Clinical features of alcohol withdrawal
Time course
Primary care providers should note that:
- Withdrawal can begin as early as six to 12 hours after the last drink
- Symptoms peak at two to three days, although they can last up to seven days
- A subacute withdrawal syndrome may last for weeks, characterized by insomnia, irritability and craving.
Risk of withdrawal
Alcohol withdrawal requiring treatment is rare in people consuming fewer than six drinks per day, except in older adults, who may develop significant withdrawal symptoms even if they were consuming only several drinks per day.
Withdrawal severity varies widely, and is partially dose-related. Some people who drink very heavily experience few or no symptoms of withdrawal, whereas others experience severe symptoms.
Elderly patients have a more complicated withdrawal course because they often have concurrent health problems and may be frail.
Past withdrawal predicts future episodes. Patients with a history of delirium tremens and withdrawal seizures are at high risk of recurrence if they return to drinking and stop again.
Signs and symptoms
The most reliable sign of alcohol withdrawal is postural and intention tremor. Ask patients to hold their hands out in front of them, to reach for an object or to walk across the room. The tremor may not be visible when the patient is at rest.
Other signs include diaphoresis, tachycardia and hypertension. Anxiety, nausea and headache are common symptoms.
Distinguishing between withdrawal and anxiety
Patients with alcohol dependence sometimes attribute withdrawal symptoms to anxiety.
Withdrawal should be suspected if:
- The patient reports having six or more drinks per day (except for older adults, who can experience withdrawal at lower amounts)
- Drinking begins at a predictable time in the morning or afternoon
- Symptoms include sweating or tremor
- Symptoms are quickly relieved by alcohol
- The patient has required medical treatment for withdrawal in the past, or has had withdrawal seizures.
In Alcohol Use:
- Alcohol Use: Home
- Screening
- Assessment
- Treatment
- Managing alcohol use disorders
- Alcoholics Anonymous
- Medications for alcohol use disorders
- Managing alcohol withdrawal
- Alcoholic liver disease
- Treating unhealthy alcohol use in older adults
- Treating unhealthy alcohol use in women
- Managing alcohol use in pregnancy
- Treating co-occurring alcohol use disorders and depression
- Long-term management of co-occurring alcohol use disorder and major depression
- Tools & Resources
- References