Alcohol Withdrawal Symptoms: Can They Be Deadly?

Despite initial stimulating effects, alcohol is a central nervous system depressant. This means it slows down brain activity. As a result, other body process begin to slow down and malfunction accordingly.

Unlike some other depressants, such as opoids and heroin, alcohol withdrawal can be fatal. But Why?

First, let’s try to understand what alcohol does inside the brain, and what happens when the brain withdraws from its effects.

Alcohol Increases Dopamine, GABA

alcoholbrainAlcohol affects brain chemistry by manipulating chemical messengers known as “neurotransmitters”.

These messengers are responsible for transmission of signals that control thought processes, behaviors, and feelings. Alcohol can affect signals which both excite the brain or inhibit activity.

For example, gluatmate is a excitatory transmitters. It normally increases brain activity and energy, but alcohol suppresses the release of this chemical, thus slowing down the brain.

Alcohol also increases GABA, an inhibitory transmitter. This messenger reduces energy and calms things down. It causes sedation and a relaxed effect. For this reason, benzodiazepines, which also increase GABA, should never be taken with alcohol.

In any case, the combination of these two effects results in much brain and body inactivity. The more you drink, the more this effect is amplified.

But alcohol also increases dopamine in the brain’s reward center. Dopamine is the brain’s “feel good” chemical, and thus, initial alcohol consumption tells you that you are being rewarded – similar to if you got a raise at work. So at the onset, you feel good or better than before, However, the sedative effects of alcohol begin creeping in, and reduce this effect that may initially feel stimulating.

Alcohol Withdrawal Symptoms

Alcohol withdrawal is the opposite of an alcohol “drunk”. The user often feels anxious, irritable, and jittery. The effects of alcohol withdrawal  greatly depend on the amount consumed, as well as the duration of consumption.

If someone who normally does not drink consumes too much alcohol one night, the next day they probably will feel “hungover” to some degree. Alcohol is also a diuretic, meaning that it rids of the body of liquid. Thus, dehydration the next day is also common, especially if the consumer didn’t drink much water.

Minor Alcohol Withdrawal Symptoms (i.e. Hangover)

  • Fatigue and weakness
  • Thirst
  • Headaches and muscle aches
  • Nausea, vomiting or stomach pain
  • Poor or decreased sleep
  • Increased sensitivity to light and sound
  • Dizziness or a sense of the room spinning
  • Shakiness
  • Decreased ability to concentrate
  • Mood disturbances, such as depression, anxiety and irritability’
  • Rapid heartbeat

Generally speaking, these symptoms go away after a day or two of not drinking.

But alcohol withdrawal on a small scale is much different than say, full blown alcohol withdrawal syndrome. This occurs when someone who has been drinking for a very long time stops abruptly. At this point, the body is dependent on alcohol, so eliminating the substance has a variety of devastating effects to the brain and body,

Alcohol Withdrawal Syndrome

anxietyAlcohol Withdrawal Syndrome, or AWS, is a whole other animal from a simple hangover.

When someone has been drinking heavily for a prolonged period and suddenly quits “cold turkey”, or dramatically reduces their intake, the neurotransmitters (as noted above) are not longer suppressed by the effects of alcohol.

Consequently, they “rebound”, not unlike a bed spring after being compressed and released.

The result is a hyperexcitability of the brain – and not in a good way. It’s precisely the opposite of the central nervous system depression that has been induced for so long.

During AWS, alcohol withdrawal begins similar to a normal hangover – however, after a few hours (average of 24-48) a rapid onset of increasing unpleasant and serious alcohol withdrawal symptoms begin to occur.

Symptoms of AWS:

  • Tremors
  • Anxiety and irritability
  • Nausea and/or vomiting
  • Headache
  • Increased heart rate
  • Sweating
  • Confusion
  • Insomnia and sleep disturbances, nightmares
  • High blood pressure

These effects can be thought of as being more severe than a hangover, but not nearly as severe as delerium tremens (see below).

Delerium Tremens

Symptoms of DTs, which usually peak after a few days, include:

  • Disorientation, confusion, and severe anxiety
  • Hallucinations (primarily visual) which are not distinguished from reality
  • Profuse sweating
  • Seizures
  • High blood pressure
  • Very rapid and irregular heartbeat
  • Severe tremors
  • Low-grade fever

Risk factors for delerium tremens include a history of withdrawal seizures, acute medical illness, liver dysfunction, and old age.

Fortunately, only probably less than 5% of all AWS cases turns into DTs.

Complications of delirium tremens (DTs) include the following:

  • Over-sedation
  • Respiratory depression, respiratory arrest
  • Intubation
  • Aspiration pneumonitis
  • Cardiac arrhythmias

heartattackThe most common cause of death for AWS and DTs is cardiac arrest and respiratory failure. If DT is medically treated, the mortality rate is probably only around 10%. If left untreated, the risk of death is much higher.

If you are a long-term heavy drinker, please do not attempt to detox alone. Although rare, it can be fatal. If you believe your problem is serious enough to result in terrible alcohol withdrawal symptoms, then you are probably right.

Please seek medical detox and do not quit abruptly without medical assistance.


~ G. Nathalee Serrels, M.A., Psychology

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