Gauging the Severity of Alcohol Withdrawal Symptoms

Symptoms of alcohol withdrawal can occur when you suddenly stop using alcohol after regular excessive drinking and can range from severe to mild. Severe withdrawal symptoms can be quite serious and in rare situations, they can actually be fatal. Because they can worsen over time, it's important to know whether your symptoms are getting more severe so you can seek help. The most severe symptoms usually occur between two and five days after you stop drinking, which means that the first day or two may not be a good indicator of your risk of serious problems.

Moderate vs. Excessive Drinking

The Centers for Disease Control and Prevention (CDC) defines moderate drinking as up to one drink per day for women and up to two drinks per day for men. Moderate drinking is considered safe for most people over the age of 21. A drink is generally defined as:

  • 12 ounces of beer
  • 8 ounces of malt liquor
  • 5 ounces of wine containing
  • 1.5 ounces of 80-proof distilled liquor or spirits, such as whiskey, gin, rum, or vodka

Excessive drinking is defined by the CDC as heavy drinking, binge drinking, or drinking that's done by anyone who is pregnant or under the age of 21. Binge drinking means you've been consuming multiple drinks during one occasion. For women, that's four or more drinks and for men, it's five or more. Heavy drinking occurs when women have eight or more drinks a week and men have 15 or more drinks per week. The majority of people who drink excessively do not have an alcohol use disorder and/or aren't dependent on alcohol.

How Withdrawal Works

If you're a heavy drinker—even if you're not an alcoholic—you're likely to experience at least some symptoms if you stop drinking suddenly. Most people use alcohol to relieve anxiety and relax. Alcohol provides this outcome by increasing the effects of GABA, a neurotransmitter responsible for creating feelings of calm and euphoria. It also decreases glutamate, another neurotransmitter that creates excitability.

Heavy drinking makes it harder and harder to increase GABA and decrease glutamate, so more and more alcohol is required for the same outcome. Your body becomes accustomed to these changes and responds by producing more glutamate and less GABA.

When you suddenly stop drinking, you are no longer suppressing these two neurotransmitters, but your body is still overproducing glutamate and underproducing GABA. As a result, you may become hyperexcited: anxious, restless, and shaky. If you were a heavy drinker, your symptoms may be much more severe, progressing to tremors, seizures, and serious high blood pressure.

Common Withdrawal Symptoms

If you've been regularly drinking excessively and you stop drinking suddenly, you may experience one or more alcohol withdrawal symptoms. Depending on your past alcohol use, these symptoms can range from being mild and uncomfortable to severe and potentially life-threatening. Though symptoms typically begin within eight hours after your last drink, you may not experience any until several days later. These symptoms tend to spike around 24 to 72 hours after your last drink, though milder ones may persist for several weeks or months in some people.

Common symptoms include:

  • Feeling anxious or nervous
  • Feeling irritable
  • Feeling depressed
  • Feeling wiped out and tired
  • Shakiness
  • Mood swings
  • Not being able to think clearly
  • Having nightmares
  • Dilated pupils
  • Sweating
  • Headache
  • Difficulty sleeping
  • Nausea and/or vomiting
  • Appetite loss
  • Faster heart rate
  • Pale skin
  • Tremor

Severe Withdrawal Symptoms

One of the most severe symptoms of alcohol withdrawal is called delirium tremens, or "the DTs."

About 3 percent to 5 percent of people who withdraw from heavy drinking experience delirium tremens. This condition can become fatal if it's left untreated, so if you or a loved one show any symptoms of the DTs, seek emergency treatment because symptoms can get worse.

Symptoms of delirium tremens include:

  • Fever
  • Extreme agitation
  • Seizures
  • Extreme confusion
  • Hallucinations (feeling, seeing, or hearing things that aren't there)
  • High blood pressure

Hospitals and detox centers have experienced staff who are familiar with these symptoms and have the tools to provide appropriate treatment.

Diagnosis

Alcohol withdrawal is primarily diagnosed with a physical exam and a toxicology screen that measures how much alcohol is present in your blood and urine. Your doctor will look for physical signs and symptoms such as:

  • Tremors in your hands
  • Fast heartbeat
  • High blood pressure
  • Dilated pupils
  • Fever
  • Fast breathing

Your doctor may also use the Clinical Institute Withdrawal Assessment for Alcohol scale to assess how severe your symptoms are. This scale uses 10 questions to measure the following symptoms:

  • Nausea and vomiting
  • Tremor
  • Sweating
  • Anxiety
  • Agitation
  • Tactile disturbances, which are abnormal feelings in, on, or underneath your skin
  • Auditory disturbances, which involve your hearing
  • Visual disturbances, which involve your vision
  • Headache
  • Confusion

Treatment

Your treatment will depend on how severe your symptoms are.

Mild to Moderate Symptoms

If you have mild to moderate symptoms of alcohol withdrawal, you can probably recuperate at home, but you need to have someone stay with you to make sure your symptoms don't get worse. You may need to see your doctor on a daily basis until you are stabilized as well.

Your doctor may prescribe a sedative such as Ativan (lorazepam), Valium (diazepam), Klonopin (clonazepam), or Xanax (alprazolam) to help you get through the early days of withdrawal. You will probably be tested for other medical problems that are related to your alcohol use and you may also have blood tests were done, as well as counseling regarding your alcohol use.

Moderate to Severe Symptoms

If your symptoms are moderate to severe, you will likely need to be hospitalized so you can be monitored more closely. Your vital signs will be monitored, as will your blood chemical levels, and you may have intravenous (IV) fluids to prevent dehydration. Your doctor may also use the IV to give you medications like the sedatives listed above to help you get through the symptoms of withdrawal or medications to stop seizures or treat other potential complications.

Long-Term Treatment

No matter how severe or mild your symptoms, the best long-term treatment is to stop drinking completely, especially when you've already gone through withdrawal. To that end, you'll need to make sure that you're living in an environment that's supportive to refraining from alcohol use. If this isn't possible at home, talk to your doctor or look online for a local shelter or housing options that can help.

Outlook

The majority of people experience a full recovery from alcohol withdrawal symptoms. Some people continue to have disruptive symptoms for months such as difficulty sleeping, fatigue, mood swings, and fatigue. A small percentage of people die from delirium tremens.

If you have underlying medical conditions, you continue to drink heavily, and/or your organs are damaged, your recovery may not be as easy.

Heavy drinking damages your organs and can lead to heart disease, liver disease, and nervous system problems, so it's important to get help and treatment if you're having a hard time abstaining from using alcohol.

Predicting Withdrawal Symptoms

You may be wondering how severe your withdrawal symptoms could be if you quit drinking. The answer to this question will depend upon many factors—your size, age, gender, drinking habits, and genetics, among others. You can get a good idea of your risk level, however, by taking a quick quiz about your symptoms. The test is completely confidential and anonymous; your results are not recorded, are available only to you, and you are not asked for any personally identifying information. It can also help if you've recently stopped drinking and aren't sure how serious your withdrawal symptoms are.

This quiz is not intended as a substitute for a professional medical evaluation. It should only be used as a guide to determining if your alcohol withdrawal symptoms are such that you should seek medical attention before you attempt to quit drinking. When answering the questions, be honest with yourself. You're the only one who will see the results of your test.

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