Alcohol withdrawal refers to the mental and physical symptoms you show when you stop drinking or drastically cut your alcohol intake after a period of heavy consumption.
The condition is caused by alcohol’s depressive effect on our bodies. Over time, the body’s central nervous system develops an alcohol dependence.
Symptoms of alcohol withdrawal can appear as early as 4 hours after your last drink and subside in two weeks. In some cases, certain symptoms may linger for more than a year. Symptoms of alcohol withdrawal include:
Depending on the severity of your alcohol withdrawal, symptoms may resolve spontaneously or require supportive care. It may even require ICU admission. The condition can also be fatal.
How soon do alcohol withdrawal symptoms start?
The time between the last drink and the development of signs and symptoms of alcohol withdrawal varies between people and depends on several factors. These factors include:
Amount of alcohol consumed,
Presence of another chronic disease or condition
Previous history of withdrawals and hospitalization due to alcohol use.
However, on average, a person can develop symptoms within 4-6 hours. Symptoms generally peak around 24-48 hours and subside in 5-7 days. During this period, a person may develop mild symptoms that may resolve without treatment or which may progress in severity and may require supportive care.
The Different Stages Of Alcohol Withdrawal Syndrome.
Depending on when symptoms appear, alcohol withdrawal syndrome is classified into two stages, which are early and late-stage alcohol withdrawal.
Based on the severity of autonomic symptoms and the presence of delirium, it is divided into minor and major stages. While withdrawal seizures and alcohol hallucinosis fall into the early and minor stage, delirium tremens comes under the late major stage.
Early-stage Alcohol Withdrawal
This stage begins is marked by symptoms like hand tremors that appear within 4-6 hours after the last drink. It is also associated with autonomic hyperactivity, including increased body temperature, heart rate, and blood pressure, as well as sweating, insomnia, hyper-vigilance, and irritability. The symptoms peak around 24-48 hours.
Patients may develop seizures at any time between 8-24 hours and within 48 hours of your last drink. Single or multiple episodes of seizure can also occur. Symptoms usually peak at around 24 hours after the last drink.
A notable and dramatic feature of early-stage alcohol withdrawal is alcohol hallucinosis, which is where patients hear threatening and accusatory voices. This symptom shows after 12-24 hours and may last for 2 days after onset.
Late-Stage Alcohol Withdrawal
Signs and symptoms of late-stage alcohol withdrawal develop after 48 hours of drinking. The most common symptom in this stage is delirium tremens, which is marked by severe sudden changes to the patient’s mental state and nervous system.
This is a dangerous form of alcohol withdrawal that requires hospitalization and can even warrant ICU admission. It usually occurs within 2-3 days after the last drink but may also be delayed for weeks.
Late-stage alcohol withdrawal stage peaks around 4-5 days with extreme symptoms of autonomic hyperactivity, altered state of consciousness, and even death. The mortality rate used to be as high as 20%, but early intervention has helped lower it to around 1%.
Symptoms of the early stage can resolve spontaneously or may require supportive care and may or may not progress to the late stage. Patients in the early stage of alcohol withdrawal may not develop all the associated symptoms.
Most of the acute episodes of alcohol withdrawal syndrome resolve within two weeks. However, some patients may experience persistent long term symptoms, including effects on the heart and brain.
Bayard M, et al. (2004). Alcohol withdrawal syndrome. aafp.org/afp/2004/0315/p1443.html
Alcohol use disorders: Diagnosis and clinical management of alcohol-related physical complications. (2010). ncbi.nlm.nih.gov/pubmedhealth/PMH0047840/