Patient information from BMJ

Alcohol withdrawal

Last published:Aug 18, 2022

Alcohol withdrawal can happen when a heavy drinker who is dependent on alcohol stops drinking for a number of hours or a few days.

Withdrawal causes unpleasant symptoms, including nausea (feeling sick) and anxiety, but it is not always dangerous. But withdrawal can sometimes trigger extreme reactions in the body’s nervous system, which can cause serious problems and even death.

This leaflet looks at the symptoms of alcohol withdrawal and at what treatments can help with those symptoms.

What is alcohol withdrawal?

When someone drinks alcohol heavily and regularly over a long period (usually a number of years), their body can become dependent on it. This means that their body has got used to alcohol and has adapted to it being there all the time.

If that person suddenly stops drinking, the body can react badly to this change. These reactions, called withdrawal symptoms, start six to 12 hours after someone stops drinking. They are usually very unpleasant and can be dangerous.

Emergencies

Severe alcohol withdrawal is a medical emergency. If you or someone you are with has symptoms of severe alcohol withdrawal, get medical help straight away.

The most obvious symptoms of severe, life-threatening alcohol withdrawal are seizures (fits) and delirium tremens.

Delirium tremens (you might have heard it called 'the DTs') is the name given to a group of symptoms that includes:

• Extreme agitation

• Confusion

• Shaking

• Chest pain

• Hallucinations

• Severe sweating.

Without treatment, between 15 and 20 in 100 people with delirium tremens will die. But with treatment almost everyone survives.

What are the symptoms?

Mild symptoms

Mild alcohol withdrawal symptoms include:

• Anxiety

• Insomnia (having trouble sleeping)

• Headache

• Fatigue (extreme tiredness)

• Craving for alcohol

• A fast, and possibly irregular heartbeat

• Sweating a lot

• Nausea or vomiting.

More severe symptoms

Severe alcohol withdrawal needs urgent medical treatment. The symptoms include seizures and delirium tremens. Delirium tremens involves:

• Extreme agitation

• Confusion

• Shaking

• Chest pain

• Hallucinations

• Skin symptoms, such as itching, pins and needles, and a feeling of 'insects crawling under the skin'

• Severe sweating.

If you have medical treatment for alcohol withdrawal, or if you show signs of withdrawal while being treated in hospital for another reason, your doctor will ask you about your symptoms. This helps in finding out what kind of treatment will help you.

A doctor or nurse might also ask you about other things linked to your drinking. For example, they might ask about:

• Any other medical problems you have

• Any medicines you take

• Whether you use any illegal or recreational ('street') drugs

• Your mental health

• Your home and work life.

Your doctor might also want to do blood tests to check for problems that can often affect people who drink heavily, such as liver problems (including hepatitis), and problems with blood sugar.

What treatments are available?

People with mild alcohol withdrawal symptoms might not need any treatment. But if you need treatment it might involve being given:

• Fluids into a vein if you are dehydrated

• Vitamin B and minerals that are low in people who drink heavily

You might also be given medicines to calm your nervous system and stop it reacting badly to the lack of alcohol in your body. These medicines help to prevent seizures and delirium tremens.

If you have severe symptoms, you might need other treatments, including:

• Help to make sure you can breathe properly

• Sedation. This is often needed if the medications to calm your nervous system don’t work well enough. The sedation makes you very sleepy or unconscious, and helps to relax your nerves and muscles.

Longer-term treatment and help

If you are dependent on alcohol it can be very dangerous if you suddenly stop drinking. Your doctor will still advise you to stop drinking. But they will explain how to do this safely over a period of time.

For example, your doctor will probably advise you to reduce your drinking gradually over several weeks or months.

This way, your body doesn’t get a sudden shock to the system, like the one that caused the withdrawal. Instead it gets used to the reduced alcohol over time.

Your doctor might suggest a plan to help you stop drinking. This might involve regular appointments, and medicines that might help.

Your doctor might also be able to refer you to specialist alcohol services, such as a community-based alcohol withdrawal programme.

Programmes like this can offer help such as:

• regular meetings with programme staff

• support with mental-health issues

• helping you to find local self-help groups, and

• help for your family and for carers, if this is needed.

What to expect in the future

People treated for alcohol withdrawal often have symptoms for a few months afterwards, such as trouble sleeping, dizziness, and sweating.

But most people don’t have long-term problems, especially if the symptoms are mild.

But some people have serious complications. For example, about 3 in every 100 people treated for alcohol withdrawal develop epilepsy.

And, even with treatment, about 1 in every 100 people who have delirium tremens will die.

The ideal long-term goal after treatment is for you to stop drinking. But this can be really hard to do. People who become dependent on alcohol often have complex reasons for doing so. And dealing with these issues can take time and be difficult.

There are various ways of starting to get help. For example, in the UK, you can start with your doctor, who might be able to refer you to specialist services.

Or you could look into organisations like Alcoholics Anonymous (alcoholics-anonymous.org.uk ) and Frank (talktofrank.com ). Different approaches work for different people, and it can take time to find what works for you.