Definition and Overview

Alcohol withdrawal syndrome (AWS) refers to a set of symptoms that occur when a person stops drinking. It only affects those who are highly dependent on alcohol and have been drinking heavily for years. Sometimes, the symptoms are mild. But most of the time, they can make a person very ill.

Alcoholics can experience alcohol withdrawal symptoms as soon as six hours after their last drink. Initial symptoms are nausea and anxiety. Some people also experience pain in the abdomen that comes and goes. The symptoms then start to get worse within the next 48-72 hours. During this time, patients also experience fever, confusion, high blood pressure, and even seizures. It is also very common to see patients shaking non-stop during this period. After 72 hours, many of the symptoms slowly start to improve.

Alcoholism affects about 15% of people in most Western countries. Of this number, 4% suffer from severe symptoms once they stop drinking. 15% of those with severe symptoms die.

Due to the serious dangers associated with AWS, it is best for alcoholics to arrange hospitalisation and medical care ahead of time. A doctor will guide them throughout the process and provide treatment for their symptoms as they appear.

Causes of Condition

As the term implies, AWS occurs when a person decides to stay away from alcohol after years of heavy drinking.

Alcohol suppresses neurotransmitters and slows down brain activity. It also reduces energy levels and causes the body to release more dopamine. This chemical has an impact on a person’s sensations of pleasure and pain. The more dopamine produced in the body, the better the person feels. That is why many people who go through difficult situations turn to alcohol. It temporarily helps them not to feel negative feelings, such as sadness and anxiety.

When a person suddenly stops drinking, neurotransmitters in the brain suddenly go back to normal levels. This causes a person to feel anxious and agitated. This can also lead to tremors and seizures.

Key Symptoms

Symptoms of AWS are:

  • Altered mental status

  • Anxiety

  • Fast heart rate or palpitations

  • Fever

  • Hearing or seeing things that are not there (hallucinations)

  • Seizures

  • Shakiness

  • Sweating

  • Vomiting

The severity of symptoms depends on a person’s level of alcohol addiction. It is also affected by the severity of previous withdrawals (in patients who have tried to stop drinking in the past). In many cases, those who drink first thing in the morning present with most severe symptoms.

The symptoms are often worst during the first three days after the last drink. They then slowly start to improve. However, some people continue to crave for alcohol. They also lose their ability to feel pleasure from other things they used to find enjoyable or meaningful. Some withdrawal symptoms, such as nausea, disorientation, vomiting, and headaches can linger for up to a year. Most also suffer from insomnia. These are some of the reasons why many people relapse at some point during their recovery.

Who to See and Types of Treatments Available

Alcoholics are assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). This protocol helps doctors determine the most appropriate treatment for patients. Before treatment, patients undergo a physical exam and blood test that measures the levels of certain hormones in their blood.

Treatment is based on the patient’s history of alcohol abuse. Doctors take into consideration the amount they normally consume, how often they drink, and for how long. Treatment options include:

  • Medications - The first and most crucial step is detoxification. This is the stage where alcoholics stop drinking. They are then monitored for any symptoms that may occur. Doctors then give them medications to control such symptoms. Doctors then decide whether inpatient or outpatient therapy is best for the patient. Inpatient treatment offers 24-hour care and provides patients with easy and quick access to facilities they require to recover faster. Outpatient treatment, on the other hand, is ideal for patients with less severe symptoms. They are allowed to do their normal routine but have to check in with their doctor on a regular basis.

  • Counseling - Emotional problems are the common reasons for alcoholism. It helps people forget what they are going through even just for a little while. During treatment, a counselor will help patients deal with their emotional problems. They will also provide support during the highs and lows of alcohol withdrawal.

  • Support groups - Many support groups, such as Alcoholics Anonymous (AA), provide support and outlet for patients. These groups allow them to share their goals and challenges with people who are going through the same journey in a safe environment where they will not be judged. Having a place or group where someone feels supported can help them stay motivated to maintain their sobriety.


Many patients struggle to stay sober. The majority says avoiding alcohol during the first year is the hardest. This is usually the time they struggle really hard because they cannot sleep well. They also find it difficult to make changes to their lifestyle. For example, they may find it difficult to attend parties of loved ones where there’s alcohol.

Statistics show that those who have managed to stay sober for at least 12 months are more likely to make a complete recovery.


  • National Institute on Alcohol Abuse and Alcoholism: “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5,” “Treatment for Alcohol Problems: Finding and Getting Help,” “Alcohol Use Disorder.”

  • National Institute on Drug Abuse: “Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide.”

  • Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment. The Role of Biomarkers in the Treatment of Alcohol Use Disorders. US Department of Health and Human Services. Available at

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