Alcohol use is one of the most socially acceptable forms of substance use. 63% of U.S. adults consumed alcohol in 2021-2022. Thus, as one would expect, heavy drinking is one of the most common and socially accepted forms of substance abuse. However, the consequences are more serious than many people recognize.
Many of us are familiar with a hangover, the term for the unpleasant short-term effects of drinking too much. But people who engage in long-term alcohol abuse can suffer much more serious symptoms.
Once their bodies become accustomed to alcohol use, an attempt to stop drinking will cause them to experience withdrawal symptoms. And the symptoms of alcohol withdrawal can be fatal. Read on to learn how binge drinking can progress into alcohol addiction, how life-threatening and severe withdrawal symptoms can impact people with alcohol use disorder, and what to do if you or a loved one is in danger of suffering severe symptoms from alcohol withdrawal.
Is A Hangover the Same As Alcohol Withdrawal?
While a hangover is an unfortunate consequence of drinking too much, it’s different from alcohol withdrawal. A hangover is the result of drinking an excess amount of alcohol in a single session (aka heavy drinking). It typically lasts less than 24 hours, and is not life-threatening.
To help distinguish between a hangover and actual alcohol withdrawal, let’s look at a few of the common features of a hangover.
Key Features of A Hangover
To distinguish between hangovers and alcohol withdrawal symptoms, let’s look at some common features of hangovers.
Dehydration
Hangovers are caused in part by dehydration. Alcohol causes you to urinate more frequently, losing the water that your body needs to function.
Electrolyte Depletion
That constant urination also depletes your body of electrolytes, like sodium, potassium, and magnesium. Electrolytes are important for vital body functions. The soreness, fatigue, and nausea that you feel when hungover is partially caused from depletion of electrolytes.
Toxic Compounds
Alcohol is toxic! It also breaks down into acetaldehyde, which is toxic to your system. If you’ve ever had a rapid heartbeat and the sweats while hungover, it may be because high levels of this compound are being released into your body as your liver processes the alcohol you consumed.
Inflammation
Since alcohol is toxic, your body reacts to it as if it’s fighting off an illness. This inflammation contributes to the headaches and muscle aches you suffer during a hangover.
Digestive Disruption
Additionally, drinking causes your stomach to produce more acid. Vomiting after a night of intense drinking may be caused by this excess stomach acid.
Less REM Sleep
While consuming lots of alcohol may make you tired, it also reduces your REM sleep, which is the period of sleep that is most important for rejuvenating your mind and body. This means that even if you pass out for several hours, you may still awaken feeling exhausted–another common aspect of hangovers.
While having a hangover is not an indicator of severe alcohol dependence, it does usually mean that you have engaged in binge drinking. We’ll go into detail about this type of alcohol consumption below.
How Much Do You Have to Drink to Suffer Alcohol Withdrawal?
A single hangover may feel life threatening in the moment, but unless paired with other medical complications, it’s not a medical emergency. In contrast, severe or complicated withdrawal from alcohol can be life threatening.
So how much do you have to drink to trigger this condition when you stop? It varies from person to person, but generally someone has to have engaged in chronic (meaning long term) “heavy drinking.” Which raises the question….
How Much Drinking Is Heavy Drinking?
The threshold for a drinking problem is much lower than many people recognize. Alcohol dependence often begins with less frequent alcohol use, then progresses to the point of alcohol use disorder. Alcohol addiction, like every form of addiction, is a progressive illness.
Alcohol dependence often begins with repeated incidents of binge drinking, and progresses to heavy drinking. But how do you know if you’re engaging in binge drinking?
Binge Drinking Defined
Binge drinking occurs when someone consumes enough alcohol in a short period of time to raise their blood alcohol level above 0.08 (which is also the cutoff for impaired drinking.
The CDC defines binge drinking as five or more drinks for a man and four or more drinks for a woman, in a period of about 2 hours. While binge drinking doesn’t mean a person necessarily has a drinking problem or will suffer from withdrawal, it is one of many risk factors for alcohol dependence.
Consequences of Binge Drinking
Binge drinking can have its own consequences. It may lead people to engage in behaviors they otherwise wouldn’t, like unprotected sex, drunk driving, or fighting with loved ones or strangers.
Binge drinking can also lead to blackouts, in which the brain literally stops forming memories. For most people, occurs when their blood alcohol level reaches 0.16% or higher. Alcohol suppresses the activity of the hippocampus, the part of the brain that records new memories.
Alcohol Poisoning
Another risk of binge drinking is alcohol poisoning. This condition typically occurs when the blood alcohol level exceeds 0.25. The central nervous system is impacted and crucial body functions may shut down.
A person with alcohol poisoning may become severely confused and incoherent, lose consciousness, experience seizures, and have their breathing slow to a dangerous rate.
If someone becomes unresponsive after drinking a large amount of alcohol, call 911 immediately. Keep the person awake if possible, shift their body onto its side so they don’t aspirate on their vomit, and perform CPR if they stop breathing. Alcohol poisoning, like binge drinking in general, is one of the risk factors for alcohol addiction.
Heavy Drinking Defined
The CDC and the National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as 5 incidents of binge drinking a month. That means if you have five drinks every Friday night and throw in a Sunday watching football, you’re over the cutoff for heavy drinking.
Alternatively, having more than 14 drinks a week for men or 7 for women can also constitute heavy drinking. So a few glasses of wine after work every day can add up to a serious habit, and mild symptoms of alcohol withdrawal can progress into severe withdrawal symptoms.
How Much Is Chronic?
As noted above, a person’s drinking must be chronic (long term) if they are to suffer from alcohol withdrawal syndrome. Notably, people who drink every day are at higher risk for alcohol withdrawal symptoms than those who binge drink more sporadically.
If someone has been drinking every day for weeks or months, they are likely to suffer from alcohol withdrawal syndrome if they suddenly decrease their consumption, or if they stop drinking completely.
It’s important to recognize the dangers of alcohol withdrawal. People who struggle with alcohol use disorder are often told that they should go “cold turkey” and stop drinking all at once. But this advice overlooks the way that chronic alcohol abuse impacts the central nervous system. Let’s look at the physiological causes of the symptoms of alcohol withdrawal.
What Causes Alcohol Withdrawal Syndrome?
The reason alcohol is relaxing for many people stems from its impact on neurotransmitters.
Alcohol Makes GABA Stronger
Alcohol strengthens the effects of GABA, an inhibitory neurotransmitter. GABA dampens the signals sent through nerves. It helps you feel calm and relaxed. It also helps your brain enter deep sleep and balances your mood. GABA also literally relaxes your body, preventing muscle spasms and seizures.
Alcohol Reduces Glutamate
Alcohol use also reduces the effects of glutamate, which can be looked at as the opposite of GABA. Glutamate is an excitatory neurotransmitter, speeding up nerve signals. It triggers muscle movements and alertness. By reducing its activity, alcohol makes people feel sedated and calm.
The Body Adapts
Because alcohol enhances GABA’s effects, the body responds by reducing the amount of GABA it produces. Conversely, because alcohol reduces the effects of glutamate, the body adapts by increasing glutamate levels. This is a recipe for disaster.
Sudden Stoppage
With GABA levels decreased and glutamate levels increased, the body becomes dependent on alcohol to keep it from getting overexcited. So when alcohol levels suddenly decrease, the brain and body go into hyperdrive.
The symptoms described below can best be understood as the effect of these paired neurotransmitters and their improper levels. Think of alcohol withdrawal as the body and brain becoming overexcited as they react to the sudden absence of the substance that they’ve adapted to.
Alcohol Withdrawal Symptoms
It’s important to note that not every person has the same alcohol withdrawal timeline. Mild withdrawal symptoms can turn into deadly withdrawal seizures at a moment’s notice. If you experience withdrawal symptoms of any kind, we urge you to seek medical attention before you stop drinking. Turning Point of Tampa has a fully equipped detoxification center where your withdrawal symptoms can be managed under medical supervision.
The following are some of the common symptoms of alcohol withdrawal, organized by when they occur in relation to the last alcoholic drink that a person with alcohol dependence has consumed.
Six to Twelve Hours After The Last Drink
These symptoms of alcohol withdrawal are relatively mild. They often affect people with alcohol use disorder on a regular basis, after periods of abstinence during sleep or work. These mild symptoms also continue (and worsen) through the other stages of withdrawal. They include:
Insomnia
Sleeping becomes extremely difficult during alcohol withdrawal symptoms. With lowered levels of GABA and increased levels of glutamate, the brain simply can’t relax enough to enter sleep.
Tremors
Also known as “the shakes,” alcoholics will experience tremors in their hands and sometimes throughout their body during early stage alcohol withdrawal, and throughout the process. Beta blockers are often prescribed to assist with tremors.
Anxiety and Irritability
Some people refer to the anxiety experienced during alcohol withdrawal as “the fear.” The body and brain react to the absence of alcohol with physical and mental stress, which can pose an obstacle for people trying to stay sober. People going through alcohol withdrawal are also likely to be easily annoyed, as their levels of the excitatory neurotransmitter glutamate are spiking.
Headache
The dehydration and electrolyte depletion that is partially responsible for hangovers (see above) is also a major factor in alcohol withdrawal, leading to headaches. Staying hydrated is of the utmost importance throughout the process. But this may be difficult due to another symptom of alcohol withdrawal…
Nausea
Nausea is one of the most dangerous symptoms of alcohol withdrawal. Keeping down food or even water can be difficult. The stomach is accustomed to alcohol use at this point, and becomes tense without it. Overwhelming nausea may cause vomiting, even after the point that the stomach is empty, producing bile and even blood.
Sweating
Another factor in the dehydration caused by alcohol withdrawal is the body’s increased sweating. Alcoholics often awaken with their sheets soaked through. This is one of the mild symptoms that is experienced on a near-constant basis by people with severe alcohol dependence, as being separated from alcohol even for a few hours while sleeping will trigger alcohol withdrawal.
Increased Blood Pressure
Beginning in this early stage of alcohol withdrawal and continuing throughout, the nervous system overactivity and dehydration leads to increased heart rate and hypertension (high blood pressure).
Alcohol Cravings
All of these unpleasant symptoms add up to create a very negative experience, and people who are used to a high alcohol intake are likely to crave alcohol during this early stage and throughout the withdrawal process, with the knowledge that it will quickly relieve their symptoms. This is one of many reasons that people trying to stop drinking after prolonged alcohol use should seek professional help. Their resolve is unlikely to last for long without medical professionals managing their symptoms.
Twelve to Forty Eight Hours After The Last Drink
These moderate withdrawal symptoms kick in after more prolonged abstinence. As with the mild symptoms, they are likely to persist and worsen throughout alcohol withdrawal.
Hallucinations
People with a severe form of alcohol use disorder will experience hallucinations as they enter this stage of alcohol withdrawal, even if their mental health is otherwise normal. They will often see things like shadows or bugs at the corner of their vision, hear voices or loud noises that aren’t there, or feel as though things are crawling on their skin. These symptoms can be terrifying.
Disorientation
At this stage, more than twelve hours after the last alcohol consumed, people may experience severe confusion and disorientation, losing track of where they are and what is happening.
Rapidly Shifting Mood
People may display rapid changes in mood as their neurotransmitters rebound, swinging between euphoria and severe depression. They can be dangerous to be around, as they lose control of their emotions and become agitated easily.
Rapid Breathing
The overexcited nervous system causes rapid breathing, sometimes to the point of hyperventilation. This is dangerous and may be life threatening, as your body’s CO2 levels can drop to the point that you faint.
Seizures
Withdrawal seizures are a medical emergency. They can occur at any point during alcohol withdrawal, but are most likely to happen 24-48 hours after you stop drinking. The body’s decreased levels of GABA (which prevents spasms and seizures) can lead to a grand mal seizure, also known as a generalized tonic-clonic seizure.
In the tonic phase, the muscles stiffen and the person loses consciousness. In the clonic phase, their body spasms violently and they may bite through their tongue. This can lead to severe injury as the person falls and spasms, and repeated seizures can cause brain damage or death.
Forty Eight or More Hours After the Last Drink
Delirium Tremens
Probably the most life threatening of all alcohol withdrawal symptoms, delirium tremens is the term for the most severe or complicated withdrawal from alcohol. It is a medical emergency and can be fatal. It includes overwhelming confusion (delirium), hallucinations, ceaseless agitation, fever, and extreme hypertension and rapid heart rate. The National Institute of Health estimates that 37% of cases of delirium tremens are fatal if not closely monitored and treated under clinical management.
People who suffer from other mental disorders are likely to experience withdrawal symptoms that overlap with the symptoms of their co-occurring conditions, meaning that people who have psychotic disorders are likely to experience psychosis during delirium tremens.
Delirium tremens can last up to a week, with symptoms peaking around four days after the last alcoholic drink.
Alcohol Withdrawal Treatment
Alcohol withdrawal, especially at the level of delirium tremens, requires treatment in a clinical practice to monitor the heart rate, blood pressure, and other vital signs, and to provide intravenous administration of fluids and electrolytes. Treatment may include short term medications like benzodiazapenes and other drugs to manage symptoms.
Depending on the level of alcohol use disorder, severe symptoms may subside after a few days. In other cases, more severe withdrawal symptoms may last for up to a week, with more mild symptoms persisting for as long as months. Alcohol health professionals are likely to assess the level of alcohol intake, and to administer the Clinical Institute Withdrawal Assessment for alcohol to determine what treatment is necessary.
Alcohol withdrawal treatment may also include the use of vitamin B1 supplements and other medications to prevent Wernicke-Korsakoff Syndrome (known as wet brain), an acute type of encephalopathy that can result in permanent brain damage. Unfortunately, wet brain can occur prior to alcohol withdrawal syndrome, and is irreversible if untreated.
Medical professionals in general internal medicine may prescribe other medications for long term symptoms, including gabapentin or beta blockers to treat high blood pressure and other health problems from long term alcohol use. But long term use of benzodiazapenes is not typical, as they have similar effects to alcohol and their own potential for addiction.
Alcoholics Anonymous and Other Support Groups
People who have detoxed from alcohol are encouraged to seek out support groups like Alcoholics Anonymous, which provide a supportive environment for continued sobriety. Support groups help people meet others who are sober and can share wisdom on how to maintain abstinence from alcohol. Alcoholics Anonymous is the biggest such group, but there are others centered on other drugs or drawing from different spiritual traditons.
How Kindling Increases Alcohol Withdrawal Symptoms
People whose alcohol intake has fluctuated repeatedly over time are likely to experience withdrawal symptoms that increase in severity with each episode of withdrawal. This phenomenon is known as kindling.
Alcohol withdrawal is rough on the brain, and the nervous system reacts more severely every time, placing people with a medical history of alcohol withdrawal symptoms at higher risk for severe or complicated withdrawal. Elderly patients who have severe symptoms in their medical history are at risk for kindling, and must be closely monitored during withdrawal.
Turning Point of Tampa Can Help
With a state of the art detox facility, Turning Point of Tampa has medical professionals with expertise in managing alcohol withdrawal symptoms. Turning Point also has residential treatment programs, with individualized therapy and long term care, to help you or your loved ones ensure that “last drink” is truly the last one.
Frequently Asked Questions About Alcohol Withdrawal
Is alcohol withdrawal really life-threatening?
Yes, in severe cases, alcohol withdrawal can be fatal. While mild symptoms like headaches and nausea are common, individuals with long-term drinking habits can develop life-threatening complications like seizures and delirium tremens (DTs). Without medical supervision, these symptoms can escalate quickly, making professional detox essential.
How long does alcohol withdrawal last?
The timeline varies depending on factors like drinking history, overall health, and individual physiology. Mild symptoms can begin within six hours of the last drink, while severe symptoms like seizures or DTs typically peak between 48 to 72 hours. Some lingering effects, such as anxiety or sleep disturbances, can last for weeks or months.
Can I detox from alcohol at home?
Attempting alcohol detox at home is extremely risky, especially for those who have been drinking heavily for a long time. The unpredictability of withdrawal symptoms means medical supervision is recommended. A detox facility like Turning Point of Tampa can provide medications, fluids, and monitoring to prevent complications.
What are the first signs of alcohol withdrawal?
Early withdrawal symptoms can resemble a bad hangover and may include anxiety, tremors, sweating, nausea, irritability, and difficulty sleeping. These symptoms can progress to more serious issues like confusion, hallucinations, and high blood pressure if left untreated.
What should I do if someone is experiencing alcohol withdrawal?
If someone is showing early withdrawal symptoms, encourage them to seek medical help immediately—especially if they have a history of alcohol dependence. If they exhibit severe symptoms like seizures, extreme confusion, or loss of consciousness, call 911 right away. Time is critical in preventing complications.
Sources:
https://extension.psu.edu/alcoholic-beverage-consumption-statistics-and-trends-2023?
https://www.who.int/news-room/fact-sheets/detail/alcohol?
https://pmc.ncbi.nlm.nih.gov/articles/PMC6761824
