The Phases of Alcohol Withdrawal

What happens when you stop drinking?

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The Phases of Alcohol Withdrawal

Alcohol withdrawal syndrome is a collection of symptoms that may occur when you stop drinking. In some cases, these symptoms can be dangerous or even fatal. Alcohol withdrawal treatment, also known as medical detox, is essential for safe, comfortable withdrawal. Typically, when withdrawing from alcohol, one will experience 3 phases. The severity of the 3 phases is dependent on the amount of alcohol one consumes on a daily basis and their tolerance levels.

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Alcohol Withdrawal Itching: Tactile Hallucinations

The most serious characteristic experienced in Phase 3 of Alcohol withdrawal is delirium tremens or DT. A major symptom of DT’s is tactile hallucinations where one feels an extreme itching, burning or numbness sensation, that is not actually happening. Often times this itch is mistaken for a rash due to its severity and that many feel as though they have bugs crawling under their skin.

Causes of Alcohol withdrawal itching are still not completely understood. Though some medical professionals believe that the tactile hallucinations are a result of the central nervous system reviving itself by means of nerve endings after having been numbed by Alcohol for such an extended period of time.

Why Alcohol Withdrawal OccursPhases of Alcohol Withdrawal

Withdrawal occurs when you stop drinking after you’ve developed a dependence on alcohol. Alcohol dependence is the result of changes in brain function and structure that may come with chronic alcohol abuse.

When you abuse alcohol, your brain compensates for its presence by adjusting its neurotransmitter activity. Neurotransmitters are brain chemicals that communicate information throughout the body and brain. Alcohol is a depressant, and in the beginning, it enhances the effects of the neurotransmitter GABA, which produces feelings of relaxation and well-being, and decreases the effects of glutamate, a neurotransmitter that produces feelings of excitability.

But when occasional drinking transitions to chronic alcohol abuse, the brain attempts to maintain normal function despite the presence of alcohol by suppressing GABA and increasing glutamate, according to the American Academy of Family Physicians.(1) As your brain continues to adjust its chemical activity, you’ll find you need increasingly higher doses of alcohol to get the desired effects. This is known as building a tolerance. As you use more and more alcohol, brain activity continues to change to compensate for its presence.

At some point, these brain changes may reach a tipping point, and the brain will begin to function more comfortably when alcohol is present than when it’s not. But when you stop using once you’ve become dependent, neurotransmitter activity rebounds. GABA activity, which has been suppressed, increases, and glutamate, which has been increased, is reduced. This results in withdrawal symptoms, which are the hallmark of alcohol dependence.

Alcohol Withdrawal Symptoms & How to Treat

Alcohol withdrawal symptoms typically set in within six to 24 hours after the last drink. Symptoms can range from mild to severe, depending on your age, how long you’ve been addicted, whether you’ve detoxed before, and how much alcohol is in your system at the time detox begins. Not everyone will necessarily experience all the symptoms of withdrawal, although nearly everyone will struggle with intense alcohol cravings.

Alcohol Withdrawal Timeline
Alcohol Withdrawal Occurs in 3 Predictable Phases

Phase #1

Mild Alcohol Withdrawal

Mild alcohol withdrawal can begin as early as 6 hours and as late as 24 hours after your last drink. 

These early symptoms of alcohol withdrawal will typically intensify and then begin to subside within 24 to 48 hours after they begin. Medications commonly used in early withdrawal can help ease many of these symptoms. 

Symptoms include:

⇢   Intense cravings
⇢   Headache
⇢   Nausea & Vomiting
⇢   Anxiety



Phase #2

Moderate Alcohol Withdrawal

Between 24 and 48 hours after the last drink, more intense symptoms may begin to appear. 

Adrenergic medications may be used to treat elevated blood pressure and pulse rate. For those at a high risk for seizures, anti-seizure medications may be given which may also help with depression, anxiety, and irritability.

Symptoms include:

⇢   Confusion
⇢   Mild Hallucinations
⇢   Irregular Heartbeat
⇢   Seizure



Phase #3

Delirium Tremens

Delirium Tremens begin within 48 to 96 hours after the last drink.

Antipsychotic medications may help impulsive behaviors, hallucinations, and lower the risk of seizures. Many people experience severe itching, burning and/or sensations of bugs crawling underneath their skin, referred to as tactile hallucinations.

Symptoms include:

⇢   Severe Itching
⇢   Impulsive Behaviors
⇢   Disorientation
⇢   Anxiety & Depression



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Inpatient vs. Outpatient Alcohol Withdrawal Treatment

Inpatient Detox Programs

Inpatient vs. Outpatient TreatmentInpatient detox involves staying at a residential facility during detox. Inpatient programs offer the best chances for success and are the safest option for withdrawal. Inpatient detox is essential for those who have a long history of alcoholism, a history of unsuccessful detox, a history of withdrawal seizures, a co-occurring medical or mental illness, or little support at home.

Inpatient detox offers a high level of emotional support and around-the-clock supervision during withdrawal. High-quality inpatient detox programs often include complementary therapies like yoga, acupuncture, massage, or meditation to help reduce stress and improve your sense of well-being. Because many people who are dependent on alcohol have vitamin deficiencies and other health problems, inpatient programs put a strong emphasis on good nutrition and adequate hydration. Inpatient detox allows you to focus on getting through withdrawal comfortably and without external stresses and triggers that can quickly lead to a relapse.

Outpatient Detox Programs

Outpatient detox involves visiting a detox center each day to discuss symptoms and monitor any medications being used. Outpatient alcohol withdrawal treatment can be successful for people who are in good physical and mental health and who are withdrawing for the first time. Successful outpatient detox requires a high level of intrinsic motivation to quit alcohol and plenty of sober support at home.

Outpatient detox offers a higher level of privacy than inpatient detox since there’s no need to explain an extended absence. It allows you to continue working, attending school, or caring for the family while ending your dependence on alcohol.

If you’re not sure which type of program to choose, a physician, addiction counselor, or other medical or mental health professional can help you decide which treatment setting is best for you.

Detox Isn’t the Same as Addiction Treatment

The Principles of Effective Treatment set forth by the National Institute on Drug Abuse make it clear that while detox ends the physical dependence on alcohol, it doesn’t address the addiction. Dependence and addiction aren’t the same things, and detox is only the first stage of addiction treatment.

Addiction is characterized by the inability to stop using alcohol even though it’s causing problems in your life, including health, relationship, financial, and legal troubles. It develops when the brain makes ironclad associations between using alcohol and the pleasure it produces. As the brain begins to associate enjoying alcohol with needing it, the result is intense cravings that lead to compulsive use. The brain changes that occur with addiction–particularly in the learning, reward, and memory centers–also affect thought and behavior patterns, leading to dysfunctional thinking and risky behaviors.

Treating an addiction requires addressing the various issues that underlie the alcohol abuse, which may include a mental illness like anxiety or depression, a history of trauma, chronic stress, or family dysfunction. It requires developing essential skills and strategies for coping with cravings, stress, and other potent triggers for relapse, and it requires finding purpose and meaning in life and learning how to have fun and enjoy yourself without alcohol.

Detox and Addiction TreatmentCognitive Behavioral Therapy is the cornerstone of addiction treatment. It helps you sort through your unique issues, and it helps you identify self-destructive thought and behavior patterns and learn to think and behave in healthier ways. Since there is no single pathway to recovery that works for everyone, the Substance Abuse and Mental Health Services Administration, or SAMHSA, stresses that a holistic approach to treatment that addresses issues of body, mind, and spirit through a variety of traditional and complementary therapies offers the best possible treatment outcomes.

Of particular concern is the effect alcoholism has on children. It is known that children from alcoholic households, be that with one or two drinking parents, are more likely to have behavioral problems, anxiety, and other emotional issues.

There is Always Hope

Recovery is a process of change that helps people improve their health, live self-directed lives, and reach their full potential, according to SAMHSA. Once the physical dependence on alcohol is broken through detox, treatment is crucial for sending the addiction into remission for the long-term.

HopeHope is the belief that a better future is possible, and it’s the foundation of recovery. But just as it takes time to develop an addiction, it takes time to establish new thought and behavior patterns and make lifestyle changes that support a life in recovery. Setbacks are a normal part of this process and holding onto hope throughout detox, treatment, and early abstinence–and focusing on the progress you’ve made so far rather than any setbacks you’ve experienced–is essential for successful long-term recovery.

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