Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.

Alcohol withdrawal usually occurs in adults, but it may occur in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol. Withdrawal usually occurs within 5 - 10 hours after the last drink, but it may occur up to 7 - 10 days later.

The following is generally considered excessive alcohol use:

• More than 15 drinks per week for men or 8 drinks per week for women
• More than 5 drinks per day for men or 4 drinks per day for women
• Habitual use of alcohol that disrupts a person's life and routines, regardless of amount consumed

In this definition, 1 drink has 12 grams of alcohol, and equals approximately 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 90 proof spirits..

The more heavily you drink every day, the more likely you will develop alcohol withdrawal symptoms when you stop drinking. The likelihood of developing severe withdrawal symptoms also increases if you have other medical problems.

Mild-to-moderate psychological symptoms:

• Jumpiness or nervousness
• Shakiness
• Anxiety
• Irritability or easy excitability
• Rapid emotional changes
• Depression
• Fatigue
• Difficulty thinking clearly
• Bad dreams

Mild-to-moderate physical symptoms:

• Headache -- general, pulsating
• Sweating -- especially the palms of the hands or the face
• Nausea and vomiting
• Loss of appetite
• Insomnia (sleeping difficulty)
• Pallor
• Rapid heart rate
• Eye pupils enlarged(dilated pupils)
• Clammy skin
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:

• Delirium tremens -- a state of confusion and visual hallucinations
• Agitation
• Fever
• Convulsions
• Black outs -- when the person forgets what happened during the drinking episode

The health care provider will check for:

• Rapid heartbeat (tachycardia)
• Rapid breathing (tachypnea)
• Elevated temperature
• Abnormal eye movements
• Shaky hands
• General body shaking
• Abnormal heart rhythms
• Internal bleeding
• Liver failure
• Dehydration

A toxicology screen may be performed as well as other blood tests.

The goals are to treat the immediate withdrawal symptoms, prevent complications, and begin long-term therapy to promote abstinence (no drinking at all).

The person will probably have to stay at the hospital for constant observation. This will include monitoring:

• Blood pressure
• Body temperature
• Breathing
• Heart rate
• Fluid and electrolyte levels (chemicals in the body such as sodium and potassium)

Many patients are given fluids or medications through a vein (IV).

Withdrawal symptoms may worsen rapidly and may quickly become life threatening. Drugs that depress the central nervous system (such as sedatives) may be needed to reduce symptoms, often in moderately large doses.

Treatment may involve placing the person in a a moderately sedated state for 1 week or more until withdrawal is complete. A class of medications known as the benzodiazepines are often useful in reducing a range of symptoms.

The health care provider will watch closely for signs of delirium tremens.

Hallucinations that occur without other symptoms or complications are uncommon. They are treated with hospitalization and antipsychotic medications as needed.

Testing and treatment for other medical problems associated with use of alcohol is necessary. Disorders related to the use of alcohol include:

• Alcoholic liver disease
• Blood clotting disorders
• Brain disorders such as Wernicke-Korsakoff syndrome
• Heart disorders such as alcoholic cardiomyopathy
• Malnutrition
• Nerve damage ( alcoholic neuropathy )

A drying-out period is recommended after withdrawal is complete. No alcohol is allowed during this time. Permanent and lifelong abstinence from alcohol is the best treatment for those who have gone through withdrawal.

Rehabilitation for alcoholism is often recommended. This may include social support such as Alcoholics Anonymous, medications, and behavior therapy.

For additional resources, see alcoholism support group.

Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin within 8-12 hours of the last drink. The symptoms peak in 48 - 72 hours and may persist for a week or more.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for 3 - 12 months or more. If a person continues to drink excessively, they may develop many medical conditions such as liver and heart disease.

Most people who go through alcohol withdrawal make a full recovery. The long term outlook depends on how much organ damage has occurred and whether the person can stop drinking completely.

Alcohol withdrawal is a serious condition that may rapidly become life threatening.

Call your health care provider or go the emergency room if symptoms suggest alcohol withdrawal, especially in a person who has a history of habitual use of alcohol, or a history of stopping use of alcohol after a period of heavy alcohol consumption. Call for an appointment with your health care provider if symptoms persist after treatment.

Go to the emergency room or call the local emergency number (such as 911) if seizures, fever, delirium or severe confusion, hallucinations, or irregular heart beats occur.

Minimize or avoid the use of alcohol. In people with alcoholism, total abstinence from alcohol may be necessary.

O’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.