Alcohol Withdrawal

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Physicians recognize three levels of alcohol withdrawal:

Level 1) Minor Withdrawal: Shaky hands, increased sweating, mild irritability and anxiety, insomnia, nausea and headache. These relatively mild symptoms may appear within 6 to 12 hours after one stops drinking.

Level 2) Mid-level Withdrawal: These are the same as the symptoms of Minor Withdrawal, but more intense and also often include visual, auditory or tactile hallucinations. The patient is usually not aware that the hallucinations are not real. Other symptoms may include: the possibility of seizures, racing pulse and irregular heartbeat. These more intense symptoms may appear within 12 to 48 hours after one stops drinking.

Level 3) Major Withdrawal: Symptoms of Major Withdrawal can be incredibly frightening, very uncomfortable and, at times, quite serious. They include: delirium, alcohol-induced hallucinations (with the person typically unable to distinguish hallucination from reality), profuse sweating, seizures, severe blood pressure spikes, sever tremous, racing and irregular heartbeat and high fever. In some extreme cases, death occurs. These symptoms may arise within 48 to 72 hours after quitting drinking and they may peak in five days.

Mediline plus, a US Government organisation defines Alcohol Withdrawal as :
“symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking alcohol.”

People going through moderate or even severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that specializes in alcohol withdrawal where they are closely supervised

Treatment in a facility may include:

  • Monitoring blood pressure, temperature, heart rate and blood levels
  • Administering fluids and/or medications
  • Sedation using medication until withdrawal is complete


Alcohol withdrawal is caused by a process called “neurotransmitter rebound.” As alcohol slows down the function of the neurotransmitter system, over time this system adapts by working harder to overcome the effect of the alcohol and to try and function at normal levels. When the alcohol is suddenly removed from the body, the system continues to function in excess of normal levels. As the alcohol is not present to slow the effects of this hyperactivity, we see effects that are the opposite of those caused by alcohol. It similar to two people of equal strength playing tug-of-war; if one person suddenly drops the rope, the other person flies off in the opposite direction. When alcohol is suddenly removed from the neurotransmitter system that has been working overtime, the system flies off in the opposite direction.

The GABA system is the primary neurotransmitter system involved in alcohol withdrawal. The effect of alcohol on the GABA system tends to cause sleep, calm and the soothing of anxiety or panic attacks. When alcohol is suddenly removed from the brain, the neurotransmitter rebound in the GABA system causes insomnia, nightmares, hallucinations, anxiety, panic attacks, muscle cramps and seizures. Benzodiazepines affect the GABA system in much the same way as alcohol does – this is why withdrawal from benzodiazepines is also life-threatening.


The process of withdrawing from alcohol dependence is a very serious matter, and different from withdrawal from most other drugs – it can be deadly. Benzodiazepines (such as Valium and Xanax) are another class of drug that cause life threatening withdrawal symptoms – especially is not managed closely. Often assumed to be the worst drug to withdraw from, Heroin withdrawal symptoms rarely result in death.


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