Here’s What Alcohol Withdrawal Symptoms Actually Feel Like

If you’ve ever been overserved (or overserved yourself) with adult beverages, you know how it can wreak havoc on your mind and body. From a throbbing headache to morning-after anxiety, hangover symptoms are just one of the risks associated with overindulging. But when drinking too much becomes a habit, those risks—and symptoms—increase. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol withdrawal symptoms can be potentially life-threatening when someone who has been drinking heavily for a long period of time suddenly stops.

So what’s actually considered heavy drinking? The CDC defines it as more than 15 drinks per week for people assigned male at birth and more than 8 drinks per week for people assigned female at birth. With long-term heavy alcohol intake, your brain adapts to the effects of booze over time.

It’s important to note that if you overindulge here and there, you’re not likely going to experience alcohol withdrawal syndrome (which occurs when someone who is physically dependent on alcohol suddenly stops drinking). But if you’re consuming over the recommended amount for weeks, months, or even years, withdrawal symptoms are more likely to pop up. Here’s why: When you suddenly stop drinking, your nervous system kicks into overdrive to compensate, triggering withdrawal symptoms.

The first symptoms—and maybe the only symptoms—you experience may resemble a bad hangover. These are considered mild, but they can worsen. Although the onset of alcohol withdrawal varies from person to person, symptoms typically appear as early as 6 to 24 hours after the last drink, Seonaid Nolan, MD, a clinician-scientist at the British Columbia Centre on Substance Use, tells SELF. She adds that withdrawal can also occur after a significant reduction in alcohol consumption.

According to a 2019 systematic review published in the Journal of the American Medical Association, and coauthored by Dr. Nolan, mild withdrawal symptoms are common: “Up to 50% of individuals with a history of long-term, heavy alcohol consumption will experience some degree of mild withdrawal when alcohol use is stopped.”¹

Mild symptoms can take between 24 and 48 hours to resolve. If they don’t progress during this period, the worst may be over.² Here’s what to look out for:

“Generally, the first symptoms to develop include anxiety, agitation, and restlessness,” says Dr. Nolan. In fact, in the early stages of withdrawal, “women with alcohol use disorder consistently report more anxiety symptoms than men,” Kathryn McHugh, PhD, an associate professor of psychology at Harvard Medical School, tells SELF. Withdrawal-related anxiety can perpetuate the cycle of addiction, pushing you to seek out that next drink.

This can occur when alcohol causes inflammation in the stomach lining, which can reduce hunger signals.¹ Alcoholic hepatitis, a dangerous inflammation of the liver, can occur in some people who drink and may also cause a lack of appetite, according to the Mayo Clinic.

As your body detoxes, nausea and vomiting are pretty common symptoms. You may also experience periods of dry heaving without vomiting. If severe vomiting is present, you may need to receive IV fluids so you don’t become dehydrated.

Headaches can also crop up in the early stages, likely due to sensitization in certain neurons and cell receptors, as well as a release of chemicals associated with head pain, according to a 2021 study published in the journal BioRxiv. While there aren’t current treatments specifically for alcohol-withdrawal-related headaches, targeting these cell receptors in the brain could be a future treatment option.³

Since alcohol affects your central nervous system, your circulatory system, and pretty much all other areas of your body, it’s no surprise that withdrawal can make things go a little haywire. Your autonomic system—basically the bodily functions you do involuntarily—can become hyperexcited, leading to things like profuse sweating.⁴

In addition to sweating you may develop heart palpitations from a hyped-up autonomic system. This is characterized as a heart rate of greater than 100 beats per minute.⁴

This is yet another autonomic nervous system response to alcohol withdrawal. Tremors often affect the hands but can occur elsewhere in the body as well, according to the U.S. National Library of Medicine.

Sleep disturbances are extremely common in the early stages of alcohol withdrawal, according to an older study published in the Journal of Addiction and Addiction Disorders, and may continue for several months, even with continued abstinence from alcohol.⁵

It’s sometimes hard to predict who will go from mild symptoms to moderate or severe symptoms, but the severity of your symptoms generally will depend on the amount of alcohol you’ve been consuming and how long you’ve been consuming it, according to an older study published in American Family Physician.⁶ If you progress to moderate or severe alcohol withdrawal symptoms, they may take some time to develop, but can include:

Seizures can occur within 6 to 48 hours, while hallucinations can occur within 12 to 48 hours after drinking is reduced or stopped, says Dr. Nolan. About 3% of people who develop seizures may have what’s called status epilecticus, when a seizure lasts for more than five minutes, or you have more than one seizure in a five-minute period and do not regain normal consciousness between episodes, according to Johns Hopkins Medicine. This is considered a medical emergency because it can lead to permanent brain damage.

Around half of all people who have a seizure during alcohol withdrawal will experience delirium tremens, a medical emergency that affects 3 to 5% of people with a history of alcohol abuse. Delirium tremens appear even later, between 48 and 96 hours after a reduction in drinking.²

Alcohol withdrawal that progresses to delirium tremens causes intense hallucinations, as well as severe confusion, disorientation, and agitation. It’s characterized by a frenzy of activity in the nervous system, and physical symptoms like high blood pressure, a fast pulse, fever, and sweating.

If left untreated, delirium tremens can trigger cardiovascular collapse. This is comparable to shock, which occurs when the heart cannot pump blood fast enough to deliver oxygen to the organs. As a result, the organs may fail. Death occurs in approximately 15% of people who do not seek treatment, according to a 2021 study published in Current Psychiatry.⁷

With treatment, severe symptoms can take up to a week to fully resolve, explains Dr. Nolan. In other words, even once the worst is over, it might still take you a few days to feel better.

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Delirium tremens is most prevalent among younger, adult men who are caucasian and single, but what and how much you drink may also play a role.

A 2019 study published in Acta Psychiatrica Scandinavica looked at 3,582 people with alcohol dependence and assessed whether the number of and type of drinks influenced withdrawal symptoms. The authors reported that drinking an average of more than 20 alcoholic beverages per day and drinking hard liquor—as opposed to beer or wine—increased the risk of delirium tremens.⁸

Other risk factors include previous episodes of severe alcohol withdrawal. In Dr. Nolan’s experience, “the more episodes of untreated alcohol withdrawal a person has, the higher their risk for future withdrawal events to be severe.” Again, this is why it’s so important to seek treatment when stopping alcohol use.

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For heavy drinkers, quitting cold turkey isn’t the safest option. If you or someone you know wants to stop drinking, it’s best to do so under medical supervision. There are a ton of treatment options available. Inpatient treatment, which requires staying overnight at a facility, might be safest for those at risk of severe alcohol withdrawal symptoms.

According to guidelines published in American Family Physician, mild to moderate withdrawal symptoms can be treated in outpatient settings, which allow you to stay in your own home and make regular visits to a treatment facility.⁹

It’s important to weigh the pros and cons—in particular, costs and insurance coverage—of the type of treatment with your family members and primary care physician. If you do not have insurance, your doctor can help put you in touch with a facility or treatment program that offers financial aid, financing, or a sliding scale payment system, in which you pay what you can.

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During alcohol detox, medication can ease your discomfort and prevent symptoms from worsening. According to Hilary S. Connery, MD, PhD, the clinical director of the division of alcohol, drugs, and addiction at McLean Hospital in Boston, withdrawal medications are suitable for most people.

Doctors typically prescribe benzodiazepines, or benzos, to alleviate the anxiety associated with alcohol withdrawal, as well as physical symptoms such as high blood pressure, heart palpitations, and restlessness. For people at risk of moderate to severe alcohol withdrawal, benzos also reduce the likelihood that symptoms will progress.

Although there are many benzos available, diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium) are the most frequently used. They’re sedatives that work by stimulating gamma-aminobutyric acid (GABA), a chemical in the brain that is involved in setting off alcohol withdrawal symptoms.

Two alternatives to benzodiazepines include the anti-seizure drugs carbamazepine (Tegretol) and gabapentin (Neurotonin). Although they haven’t been studied as extensively as benzodiazepines, evidence shows that both are likely effective at relieving alcohol withdrawal symptoms such as anxiety and insomnia, particularly in mild to moderate cases.⁸

Carbamazepine works by slowing down electrical signals in the brain that can cause symptoms. It may also reduce the activity of glutamate, an amino acid that has been shown to play a role in withdrawal. Gabapentin works by increasing levels of GABA in the brain to alleviate symptoms.

Your doctor can help you learn more about the medical treatments available for alcohol withdrawal, and what treatment will look like for your specific situation.

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When it comes to alcohol withdrawal, don’t go at it alone. Seeking help is the first—and often the hardest—step. Although you might be tempted to tough out withdrawal symptoms by yourself, it’s not worth the risk.

For one, even mild alcohol withdrawal symptoms can be uncomfortable. And regardless of your history with alcohol, there’s always a chance that your symptoms will worsen. If your symptoms progress, it may be harder for you to seek help. The more your symptoms progress, the harder they will be to treat. Not to mention, having an episode of severe withdrawal increases the likelihood that future withdrawal will be severe.²

Keep in mind that alcohol detox is only the first step, and additional treatment—including medication and individual or group counseling—is a must if you want to maintain your sobriety.

To get started, talk to your doctor or reach out to one of these resources:

• The Substance Abuse and Mental Health Services Administration: Call the national helpline at 1-800-662-4357 for confidential, free, 24-hour information about available treatment options.
• The National Institute on Alcohol Abuse and Alcoholism’s Treatment Navigator: Visit the website to learn more about types of treatment, how to choose a program that meets your needs, and treatment providers available in your area.

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Sources:

1. Journal of the American Medical Association, Will This Adult Patient Develop Severe Alcohol Withdrawal? The Rational Clinical Examination Systematic Review
2. StatPearls, Alcohol Withdrawal
3. BioRxiv, Mast Cell-Specific Receptor/Corticotropin-Releasing Factor Axis Regulates Alcohol Withdrawal-Associated Headache
4. Alcohol Health and Research World, Complications of Alcohol Withdrawal
5. Journal of Addiction and Addiction Disorders, Treatment Options for Sleep Disturbances During Alcohol Recovery
6. American Family Physician, Alcohol Withdrawal Syndrome
7. Current Psychiatry, Anticonvulsants for Alcohol Withdrawal: A Review of the Evidence
8. Acta Psychiatrica Scandinavica, Alcohol and Delirium Tremens: Effects of Average Number of Drinks Per Day and Beverage Type
9. American Family Physician, Alcohol Withdrawal Syndrome: Outpatient Management

Related:

• 6 Signs Your Relationship With Alcohol Might Not Be Healthy
• Understanding the Different Types of Addiction, From Chemical to Behavioral
• 6 Ways to Set Boundaries and Drink Less Right Now