Alcohol withdrawal symptoms?

Dear Alice,

I've been a very heavy drinker for a number of years and it has started to impact my job and family relationships. Recently I've been trying to quit or moderate my drinking and that has been met with little success. I will go a few days without drinking and then the uncontrollable urge overcomes me and I end up at the bar promising to have only one to two (which then end up being my normal ten or eleven).

Every time now that I cut back on my alcohol intake, I get very serious withdrawal symptoms, such as twitches, shakes, night sweats, nervousness, and anxiousness. It is getting to be so bad that I feel worse than if I was suffering a hangover. I'm wondering how long will these symptoms continue?

A few weeks ago, I went about ten days without drinking and thought I was over the symptoms, but I regressed and started drinking heavily again. Now, it has been four days since my last drink and I can barely concentrate at work because of the twitching and nervousness. I don't go to doctors and think that I can work myself through this on my own. I'm just wondering how long this will last and if there is anything that I can do that would make this process easier. Thank you!

Dear Reader,

It's great that you're reflecting on how substance use is affecting your life. If you've been a heavy drinker for a long time, you may experience some side effects when you try to cut back on your alcohol consumption. Symptoms of alcohol withdrawal may last anywhere from 24 hours to weeks, based upon how dependent a person has become. As you mentioned, some of the symptoms overlap with those of a hangover, but some, such as seizures and tremors, are specifically related to alcohol withdrawal syndrome. If dependency worsens or is left untreated, some people develop a life-threatening condition called delirium tremens (DT), which is a medical emergency. DT has an 11 to 35 percent chance of mortality when untreated, but treatment reduces the chance to three to five percent. Further, while you mention not seeing health care providers, you may find their support to be helpful as you make this change. If you still don't want to see them, there are different types of support groups that may help that aren't overseen by anyone in the medical profession.

The symptoms that you describe are similar to those people experience during alcohol withdrawal:

  • A strong desire to drink to relieve the symptoms of withdrawal
  • Irritability
  • Sweating
  • Difficulty sleeping
  • Difficulty concentrating
  • Anxiousness
  • Nausea and vomiting
  • Increased blood pressure or heart rate
  • Seizures

Further, some symptoms, if present between 48 and 96 hours after the last drink, may indicate the need to seek immediate medical attention, as these may be signs of DT. They may include: 

  • Hallucinations
  • Agitation
  • Confusion
  • Excessive sweating
  • Fever
  • Extremely high heart rate and blood pressure
  • Seizures

You say that you’ve been feeling nervousness and twitchy, and this may be due to a process that happens in the brain when someone is experiencing alcohol withdrawal. Alcohol acts as a nervous system depressant by mimicking a neurotransmitter called GABA. GABA works by calming down the central nervous system, which is why some people might find that alcohol has relaxing effects. With long-term alcohol consumption, however, GABA production decreases. So when alcohol isn’t present to mimic it, the central nervous system starts to act up. While you've mentioned wanting to get through the process on your own, since you've gone four days with twitching and nervousness, it might be worth your while to speak to a health care provider. They may be able to assist with relieving discomfort during this time.

Based on what you've said, it sounds as though you've had limited success in quitting drinking on your own without other supports. Has this strategy worked for you? What is it about seeing a health care provider that is unappealing to you? What would it be like for you to talk to a professional who may provide some support and help? Are you open to seeking support from others who aren't health care providers? It's understandable that talking to someone about your alcohol use may feel uncomfortable or overwhelming. That being said, recovering from a dependency usually requires both internal (your willpower) and external (outside help, other people, services) forces. Although it can be nerve-wracking to seek support, it’s a tough syndrome to kick on your own — research has shown that of people with alcohol dependencies, only about 20 percent are able to quit without the help of treatment or a program. If you do decide to reach out, there are several options you might explore.

In the case that you see a health care provider, they may ask about your medical history, your alcohol consumption, and your symptoms, especially as they relate to going cold turkey. Your honesty will help the provider take the best possible care of you. They may refer you to a substance abuse counselor or program to better understand why and when your drinking became excessive and uncontrollable to develop a plan to combat your dependency.

A myriad of services and resources are available to support you in the process of quitting drinking. Your job may offer a confidential employee assistance program (EAP) that aids its employees in finding substance abuse services to fight their dependencies or addictions. If you're concerned about cost, you may consider reviewing Finding low-cost counseling to learn more about options that fit into your budget. Alcoholics Anonymous (AA), where you can find other people who have been in similar situations to you, is another option to consider. Al-Anon/Alateen is a similar program, but is geared towards family and friends of people who drink.

Even though you want to stop drinking without any help, recovery from alcohol use is difficult and time-consuming — if not all-consuming — so taking advantage of resources and support available to you may significantly help with the day-by-day. You've already taken a step by reaching out for information, so kudos to you! Best of luck with whatever steps you choose to take next. 

Last updated Jan 31, 2020
Originally published May 05, 2005

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