You might scoff at something like alcohol withdrawal while the opioid epidemic continues to wreak havoc on our country, but withdrawal from alcohol is very real and nearly as prevalent. Withdrawal from other drugs like benzodiazepines (benzos) and opioids have certainly taken hold of the public consciousness, and rightfully so, but alcohol withdrawal is just as dangerous, even deadly.

In this post, we’re going to discuss what exactly alcohol withdrawal is, how alcohol affects family members, its symptoms, the withdrawal timeline, and also dish out some advice on how to avoid alcohol withdrawal.

What Is Withdrawal?

Withdrawal will be a difficult part of the recovery process no matter what substance a person has become dependent upon, but alcohol withdrawal is actually more severe than most other drugs. Alcohol is one of the few substances that can cause death, along with opioids. Fortunately, alcohol withdrawal fatalities can be prevented as long as a person tapers off their alcohol use safely.

The Alcohol Withdrawal Timeline

Alcohol withdrawal occurs in three levels and comes with a wide range of alcohol withdrawal symptoms:

Stage 1: Minor Withdrawal – The symptoms of minor withdrawal may start to appear just six to 12 hours after an alcoholic stops drinking. They will include sweating, shaky hands, mild anxiety, nausea, insomnia, panic, twitching, and headaches.

Stage 2: Mid-level Withdrawal – Mid-level withdrawal symptoms will set in around 12 to 48 hours after the last drink. These can manifest as more intense versions of the symptoms listed above, as well as some visual and auditory hallucinations. The person usually will be aware that the hallucinations aren’t real, but they will still be difficult for them to deal with. Other symptoms may include an irregular heartbeat, elevated pulse, and even possible seizures.

Stage 3: Major Withdrawal – Setting in 48 to 72 hours after a person stops drinking, significant withdrawal symptoms will peak in around five days. These can include further hallucinations, during which the person won’t be able to distinguish their hallucination from reality. They may also endure withdrawal seizures, an irregular heart rate or racing heartbeat, profusely sweating, fever, high spikes to their blood pressure, rapid breathing, become easily agitated, intense tremors, or even death.

As you can see, major withdrawal is the one where the real danger lies. Minor and mid-level withdrawal can be dangerous as well if the person already has high blood pressure or a bad heart. And the longer a person has abused alcohol, the more severe their alcohol withdrawal symptoms will be.

Another common symptom of minor and mid-level withdrawal is shakiness, which people will often refer to as “DTs,” or delirium tremens, however, this is a bit of a mislabel, because actually DT is more associated with major withdrawal and can be severe and life-threatening. Shakiness from minor and mid-level withdrawal is not dangerous and should pass within a few days.

What Actually Causes Alcohol Withdrawal?

On the surface, the cause of alcohol withdrawal seems rather obvious: a person who was abusing alcohol stops drinking, and then alcohol withdrawal symptoms set in. But what actually occurs in the body?

When a person drinks, the dopamine levels in their brain become elevated, which results in pleasant feelings. Thus, the consumption of alcohol can elevate a person’s mood, low their inhibitions, and increase self-confidence. When the person stops drinking, the alcohol leaves their bloodstream and the dopamine levels and feelings that come along with it will dissipate.

When this behavior is repeated by the constant consumption of alcohol, the repeated altering of dopamine levels in the brain will cause it to expect alcohol to be present, and will discontinue its normal production without the presence of alcohol. This is how a person builds a tolerance to alcohol.

The more they drink, the more tolerant to alcohol their body becomes, and the more dependent their brain will be on its interference. When this has reached the level of dependence, the person may suffer withdrawal symptoms as the effects of alcohol wear off, symptoms that can range from mild to quite severe.

To be more scientific, it turns out alcohol withdrawal is actually caused by a neurotransmitter rebound within the brain in the GABA system. When a person consumes high levels of alcohol over an extended period, their neurotransmitters will adapt and work harder to try and perform their function despite the effects of alcohol. When the person removes alcohol from their system, the neurotransmitters won’t switch right back with them, they will actually continue to produce excess levels.

With alcohol no longer coming into their body to suppress the hyperactive neurotransmitters, the person will begin to see the symptoms we listed above in stages. The symptoms of withdrawal are actually quite the opposite of the symptoms caused by consuming alcohol. When alcohol is in a person’s system, it causes relaxation, sleep, and calm, while removal and alcohol withdrawal cause panic, insomnia, anxiety and others. Benzo and opioid withdrawal affect the body much in the same way.

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How To Avoid Alcohol Withdrawal

Obviously, the easiest way to avoid alcohol withdrawal is to never drink at all, but if you do plan to consume alcohol, is it always best enjoyed, and safest, in moderation. Alcohol withdrawal will occur when your brain has been affected by alcohol over a long period of time.

Have Less Than Four Drinks Per Day

Therefore one way to avoid withdrawal is to not exceed four drinks per day if you are going to drink every day. This should limit the level of affect alcohol has on your brain. However, while you can generally consume low amounts of alcohol daily and avoid withdrawal, drinking that much every day is not recommended for your overall health.

Mix In Abstinence Days

If you can avoid drinking every day, you should. Another way to avoid alcohol withdrawal is to mix in abstinence days each week, and it’s best if you can take several days off from drinking at a time. Even if you do choose to get intoxicated some days, as long as you mix in some detox days in between, you should be able to avoid any withdrawal symptoms.

If you can manage to have several abstinence days each week it will give your neurotransmitter systems the chance to return back to their normal levels. This is because it takes a few days off each week for the alcohol to get completely out of your system. Since the body metabolizes roughly one standard drink per hour, limiting yourself to four drinks per day will give your neurotransmitter systems the time they need to  As long as your neurotransmitters have enough time to return to their normal levels, alcohol withdrawal will not set in.

If you go on a weekend bender, say for a bachelor party or any other big event, you may encounter some minor symptoms at the end, especially if your alcohol consumption was especially high, however it should be rather minor, and pass within a day. Yes, this is also known as the infamous “hangover.”

Don’t Mix Alcohol With Benzos & Opioids

Benzos like Valium and Klonopin and alcohol have similar effects on the GABA neurotransmitter system. If you were to mix the two, it would first increase the chances that a person can overdose on benzos, but also compound the withdrawal symptoms from each, making the process much worse when the person stops using one or both.

Who Is Most Likely To Have Alcohol Withdrawal Symptoms?

Alcohol withdrawal is a largely individual process that will depend on a lot of factors, including a person’s body composition and genetics, their history with alcohol, length of alcohol abuse, amount of alcohol consumed, and more. However, in general, some common factors would position a person to be more likely to encounter significant alcohol withdrawal symptoms.

This group mainly includes those people who have consumed alcohol to the point of getting drunk over any duration of time. Someone who has stayed drunk for several days in a row can expect to feel some minor withdrawal symptoms once they stop drinking. Those who drink during the day for over a month, or get drunk every night for a month or more are highly likely to have severe withdrawal symptoms. Those with a history of alcohol abuse, or have dealt with alcohol withdrawal symptoms in the past, will be highly likely to re-encounter them, most likely in a more intense form.

Those who drink in moderation or just get drunk every once in a while are unlikely to see any alcohol withdrawal symptoms. But those who abuse alcohol for a month or more can expect to experience both physical and mental health issues if they stop drinking.

Alcohol Withdrawal Treatment

If you do encounter lighter forms of alcohol withdrawal, it’s not an emergency situation, and you most likely won’t need any help or support to get you through it. Simply keep yourself in a quiet place with soft lighting and try to have limited contact with people, as you’ll probably be quite easily agitated. The best thing you can do to support your own system is to drink a lot of water or drinks with electrolytes as well as eating healthy food. In a couple days, the symptoms should pass.

For more severe cases of withdrawal, as in those who have a long history of alcohol use disorder and are in stage 3 of withdrawal, you should seek help to deal with your symptoms. Since alcohol withdrawal can be quite difficult and dangerous, it is in your best interest to not attempt to recover on your own. Enter yourself into a alcohol treatment center so you can safely taper off of your alcohol dependence.

Tapering Off Of Alcohol Withdrawal

Because the symptoms can be so severe, it is not recommended to stop drinking “cold turkey ” or detox from home. Someone who has abused alcohol for any duration of time should actually taper off of their drinking, instead of trying to completely stop drinking all at once. This helps keeps withdrawal symptoms moderate and allows the person to safely cut back on their drinking.

Essentially, if you or someone you know have been drinking consistently for a long period of time, visibly shake, sweat profusely, have a rapid pulse or heartbeat, or high blood pressure, then it will be much safer to taper off from drinking rather than quit cold turkey. Tapering off of alcohol actually means that you will continue to drink, just in smaller amounts incrementally until your body and mind become less dependent on alcohol, and it is safe to stop. Doctors can now even prescribe prescription medication to take along with a tapering plan, and tapering off of alcohol should be done under supervision, most likely in a rehab facility.

When tapering off of alcohol, it’s best to use beer because of its low alcohol content. The person dealing with withdrawal symptoms should only drink as much as they need to keep their sweats and shakes at bay. Depending on the person’s level of alcohol abuse, the process may only take a day, while for others it can take up to a week or more. While tapering, the person must also remember to stay hydrated. If the person is tapering in a rehab facility, they may be given an IV and vitamin shots, but if you’re trying to taper at home, Gatorade is a great pick because of its balanced electrolytes.

If a person chooses to taper off of alcohol, they will be most successful if they set up a tapering schedule. The schedule will depend upon how much the person has been drinking and the withdrawal symptoms they are already encountering. But essentially, the more they have been abusing alcohol, the slower the taper schedule will be, meaning the process will last longer. The person will have to pinpoint their average consumption, put it in terms of how many beers that amounts to, and slowly start to cut a couple beers out of the schedule each day.

If the person tries to taper too fast, their blood pressure and pulse will rise, and the shakes and sweats will return. No matter what, it’s important to remember during the process that the beer is being consumed as medicine, and not for pleasure. Tapering too quickly can be fatal, which is why it is best to detox in a professional rehab facility, where the patients can be properly supervised.

At APEX Recovery, we help you identify motivating factors for long-term change, develop necessary skills to maintain recovery and include your loved ones in your recovery.  We treat individual patients and their unique needs through a model that we recognize is not a “one size fits all”. Our admissions coordinators are available 24 hours a day to give you the support you need to make positive changes.  Call APEX today.