What to Expect During Alcohol Withdrawal

“What Will Happen If I Stop Drinking?”

Making the decision to stop drinking is one of the biggest choices a person can make. But recovery can vary in difficulty. Your body clears alcohol from its system in what’s called the Detoxification (detox) stage. This often involves Alcohol Withdrawal Syndrome (AWS), a series of physical and mental ailments ranging from anxiety and tremors to more intensive symptoms such as seizures and Delirium Tremens (DTs).

Although the detox and withdrawal phases can be intimidating to many people, it is important to remember these stages are temporary. And by understanding what could happen to you or a loved one, you can plan ahead for that road to a better life. In this blog we review the precise mechanisms, stages, and risks associated with alcohol withdrawal.

Alcohol Withdrawal in the Brain

Heavy alcohol consumption chemically alters the brain’s baseline function. Understanding its impact is paramount to knowing what happens in your brain during AWS. Alcohol works as a central nervous system (CNS) depressant. Over time, the brain adapts to this and learns to work with the depressant in tandem.

But when alcohol is suddenly removed, this balance is ruptured. Without its constant effect, the brain is left in a state of confusion. This is followed by the central nervous system experiencing hyperactivity causing withdrawal symptoms from tremors to seizures. Seeking a professional treatment setting to undergo these stages in a safe, structured environment is highly recommended.

The Stages of Alcohol Withdrawal

Alcohol withdrawal has four distinct stages. The severity, and timing, of symptoms vary from person to person. All of it depends on the duration and amount of alcohol consumed, prior withdrawal history, and co-occurring medical conditions. Professional help is recommended for moderate to severe cases.

Stage 1: Minor Withdrawal Symptoms (6 to 24 Hours)

This initial stage begins within hours of the last drink, often before the blood alcohol concentration (BAC) has dropped to zero. Symptoms are primarily physical manifestations of CNS hyperactivity:

• Autonomic Hyperactivity: Increased heart rate (tachycardia), elevated blood pressure, and profuse sweating (diaphoresis).
• Physical Discomfort: Mild to moderate hand tremors (the “shakes”), headache, and gastrointestinal distress (nausea and vomiting).
• Mental Symptoms: Anxiety, restlessness, and insomnia.

Stage 2: Alcoholic Hallucinosis (12 to 48 Hours)

A minority of patients may experience hallucinations, which are distinct from Delirium Tremens because the patient typically remains clear-minded and oriented to reality, knowing the hallucinations are not real.

• Symptoms: Transient visual, auditory (hearing sounds or voices), or tactile (feeling bugs or pins-and-needles) hallucinations or illusions.
• Duration: These symptoms typically dissipate by 48 hours.

Stage 3: Withdrawal Seizures (24 to 48 Hours)

The risk of a generalized tonic-clonic seizure (formerly known as grand mal) peaks during this 24 to 48-hour window. This is a critical indicator that the body’s CNS hyperactivity has reached a dangerous level.

• Symptom: Generalized tonic-clonic seizures. Seizures may occur as a single event or as a brief flurry of multiple seizures.
• Risk Factor: A history of prior withdrawal seizures significantly increases the risk of recurrence.

Stage 4: Delirium Tremens (48 to 72+ Hours)

Delirium Tremens (DTs) is the most severe and potentially fatal complication of alcohol withdrawal, occurring in a small but significant percentage of patients (estimated 5% to 20% of untreated severe withdrawals). The DTs represent an overall failure of the body’s ability to regulate its nervous system.

• Symptoms:

• Profound Confusion and Disorientation: Severe delirium, inability to recognize place or person, and impaired attention.
• Extreme Autonomic Instability: High fever (hyperthermia), dangerously rapid heart rate, and severe, uncontrollable hypertension (high blood pressure).
• Intense Agitation and Hallucinations: Frightening visual hallucinations that can be indistinguishable from reality, coupled with extreme psychomotor agitation.

• Duration: DTs can last for several days and carry a mortality rate of up to 5% to 15% if left untreated. DTs are a medical emergency.

A Critical Note on Home Detox: Given the rapid, unpredictable escalation from mild symptoms to life-threatening seizures or DTs, attempting to self-detox from alcohol at home is extremely dangerous. Professional medical supervision is mandatory to ensure patient safety and prevent irreversible harm.

It’s important to note that these stages are not permanent. Over the course of recovery, your body will undergo various health improvements only possible when you quit drinking.

Medical Management: Ensuring a Safe Detoxification

Safe detoxification focuses on two primary goals: suppressing the CNS hyperactivity to prevent seizures and DTs, and correcting nutritional deficiencies commonly found in chronic alcohol use.

Pharmacological Interventions: The Role of Benzodiazepines

Benzodiazepines (Benzos) are the first-line standard of care for treating moderate to severe AWS. Their mechanism directly counters the neurobiological imbalance by acting on the GABA-A receptor, essentially replacing the inhibitory function that alcohol withdrawal has eliminated.

• First-Line Agents: Medications like Diazepam (Valium) and Chlordiazepoxide (Librium) are long-acting benzodiazepines often preferred for their smooth and sustained effect, helping to prevent the “kindling” effect (where repeated withdrawals get progressively worse).
• Liver Considerations: For patients with significant liver disease, intermediate-acting benzodiazepines like Lorazepam (Ativan) are preferred, as they are metabolized differently and place less strain on the liver.
• Symptom-Triggered Dosing: Modern, evidence-based protocols, such as using the CIWA-Ar scale (Clinical Institute Withdrawal Assessment for Alcohol, Revised), rely on a symptom-triggered regimen. Medication is administered only when the patient’s withdrawal severity score reaches a specified threshold (typically $\ge 8$ or $10$), ensuring that the patient receives only the necessary medication to remain comfortable and stable, avoiding over-sedation.

The Importance of Nutritional Supplementation

Chronic alcohol use impairs the absorption and storage of essential vitamins, especially Thiamine (Vitamin B1). Thiamine deficiency is a major concern because it can lead to a severe neurological disorder:

• Wernicke’s Encephalopathy: Characterized by confusion, ataxia (uncoordinated gait), and eye movement abnormalities.
• Korsakoff’s Syndrome: If Wernicke’s is left untreated, it can progress to this chronic memory disorder, involving severe short-term memory loss and confabulation (inventing memories to fill gaps).

Thiamine supplementation (usually 100mg to 500mg daily) is a standard and vital part of medical detox, often administered intravenously or intramuscularly to ensure absorption and prevent Wernicke-Korsakoff syndrome.

Beyond Acute Withdrawal: Understanding Post-Acute Withdrawal Syndrome

While the physical symptoms of AWS typically resolve within a week, the brain’s recovery from the neurochemical trauma of addiction is a marathon, not a sprint. Many individuals experience a collection of persistent, fluctuating symptoms known as Post-Acute Withdrawal Syndrome (PAWS).

PAWS is primarily psychological and emotional, reflecting the slow process of the brain relearning how to regulate mood, stress, and reward without alcohol. Symptoms can last for months or, in some cases, a year or more, and are a major risk factor for relapse if not managed effectively.

Common Symptoms of PAWS

The key to managing PAWS is recognition, patience, and continued engagement in recovery work, including therapy and support groups. Understanding that these symptoms are temporary and are a sign of the brain healing helps prevent them from leading to relapse.

How Are Alcohol Withdrawal Symptoms Monitored?

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scale is the gold standard clinical tool used by healthcare professionals to accurately and objectively assess and monitor the severity of alcohol withdrawal symptoms. The primary goal is not to measure symptoms, but to guide treatment:

• Initial Assessment: Performed upon admission or when withdrawal is first suspected.
• Scheduled Monitoring: If the score is elevated, the assessment is typically repeated every 1 to 4 hours.
• Medication Titration: Scores guide the administration of symptom-triggered medication (benzodiazepines)
• Discontinuation: Once the patient’s score remains consistently low for a sustained period (e.g., 24 hours), medical monitoring can be reduced, and symptom-triggered medication can be discontinued

What are the Long Term Impacts of Alcohol Use?

The decision to seek treatment is not just about surviving withdrawal; it’s about addressing the long-term effects of alcohol on the body and brain. Chronic alcohol use can lead to significant organ damage and neurological issues:

• Liver Disease: Ranging from fatty liver (steatosis) to alcoholic hepatitis and irreversible cirrhosis.
• Cardiovascular Issues: High blood pressure, stroke risk, and an enlarged heart (cardiomyopathy).
• Gastrointestinal Damage: Gastritis and pancreatitis.
• Brain Damage: Beyond Wernicke-Korsakoff syndrome, heavy use can cause generalized Alcohol-Related Brain Impairment (ARBI), impacting executive function, abstract thought, and coordination (cerebellar atrophy).

Recovery is a chance to reverse some of this damage. With abstinence, the body, particularly the liver and the brain, possesses a remarkable ability to heal. Cognitive recovery can continue for up to 12 months post-abstinence, highlighting why comprehensive, long-term treatment is essential.

Comprehensive Treatment at Great Plains Recovery Center

Successfully navigating the entire journey—from acute withdrawal to managing PAWS and building a sober life—requires a structured continuum of care.

At Great Plains Recovery Center, we provide this comprehensive approach, beginning with medically-managed detoxification to ensure your safety and stabilization. Following detox, clients transition into personalized therapy programs that address the underlying causes of AUD and teach essential relapse prevention skills.

• Individual & Group Therapy: Utilizing evidence-based modalities such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT).
• Family Programming: Recognizing the vital role of loved ones, especially for those traveling from communities like Oklahoma City, we coordinate family sessions and education to maximize support.
• Aftercare Planning: The foundation of lasting sobriety. We work with clients to build a robust aftercare plan, including identifying local outpatient therapy, support groups (like AA/NA), and sober living resources in the Oklahoma City metro area, ensuring a smooth transition back home.

If you are an Oklahoma City resident considering addiction treatment, our facility in Tulsa offers a balance of high-quality, professional care with the manageable distance needed to focus entirely on recovery while remaining accessible to your support system.

Ready to take the next step toward lasting recovery? Contact Great Plains Recovery Center at 844-918-3518 to speak confidentially with our admissions team about safe medical detox and our comprehensive treatment options.