irritability.
- changing moods.
- depression.
- anxiety.
- aches and pains.
- cravings.
- tiredness.
The most severe type of withdrawal syndrome is known as delirium tremens (DT). Its signs and symptoms include: extreme confusion. extreme agitation.
What is the last stage of addiction? ›Stage 4: Addiction
Once the final stage is reached, you have entered addiction and complete dependency upon the substance. It's no longer a question about whether or not you're addicted to drugs or alcohol.
You could experience withdrawal symptoms within a day or two after you stop drinking. If you chronically, heavily abused alcohol, withdrawal symptoms may begin only a few hours after your last drink. Mild to moderate alcohol withdrawal symptoms typically last a week or two.
What happens when you drink alcohol everyday? ›
Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including: High blood pressure, heart disease, stroke, liver disease, and digestive problems. Cancer of the breast, mouth, throat, esophagus, voice box, liver, colon, and rectum.
What is the best way to stop drinking? ›- Make your intentions known. Tell your family and friends that you're aiming to stop drinking alcohol and explain why. ...
- Avoid temptation. In the early stages, it's a good idea to avoid situations where you may be tempted to drink. ...
- Try something new. ...
- Reward progress. ...
- Enjoy the benefits.
These findings suggest that the detrimental effects of alcohol on protein trafficking pathways occur rather rapidly (1 to 5 weeks) and that complete recovery is obtained within 7 days after cessation of alcohol consumption.
What happens after a week without alcohol? ›All of your body's systems are back to their usual working levels. You may find that you have more energy and better concentration. Even if you toss and turn a bit at first, when you do drop off you'll get better-quality sleep and probably wake feeling more refreshed the next day.
What happens on day 4 of no alcohol? ›However, by day 4 without alcohol, most people will have got beyond any initial withdrawal symptoms. All the alcohol will have left your system by now, and your body will begin to bounce back. If you're not as focused on alcohol, you may be eating better, drinking water, moving more, and perhaps sleeping more deeply.
How long does it take for brain chemistry to return to normal after alcohol? ›It takes at least two weeks for the brain to return to normal after drinking. Therefore, this is when the alcohol recovery timeline begins. It is less able to suppress a desire to drink until the brain has recovered. The reason for this is that alcohol has harmed the brain's cognitive function.
What is an alcohol belly? ›Bloating is one of the most common effects drinking alcohol can have on the body. Most people are familiar with the term “beer belly,” the name for the stubborn fat that tends to form around your middle if you are a frequent drinker.
How much weight will I lose quitting drinking? ›2 weeks with no alcohol will save you 7,000 calories. 3 weeks with no alcohol will save you 10,500 calories. 1 month with no alcohol will save you at least 14,000 calories.
What are three common signs that a person may have a problem with alcohol? ›- Being unable to limit the amount of alcohol you drink.
- Wanting to cut down on how much you drink or making unsuccessful attempts to do so.
- Spending a lot of time drinking, getting alcohol or recovering from alcohol use.
- Feeling a strong craving or urge to drink alcohol.
Drinking a bottle of wine per day is not considered healthy by most standards. However, when does it morph from a regular, innocent occurrence into alcohol use disorder (AUD) or alcoholism? First, it's important to note that building tolerance in order to drink an entire bottle of wine is a definitive red flag.
What do you call a person who drinks alcohol everyday? ›
Alcoholism is a dependence on alcohol characterized by a habitual use of alcohol; it is both a physical and mental addiction.
What is one of the first signs of withdrawal? ›- Agitation.
- Anxiety.
- Muscle aches.
- Increased tearing.
- Insomnia.
- Runny nose.
- Sweating.
- Yawning.
Symptoms of Withdrawal
Muscle pain or aches. Hunger or loss of appetite. Fatigue. Sweating.
Medications used in the treatment of withdrawal symptoms include opioid agonists such as methadone and buprenorphine (a partial agonist), as well as alpha-2 adrenergic agonists such as clonidine and lofexidine.
What drug is commonly used to treat alcoholics? ›Three medications are approved by the U.S. Food and Drug Administration to treat alcohol use disorder: acamprosate, disulfiram, and naltrexone.
What are three things that can help with withdrawal symptoms? ›- Ask for help. ...
- Eat well. ...
- Exercise. ...
- Drink plenty of water. ...
- Relieve symptoms with over the counter (OTC) medications. ...
- Sleep.
For men, consuming more than 4 drinks on any day or more than 14 drinks per week. For women, consuming more than 3 drinks on any day or more than 7 drinks per week.
What are the 4 levels of addiction? ›There are four levels of addiction: physical, emotional, mental, and spiritual. We will discuss each level in-depth and provide tips for overcoming addiction. Most people who try drugs or engage in risky behaviors don't become addicted.
How does the brain heal after addiction? ›Our brains have an incredible ability to adapt and repair – even after prolonged AOD use and addiction. The brain continues to build brain cells and neural pathways throughout our life, and its ability to adapt and change – called neuroplasticity – allows it to modify, grow and reorganise itself after addiction.
What are the 5 phases of recovery? ›The five stages of addiction recovery are precontemplation, contemplation, preparation, action and maintenance.
Is withdrawal worse than failure? ›
Croskey notes that dropping a class is better than withdrawing, but withdrawing is better than failing. “A failing grade will lower the student's GPA, which may prevent a student from participating in a particular major that has a GPA requirement,” Croskey says.
What does it look like to go through withdrawal? ›Fatigue and lethargy are common symptoms caused by many substances because of the toll drugs take on the body. Sweats, shakes, clammy skin, tingles, and feeling cold are other examples. Muscle pains and spasms are seen when withdrawing from drugs like opiates or muscle relaxers.
What does it feel like to go into withdrawal? ›Withdrawal causes the body to feel intense pain. You may even notice that it feels as though your body is burning—some say it feels like their body is on fire. Your eyes will burn, your nose will run.
Is it OK to drink every night? ›Should I be concerned? ANSWER: Occasional beer or wine with dinner, or a drink in the evening, is not a health problem for most people. When drinking becomes a daily activity, though, it may represent progression of your consumption and place you at increased health risks.
Why do I need to drink every night? ›If you feel that you need a drink every night or to get through a social event, stressful situation or personal struggle, and you have a compulsion to drink or constantly crave alcohol, maybe even daily, this could be a sign of psychological dependency.
What is the healthiest alcohol? ›Red Wine. Red wine is widely recognized as one of the healthiest alcoholic drinks out there. Poon notes that it's "relatively low in calories and also offers some health benefits."9 She adds that red wine is rich in antioxidants such as resveratrol and proanthocyanidins and can promote cardiovascular health.
How can I train my brain to stop drinking? ›Cognitive bias modification is a computerised brain-training program that trains people to repeatedly “avoid” alcohol-related cues, and to “approach” neutral or positive ones. Using a joystick, the user repeatedly pushes away pictures of alcohol, and pulls healthier alternatives, such as bottled water, towards them.
Why can't I just stop drinking? ›There is a perception out there that if you just “had more self-control,” you would be able to stop drinking. In reality, long-term and regular alcohol consumption alters the brain chemistry, so you become physically dependent on it — you actually need alcohol to feel normal.
How do I motivate myself to stop drinking? ›- Set specific goals.
- Consider what motivates you.
- Alcohol and weight.
- Think about what you will miss.
- Communicate your intentions.
- Be aware of your triggers.
- Notice how you feel.
- Celebrate your successes.
"When you stop drinking alcohol, you restore ADH levels to their natural state, and your kidneys expel the appropriate amount of water." By retaining water and staying hydrated, your whole body will feel better. "Our bodies are entirely dependent on water," Raichbach said.
How do you know when your liver is healed? ›
You will experience physical signs your liver is healing, such as healthier-looking skin and eyes, increased energy levels, and reduced stomach pain and swelling. Other signs your liver is healing include: Improved amino-acid regulation – Your liver processes proteins and amino acids that your body cannot store.
How long does it take alcohol to get out of your liver? ›The half-life of alcohol is four to five hours. A half-life is how long it takes for your body to get rid of half of it. But you need about five half-lives to get rid of alcohol completely. So, it takes about 25 hours for your body to clear all the alcohol.
What happens to your body day by day when you stop drinking? ›Symptoms/outcomes you may see
Withdrawal symptoms continue. Alcohol cravings, reduced energy and feeling low or depressed are common. Sleep is likely to be disturbed. This is the danger period for the most severe withdrawal symptoms such as dangerously raised heart rate, increased blood pressure and seizures.
- Weight loss.
- Clear skin.
- More energy.
- Improved gym performance.
- Reduced anxiety and improved mood.
- Saved money.
- Feelings of accomplishment.
- Better sleep.
Generally, symptoms of alcoholic liver disease include abdominal pain and tenderness, dry mouth and increased thirst, fatigue, jaundice (which is yellowing of the skin), loss of appetite, and nausea. Your skin may look abnormally dark or light. Your feet or hands may look red.
What happens when you don't drink alcohol for 2 weeks? ›Two weeks off alcohol will help you reset your sleep cycle, getting you into a regular and undisturbed pattern. You'll wake more refreshed and alert each day, helping to boost your concentration and performance at work and play.
How long after drinking does your body heal? ›The First Two Weeks
Most people will stop experiencing withdrawal symptoms in less than a week, in which time their body will begin to restore its normal function and quality of life can already improve considerably. Some improvements in sleep occur as early as seven days, and these gains increase in the week after.
You will experience physical signs your liver is healing, such as healthier-looking skin and eyes, increased energy levels, and reduced stomach pain and swelling. Other signs your liver is healing include: Improved amino-acid regulation – Your liver processes proteins and amino acids that your body cannot store.
What does not drinking for 30 days do? ›Cutting out alcohol for 30 days or more can lead to a "reduction in things like joint pain, headaches, and body aches," Scheller says. In fact, alcohol use can actually cause arthritis by increasing inflammation in your joints. Plus, alcohol can dehydrate you, contributing to the headaches.
What alcohol does to your face? ›Alcohol causes your body and skin to lose fluid (dehydrate). Dry skin wrinkles more quickly and can look dull and grey. Alcohol's diuretic (water-loss) effect also causes you to lose vitamins and nutrients. For example, vitamin A.
How long do you have to abstain from alcohol for your liver to recover? ›
Individuals who occasionally binge drink on weekends can usually avoid toxic liver diseases when abstaining from alcohol for two weeks to a full month. Most expert guidelines suggest avoiding drinking alcohol for 30 days to help your liver restore to its normal function.
How long does your liver take to recover after alcohol? ›Healing can begin as early as a few days to weeks after you stop drinking, but if the damage is severe, healing can take several months. In some cases, “if the damage to the liver has been long-term, it may not be reversible,” warns Dr.
How do I know if my liver is detoxing? ›- Nausea.
- Vomiting.
- Anxiety.
- Tremors.
- Headache.
- Confusion.
- Insomnia.
- Restlessness.
- Skin and eyes that appear yellowish (jaundice)
- Abdominal pain and swelling.
- Swelling in the legs and ankles.
- Itchy skin.
- Dark urine color.
- Pale stool color.
- Chronic fatigue.
- Nausea or vomiting.
- Coffee. Coffee is one of the best beverages you can drink to promote liver health. ...
- Tea. ...
- Grapefruit. ...
- Blueberries and cranberries. ...
- Grapes. ...
- Prickly pear. ...
- Beetroot juice. ...
- Cruciferous vegetables.
Coconut water is a great alternative to alcohol's buzz because it helps you rehydrate without the negative side effects of alcohol. It's a natural, healthy beverage that contains electrolytes and other nutrients that are beneficial for your health.
Does your body hurt when you quit drinking? ›Abdominal Pain and Nausea
When someone stops drinking, it causes their body to go into a state of physical and emotional stress. It can cause them to feel very uncomfortable and even hurt. This can result in heart problems and stomach aches that may be accompanied by nausea or vomiting.
Drinking alcohol can leave a noticeable smell on the breath. Those who have been drinking heavily can also have a strong odor that is produced by their skin pores. Most people feel uncomfortable if they are carrying around the smell of alcohol on their body. They will use different methods to hide it.