Alcohol Withdrawal Symptoms
Alcohol addiction can affect every aspect of your life. It can lead to strained relationships with family and friends, financial difficulties and serious health problems if not properly treated.
If you have been dealing with alcohol addiction and wish to remove alcohol from your life completely, you should be commended.
Giving up alcohol is not an easy decision to make. However, care must be taken to ensure that the detoxification process is undertaken in a safe environment and that any withdrawal symptoms are closely monitored.
When a person consuming large amounts of alcohol on a regular basis attempts to reduce or completely stop their intake, the resulting chemical imbalance can lead to a number of physical and psychological symptoms known as alcohol withdrawal syndrome.
In general, people who consume less alcohol will experience mild or moderate symptoms while heavy drinking can result in more severe withdrawal symptoms.
Heavy drinking is defined as more than 8 units per week for women and more than 15 units per week for men.
Not everyone will experience severe withdrawal symptoms and some people are at a greater risk than others. However, there is no way to definitively assess the risk and even the mildest symptoms can get worse very quickly.
Alcohol withdrawal can be dangerous and even life-threatening, and it is advised that anyone attempting to reduce or completely stop their alcohol intake should do so under the care of an experienced medical professional within a rehabilitation centre or treatment programme.
Why do people experience alcohol withdrawal symptoms?
The regular and frequent consumption of large amounts of alcohol can cause physical changes in the body, upsetting the delicate chemical balance and affecting the way that the brain and body works.
Alcohol has a depressive effect, actively slowing down the central nervous system. As a result, the body has to work extra hard and learn to function in a hyper-alert state in order to compensate for the amount of alcohol in the system.
When the alcohol is reduced or completely taken away, the body continues to function in this hyper-alert state resulting in mild, moderate or severe alcohol withdrawal symptoms depending on the length of the addiction and the amount of alcohol consumed on a regular basis. 
Physical alcohol withdrawal symptoms
The physical symptoms of alcohol withdrawal can feel unpleasant and difficult to deal with, but in most cases, they will dissipate within three or four days.
It is important to seek medical guidance when attempting to detox from alcohol, as even the mildest symptoms can get worse very quickly and can lead to serious health effects.
Physical symptoms of alcohol withdrawal include:
- Nausea and vomiting
- Body tremors
- Excessive perspiration
- High blood pressure
- Fast and/or irregular heart rate
- Intestinal problems including diarrhoea and stomach pain
- Extreme tiredness and fatigue
- Loss of appetite
Psychological alcohol withdrawal symptoms
Many people find the psychological aspect of alcohol withdrawal the most difficult to deal with. Cravings for alcohol can linger past the point of physical detoxification, and feelings of anxiety and depression can make it difficult to push through the process without turning to alcohol.
Psychological symptoms of alcohol withdrawal include:
- Depression and anxiety
- Feeling restless and irritable
- Trouble sleeping, including insomnia and nightmares
- Intense cravings for alcohol
- Mood swings
What is delirium tremens?
In some cases, alcohol withdrawal symptoms can develop into delirium tremens, the most severe and dangerous form of alcohol withdrawal syndrome. 
If you suspect that you or someone you care about may be at risk of developing delirium tremens, seek immediate medical assistance.
Common symptoms of delirium tremens include:
- Visual, auditory and tactile hallucinations
- Extreme confusion and agitation
- Flu-like symptoms including a high fever
- Severe tremors and shaking
- High blood pressure
- Pale skin
- Extreme sensitivity to light and sound
Delirium tremens can get worse very quickly, and may not develop until around 10 days into the detoxification process.
Although anyone can develop delirium tremens when attempting to reduce or completely stop their alcohol intake, some people are more at risk than others. These include:
- People who have experienced severe alcohol withdrawal symptoms in the past
- Extremely heavy and frequent alcohol drinkers
- People who are dealing with a long-term alcohol addiction over a period of years
- People with a prior history of seizures
How long do alcohol withdrawal symptoms last?
While the alcohol withdrawal process varies from person to person, mild to moderate symptoms usually begin within a few hours of alcohol consumption and continue to worsen for a few days before eventually peaking within 72 hours.
During the first few days, you will likely experience symptoms such as tremors, anxiety and irritability. You may also feel nauseous and even vomit, so it’s important to ensure that you drink an adequate amount of water during this time.
In some cases, your symptoms may worsen after a couple of days and you may begin to experience hallucinations and seizures.
These are symptoms of delirium tremens, a severe form of alcohol withdrawal that can be life-threatening – seek medical assistance immediately if your symptoms begin to worsen within the first 10 days of the detoxification process.
Most people will begin to notice a reduction in alcohol withdrawal symptoms within five days, although some will continue to experience symptoms for a few weeks.
What is post-acute withdrawal syndrome?
Post-acute withdrawal syndrome (PAWS) can occur after the physical detoxification process is complete. While the physical symptoms of alcohol withdrawal may have dissipated, the psychological symptoms can remain and may even increase for a period of time. 
PAWS occurs as the body’s chemical balance slowly returns to normal, resulting in occasional fluctuations over a period of around two years. You may experience episodes lasting for a few days at a time – it is unlikely that you will need to deal with PAWS on a daily or even weekly basis after a period of time.
Common symptoms of PAWS include:
- Mood swings
- Withdrawn and unenthusiastic
- Feeling irritable and restless
- Depression and anxiety
- Trouble sleeping
There is no cause for alarm if you begin to notice the symptoms of PAWS – most people will experience this syndrome and a professional treatment programme will prepare you for the possibility of this occurrence, providing guidance and strategies to help you successfully navigate this period of recovery.
What is the difference between a hangover and alcohol withdrawal?
The symptoms of mild alcohol withdrawal can be similar to the feeling of waking up after a big night out, and as a result, it can be difficult to spot the difference.
A hangover is the body’s response to a large amount of alcohol. You may feel nauseous and potentially vomit, suffer from tiredness and headaches and even experience slight tremors and shakes. However, a hangover will usually dissipate after a day or so of avoiding alcohol and replenishing fluids.
While a hangover is a sign that you have consumed too much alcohol, alcohol withdrawal is the body’s response to having consumed less alcohol than it currently requires to function. These symptoms can linger for a number of days and may even get worse if alcohol is not consumed, and can include psychological cravings for this substance.
Can I die from alcohol withdrawal?
While most people dealing with mild to moderate alcohol withdrawal symptoms will make a full recovery without the need for medical intervention, severe withdrawal symptoms can result in death if not properly treated.
However, alcohol withdrawal symptoms can get worse very quickly and without warning. Even a seemingly mild reaction to reducing or stopping your alcohol intake can potentially develop into delirium tremens, which can be life-threatening.
Excessive perspiration and vomiting can lead to dehydration, which can result in serious illness or even health if proper medical treatment is not provided in a timely manner. Severe withdrawal symptoms also include seizures, which can lead to coma or even death.
Some people assume that the risks of alcohol withdrawal far outweigh the benefits of recovering from alcohol addiction. However, this is incorrect – when properly managed in a medical setting, alcohol withdrawal is reasonably safe. For this reason, it is advised that anyone considering alcohol detoxification should do so under the care of a trained and experienced medical professional.
How is alcohol withdrawal diagnosed?
If you believe that you or a loved one are suffering from the effects of alcohol withdrawal syndrome, it is important to receive a medical diagnosis. This can help you to get the physical and psychological treatment that you need.
A trained and experienced doctor will review your medical history and ask questions about your alcohol intake, including how much you drink and how frequently you drink. They will also attempt to determine whether you are dealing with mild, moderate or severe symptoms – this can involve blood tests, careful monitoring and asking you to describe your symptoms in detail.
Your doctor may also use the Clinical Institute Withdrawal Assessment of Alcohol (CIWA) to determine the severity of your symptoms.  This is a series of questions designed to provide greater insight into the intensity of any potential symptoms and provide a more definite diagnosis of alcohol withdrawal syndrome.
You can attend a local rehab clinic that will provide additional information on this process.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597013/ (CIWA)