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What is alcohol withdrawal syndrome?

Mina Draskovic, B.Psy., reviewed this content for accuracy on 17/10/2023

Tremors, uncontrollable sweating, racing heart, and hallucinations some of the symptoms of alcohol withdrawal. As your brain and body adjust to the absence of alcohol, you experience a range of unpleasant and potentially dangerous complications.

This cluster of symptoms is known as alcohol withdrawal syndrome (AWS).

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When you decide to break your alcohol dependency, Ardu Recovery Center can help. Our alcohol detox can get you through the withdrawal stage, and then our comprehensive alcohol addiction treatment program provides the tools and the support you need to overcome dependency and reclaim your well-being.

Ardu has highly exceptional staff that truly love their jobs and care about the clients treating them with the utmost love and respect. After graduating from Ardu…I am still clean and sober six months later. The tools I learned at Ardu are tools I can take with me for a lifetime.

Skyla Child


What is alcohol withdrawal syndrome?

Alcohol withdrawal syndrome happens when a person who is physically dependent on alcohol suddenly stops drinking or dramatically reduces the intake. This complex condition arises because the brain has adapted to the constant presence of alcohol. In the absence of alcohol, the brain goes into overdrive, causing a reaction throughout the body.

AWS stems from a biological revolt inside the body and brain of a dependent drinker. The nervous system has been so long saturated in liquor that it starts to rebel in its absence. AWS brings unpleasant and often severe symptoms. 

What are the symptoms of alcohol syndrome?

The symptoms of alcohol withdrawal syndrome can range from mild to moderate to severe, in which case you can experience seizures, hallucinations, and life-threatening delirium tremens. The severity depends on: 

  • How much and how long you’ve been drinking
  • Your general health status
  • Any prior detox experiences
  • Your physiology 

To make things easier, we’ve grouped the symptoms based on when they tend to emerge during alcohol detox.

Early withdrawal symptoms (6-12 hours after the last drink)

The early signs of withdrawal mean that the alcohol is leaving the system. These mild symptoms are uncomfortable but generally not severe or dangerous. 

In the early withdrawal stage, you may experience: 

  • Tremors
  • Headache
  • Nausea
  • Anxiety
  • Insomnia
  • Profuse sweating
  • Rapid heart rate

Middle-stage withdrawal (12-48 hours)

These moderate withdrawal symptoms peak during the middle stage of withdrawal and often require close medical monitoring and management. These include:

  • Heightened pulse
  • Increased blood pressure and temperature
  • Continued tremors and anxiety
  • Potential seizures or hallucinations
  • Dehydration from ongoing sweating or vomiting
  • Delirium with periods of confusion

Late-stage withdrawal (48-72+ hours)

The last stage of withdrawal syndrome is also the most hazardous and often involves extended delirium. You may need urgent medical intervention (such as from a medical detox facility) to avoid life-threatening seizures, arrhythmias, and organ failure. 

The following symptoms gradually abate with treatment over 5-7 days:

  • Most intense hallucinations (visual hallucinations, tactile hallucinations, and auditory hallucinations)
  • Fever spikes
  • Severe confusion and agitation
  • Delirium tremens
  • Worsening vital sign instability

Delirium tremens starts about three days after the beginning of detox and can last upwards of a week or more, depending on the severity of withdrawal effects. 

With the worst of the withdrawal symptoms behind you on day eight, you’ll need ongoing care. Our qualified rehab facility can help you adjust to life without alcohol and fight cravings with cognitive behavioral therapy, group therapy, and other modalities.

The more dependent your body is on alcohol, the worse AWS gets. That’s why it’s so important to diagnose this condition correctly. Our detox center can help you through severe alcohol withdrawal, including delirium tremens. Once you’re detoxed, we can help you combat the long-term effects of alcohol addiction and get your life back.

What causes alcohol withdrawal syndrome?

Regular alcohol consumption throws your brain and entire body out of homeostasis. Then, when you quit booze, critical bodily processes lose their equilibrium even more, spiraling into dysfunction and distress. 

While the liver, heart, and other organs are taxed during withdrawal, they are simply responding to distress signals arising from the central nervous system (read about the effects of booze on the CNS). 

Let’s explain how the brain and other vital body parts react when you stop drinking.

What happens to your brain when you stop drinking?

Heavy drinking can do a serious number on your brain. When you stop drinking, your brain has a chance to (at least partially) recover.

Here are some of the ways alcohol affects your brain:

  1. It enhances the inhibitory neurotransmitter GABA, producing feelings of relaxation and calm.
  2. It blocks excitatory glutamate receptors, slowing down brain activity.
  3. It triggers dopamine release, contributing to euphoric effects and addiction.
  4. It inhibits serotonin reuptake, temporarily boosting mood.
  5. Alcohol suppresses the hypothalamus, disrupting body temperature, appetite, and sleep regulation.
  6. Alcohol constricts brain blood vessels, impairing oxygen supply to parts of the brain.
  7. Alcohol damages dendrites and neurons in the prefrontal cortex, affecting planning and judgment.
  8. It shrinks the cerebral cortex, leading to impaired thought processing and loss of behavioral control.
  9. Alcohol erodes white matter connections between brain regions, impairing coordination and cognition.

Let’s explore these effects in more detail.

The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. (Jesse, et. al.)

Alcohol acts on neurotransmitters like GABA, glutamate, dopamine, serotonin, and norepinephrine. Neurotransmitters are the brain’s chemical messengers that send and receive signals between neurons. Our thoughts, emotions, behaviors, and physiological processes rely on this delicate neurochemical signaling system.

GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the central nervous center. GABA has particular binding sites available for ethanol, thus increasing the inhibition of the central nervous system when present. Chronic ethanol exposure to GABA creates constant inhibition or depressant effects on the brain. (Newman, et. al.)

Newman, et. al. also reveal that alcohol acts on another neurotransmitter to counter the decreasing GABA inhibition. 

Ethanol also binds to glutamate, which is one of the excitatory amino acids in the central nervous system. When it binds to glutamate, it inhibits the excitation of the central nervous system, thus worsening the depression of the brain. 

Once the alcohol is gone, there’s too much glutamate excitation and not enough GABA inhibition. As a result, the brain enters a hyper-excited state of neuronal overactivity and miscommunication between critical brain regions.

This “neuronal hyper-excitation” underlies every alcohol withdrawal symptom:

  • GABA drops rapidly without alcohol to stimulate it, which causes nerve impulses to fire uncontrolled.
  • Glutamate spikes as it’s no longer suppressed by alcohol. This chemical chaos aggravates withdrawal.
  • Dopamine plays essential roles in motor control, motivation, pleasure, and reward pathways. In the absence of alcohol, dopamine increases beyond normal levels and contributes to elevated blood pressure, heart rate, and anxiety.
  • Serotonin, which contributes to feelings of well-being and happiness, drops, possibly underlying depression, irritability, and cravings.
  • Norepinephrine, also known as a stress hormone, rises, triggering fight-or-flight responses like sweating, and rapid heart rate.

This means that, by removing alcohol from your system—which is the right choice—your alcohol-adapted brain turns against you. However, wonderful things happen to your brain when you stop drinking. You just need to give your brain the chance and time to recover from alcohol’s toxic effects.

What happens to your liver when you stop drinking?

The liver gets hit hard by alcohol abuse, but ironically it also gets thrown for a loop when booze disappears during withdrawal. 

The liver is something of a rockstar among the organs. It is responsible for filtering toxins from the blood and so many more vital functions that basically keep you up and running. When alcohol floods the system daily, the liver works overtime trying to metabolize it.

So when drinking suddenly stops, the liver is still primed and ready with extra metabolic capacity. But there’s no alcohol coming in. This can lead to rapid rises in liver enzymes as the organ readjusts. 

The liver suffers significant short-term duress during withdrawal. Here’s what happens to your liver when you stop drinking:

  • Liver inflammation flares up as cells recover from alcohol’s toxic effects. This leads to discomfort, nausea, and fatigue.
  • Liver enzymes spike as the liver adjusts to the lack of alcohol to process.
  • Pre-existing liver conditions like fatty liver disease or cirrhosis may worsen without alcohol’s suppressive effects.
  • Liver cell damage from heavy drinking can hinder the liver’s ability to produce bile needed for digestion.
  • Detox stresses the liver, potentially causing acute hepatitis marked by jaundice, fever, and vomiting.

The best thing you can do for your liver is to quit alcohol. With the right help, you can regain control and heal from alcoholism’s adverse effects. Contact Ardu and start your recovery.

How does your stomach react to the lack of alcohol?

Think your stomach had it bad while you were drinking? The pain can get even worse when you try to get clean. That’s because your digestive system got used to operating with alcohol constantly suppressing nerves and damaging tissue. 

So when you stop drinking, the stomach and intestines essentially revolt, stirring up inflammation, dysfunction, and distress from mouth to colon. The gastrointestinal system faces significant disruption when you remove alcohol after heavy, prolonged use. 

  • The stomach lining becomes irritated and inflamed without alcohol’s numbing effect. This can cause pain, nausea, and loss of appetite.
  • Digestive enzymes and acid production swing out of balance, making it difficult to break down food and absorb nutrients. The intestines also struggle to absorb vitamins and minerals properly.
  • Alcohol’s diuretic effect subsides, leading to fluid retention and bloating. A common side effect of this is constipation.
  • Diarrhea frequently occurs as the intestines struggle to regulate normal absorption and motility.

Your stomach and intestines demand the return of toxins to quell their uprising. If you pull through these arduous stages of alcohol recovery, you get closer to feeling healthy and vibrant again, no longer chained to the cycle of alcohol dependence.

What are the kidney-related effects of alcohol withdrawal?

The kidneys suffer toxic effects from alcohol and secondary impacts during withdrawal. When you quit drinking, here’s what can happen to your kidneys:

  • Dehydration: alcohol is notorious for its dehydrating effects. When you lose fluid, it stresses the kidneys and makes them less efficient at filtering waste. This can lead to electrolyte imbalances, causing cramps, weakness, fatigue, and headaches.
  • Toxin buildup: withdrawal disrupts the kidneys’ ability to filter toxins from the blood, allowing wastes and byproducts to accumulate. This can make you nauseous, feverish, and generally unwell.
  • Alcohol myopathy: direct damage to kidney muscle fibers causes leaks and improper fluid regulation.

While kidneys can recover after alcohol abstinence, withdrawal puts them through the wringer. Take the strain off this vital organ and make sure kidneys are properly hydrated and nourished.

Do you want to put a stop to the damage alcohol is doing to your body? Seek the help of our compassionate, skilled professionals at our drug and alcohol rehab center. We will support you through medically supervised alcohol detox and provide therapeutic treatment to start your journey toward healing and long-term sobriety.

Can alcohol withdrawal syndrome trigger addiction?

Alcohol withdrawal syndrome can in fact contribute to the vicious cycle of alcohol addiction by driving someone back to drinking to make the symptoms stop. AWS can potentially exacerbate cross-addictive tendencies as well, as the addict looks for a new addiction to distract them. 

A 2008 study on alcohol dependence, withdrawal, and relapse suggests that alcohol withdrawal syndrome can often perpetuate addiction. 

Although many physical signs and symptoms of withdrawal typically abate within a few days, symptoms associated with psychological distress and dysphoria may linger for protracted periods of time. The persistence of these symptoms (e.g., anxiety, negative affect, altered reward set point manifesting as dysphoria and/or anhedonia) may constitute a significant motivational factor that leads to relapse to heavy drinking. 

Withdrawal-related anxiety and sensitivity to stress cues can increase the risk of relapse in alcoholics. Animal models showed similar hypersensitivity during withdrawal, confirming that dependence enhances susceptibility to relapse triggers.

Then there are the distressing physical and psychological symptoms that provide strong motivation to resume drinking in order to quickly alleviate the discomfort. The looming possibility of repeated agonizing withdrawals can drive continued excessive drinking despite negative consequences. That’s why relapse is considered a natural part of every addiction

Each symptom of withdrawal on its own can make you curse the day you took up the bottle. But when those symptoms converge and attack all at once, you’ll know that alcohol withdrawal syndrome has taken hold. 

What’s the difference between alcohol withdrawal symptoms and syndrome?

You may have heard the terms “alcohol withdrawal” and “alcohol withdrawal syndrome” used interchangeably. While withdrawal symptoms refer to individual effects such as tremors, anxiety, or sweating, alcohol withdrawal syndrome represents the full cluster of severe symptoms that accompany withdrawal.

Specifically, AWS goes beyond a few unpleasant symptoms to a dangerous complex of uncontrolled central nervous system and bodily reactions. 

Here are the key ways AWS is more complex and dangerous than individual symptoms of withdrawal: 

  1. AWS involves multiple severe forms of symptoms that occur simultaneously, while individual symptoms happen in isolation.
  2. AWS disrupts the functioning of the entire nervous system and body. Symptoms often affect localized regions.
  3. Symptoms can often be managed with supportive care, but AWS requires medication and intensive treatment.
  4. Symptoms of alcohol withdrawal are uncomfortable but not immediately dangerous. AWS can be life-threatening without medical intervention.
  5. Symptoms may manifest after a single night of heavy drinking. AWS arises after extended alcohol dependence and cessation.
  6. Symptoms serve as early warning signs alcohol is impacting health, while AWS indicates physiologic dependence and addiction.

With alcohol abstinence, proper nutrition, and therapeutic support, you can overcome alcohol syndrome. 

What is the treatment of alcohol withdrawal syndrome?

There is no medical “cure” for alcohol withdrawal syndrome, other than staying the course with your sobriety and letting the symptoms run their course under proper medical supervision. 

Here are some ways to mitigate the effects of AWS:

  • Medically supervised detox in an inpatient care or outpatient setting. Medical professionals administer medications to smooth out symptoms and prevent complications. This tapering process safely processes toxins out of the body.
  • Supportive care including fluids, vitamins, nutrition and rest helps stabilize the body as it rebalances. Light therapy or massage can also calm the nervous system.
  • Anti-seizure medications (benzodiazepines) control tremors, convulsions, and seizures by soothing electrical hyperactivity in the brain.
  • Other drugs target specific symptoms like high blood pressure, nausea, insomnia, or hallucinations on an as-needed basis.
  • Ongoing psychological therapy for underlying issues fueling addiction. This is key for long-term recovery and preventing future withdrawal episodes.

Doctors recommend combining medical and psychotherapeutic interventions that allow you to pass through the acute alcohol withdrawal phase safely. 

If you need help, our alcohol detox program can help you get over the withdrawal stage, and our alcohol rehab can help you rewire your patterns, body, and brain for an addiction-free life. 

How much do I have to drink to experience withdrawal?

How much booze until those first symptoms kick in? Unfortunately, there’s no magic number. In general, consuming more than 3–4 drinks daily over months to years often results in physical alcohol dependence and subsequent withdrawal upon quitting. Some people can drink heavily for years with no withdrawal effects. Others get hooked after just a few months of moderate use. 

Your unique biology and drinking habits interact in complex ways. Many factors influence a person’s susceptibility to booze.

  • Duration. Longer duration of heavy drinking increases withdrawal risks. Symptoms typically appear after excessive alcohol use for months to years.
  • Frequency of use. Consuming alcohol daily rather than occasionally promotes dependence.
  • Quantity. Heavy, binge drinking correlates with more severe withdrawal than moderate consumption—which is why you should quit binge drinking while you’re ahead.
  • Past withdrawal episodes. Prior detoxes can kindle more intense withdrawal symptoms.
  • Individual factors such as genetics, health status, and age all affect your vulnerability.

One thing is certain—the more heavily and frequently you consume over time, the higher the risks. Cutting back or quitting altogether is the surest way to steer clear of the risk of developing AWS. 

Do you need help detoxing from alcohol?

Alcohol withdrawal symptoms can range from mild to life-threatening, but you don’t have to face this challenge alone. We offer compassionate care and treatment to ensure your safety and success. 

At Ardu, you can choose medical detox, holistic detox, or a combination of the two approaches.

  1. Medical detox provides pharmacological treatment to safely manage alcohol withdrawal symptoms and prevent dangerous complications. Under medical supervision, the management of alcohol withdrawal is done with medications to relieve symptoms and prevent complications such as anxiety, tremors, seizures, hallucinations, and delirium. In addition to medications, medical detox provides fluids, nutrition, vitamin supplements, and around-the-clock monitoring and supportive care to ensure your comfort and safety during alcohol detoxification.
  2. Holistic detox focuses on treating alcohol withdrawal symptoms without medication. It uses natural therapies such as nutritional therapy, meditation, massage therapy, counseling, and other modalities. 

What happens after the detox?

We know recovering from alcohol addiction is a lifelong process. Our goal is to support you each step of the way with compassion and evidence-based care. You can continue treatment with us through our welcoming inpatient care facilities or our flexible outpatient therapy sessions.

We offer multiple forms of individual therapy, including motivational interviewing, cognitive-behavioral therapy, and family therapy, as well as group therapy options and dual diagnosis treatment for those with a co-occurring mental health disorder.

You can also choose to stay at our residential treatment facility 24/7 for one to three months while undergoing intensive therapy and medical management of withdrawal and addiction. We provide counseling, group therapy, art therapy, and other programs during your stay.

If you’re looking for more flexible arrangements, our outpatient addiction treatment allows you to maintain your daily routines to help you overcome alcohol use disorder. With our support, you can achieve sobriety and build a strong foundation for long-term recovery while still taking on home and work responsibilities.

Alcohol withdrawal FAQ

Can alcohol use disorder be cured? 

Alcohol use disorder (AUD) is a chronic yet treatable brain disease characterized by an inability to control alcohol use despite negative consequences. While it may not be “cured” in the traditional sense, it can be effectively managed and treated.

Treatment for AUD typically involves a combination of behavioral therapies, counseling, and medications. The goal is to help the person with alcohol addiction reduce or stop their consumption, manage alcohol cravings, and address underlying factors contributing to the abuse.

Recovery from AUD varies from person to person, and it’s an ongoing process. Some people achieve long-term abstinence, while others may learn to moderate their alcohol intake. 

What is a Type 1 alcoholic?

The term “Type 1 alcoholic,” while not a formal medical classification, is often used to describe people with severe alcohol addiction. These individuals often display compulsive drinking behavior, a high tolerance for alcohol, and significant life disruptions due to their addiction. The so-called type 1 alcoholics also tend to experience more severe withdrawal symptoms. 

However, addiction is a complex issue, and attempting to categorize individuals into types oversimplifies the reality of AUD. Alcohol addiction exists on a spectrum, and there are no universally accepted “types” of alcoholics. Each person’s experience with alcohol use disorder is unique and may require personalized treatment.

What is the life expectancy of a recovering alcoholic?

The life expectancy of a recovering alcoholic depends on several factors, including the severity of their alcohol use disorder, their overall health, and their commitment to recovery. Generally, once an individual stops drinking and seeks treatment, their life expectancy can improve.

Alcohol abuse can lead to a wide range of health issues, such as liver disease and liver cirrhosis, cardiovascular problems, and increased risk of accidents and injuries. The extent of recovery depends on the damage done during the period of heavy drinking.

What is a severe withdrawal syndrome seen in alcoholics?

Severe withdrawal syndrome in alcoholics is typically referred to as “Delirium tremens” (DT). It’s a life-threatening condition that can occur when individuals with severe alcohol addiction suddenly stop drinking. DT is characterized by a combination of severe symptoms, including hallucinations, confusion, severe agitation, tremors, and potentially life-threatening autonomic nervous system disturbances.

DT is a medical emergency and requires immediate hospitalization and intensive medical care. Without proper treatment, it can lead to seizures, respiratory failure, and even death. 

What are the symptoms of withdrawal behavior?

Withdrawal behavior encompasses a broad spectrum of physical and psychological symptoms. 

Physically, individuals experiencing withdrawal from substances like alcohol or drugs may encounter symptoms such as tremors, sweating, increased heart rate, nausea, vomiting, and even seizures in severe cases. These physical manifestations stem from your body’s reaction to the sudden deprivation of the substance it has become dependent on. These symptoms can be both uncomfortable and, in extreme cases, life-threatening.

Psychologically, withdrawal often leads to mood disturbances, such as anxiety, depression, irritability, and intense cravings for alcohol. The psychological aspects of withdrawal can be emotionally challenging, with cravings being a powerful force compelling you to return to your addictive behaviors.

How do you deal with withdrawal patients?

People who are in the throes of withdrawal from substances need compassion and support. Withdrawal is a vulnerable and often distressing experience. Here’s how to effectively deal with those going through withdrawal:

  • Provide a safe environment for your loved one who’s struggling with withdrawal. Ensure that their physical and emotional needs are met, and any immediate health risks are addressed.
  • Offer emotional support: be empathetic and understanding. Let them know you’re there to support them through this challenging time. Encourage open communication about their feelings and struggles.
  • Encourage professional help: withdrawal can be severe, especially for alcohol and certain drugs. It is crucial to encourage people to seek professional treatment, as this offers the best chance for a safe and successful recovery.
  • Build a support system: help them establish a support network, which may include friends, family, or support groups. A strong support system can be invaluable during recovery.
  • Understand triggers: identify the triggers or situations that may lead to substance use. Understanding these triggers can help individuals avoid them or develop healthier coping strategies.
  • Develop coping strategies: encourage the development of healthy coping mechanisms for dealing with stress, cravings, and triggers. This can be achieved through therapy, counseling, or addiction support groups.

Everyone’s withdrawal experience is unique, and there is no one-size-fits-all approach. Offer empathy, patience, and unwavering support to help your loved one successfully navigate withdrawal and embark on their journey to recovery.


Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2016). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4-16. https://doi.org/10.1111/ane.12671

Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. [Updated 2023 July 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441882/

Becker, H. C. (2008). Alcohol Dependence, Withdrawal, and Relapse. Alcohol Research & Health, 31(4), 348-361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860472/

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