The first day without a drink can feel strange in ways people don’t expect. Your heart beats faster, your hands keep trembling, and it is hard to get rid of the feeling of unease. Many people like to call it nervousness and ignore it, however, alcohol withdrawal anxiety is an emotional phenomenon as much as a physical one.
For some people, the withdrawal subsides after a few uncomfortable days. However, for some people, the withdrawal symptoms may cause seizures and a state called delirium tremens. Understanding how withdrawal is affecting you is key to knowing if you can manage the problem yourself or if you should seek help.
Why Stopping Alcohol Can Trigger Anxiety
Drinking alcohol causes a slowing of the nervous system. Alcohol slows down activity in the central nervous system, which is why people may feel relaxed after drinking. Over time, the brain adapts to the presence of alcohol to maintain balance. When someone suddenly stops drinking, the brain can become overactive because it has adjusted to alcohol’s effects. This increased activity can cause withdrawal symptoms such as anxiety, restlessness, sweating, and a racing heartbeat
This is why withdrawal anxiety feels so real physically. People may experience racing thoughts as well as sweaty palms. People suffering from anxiety disorder will remark that the feeling is similar to what they normally feel daily, except a heightened sense of anxiety may be experienced in response to their mind being more active than expected.
Common Alcohol Withdrawal Symptoms
The MedlinePlus overview of alcohol withdrawal from the U.S. National Library of Medicine lists a wide range of symptoms. Some are emotional or cognitive. Among them are:
- Anxiety or nervousness
- Irritability and mood swings
- Depression and fatigue
- Nightmares and trouble thinking clearly
Other symptoms are mostly physical, including headaches, insomnia, nausea, sweating, a rapid heart rate, and tremors. The mix varies from person to person. Two people with similar drinking histories can have noticeably different experiences in the same early days.
The Withdrawal Timeline: What to Expect
According to MedlinePlus, symptoms typically begin about eight hours after the last drink, although they may not arise until days later. Symptoms are usually at their worst during the 24- to 72-hour period, referred to as the critical period when symptoms may reach a peak level.
Along with physical symptoms, alcohol withdrawal can also affect a person’s mood, sleep, and energy levels. Some people experience mood swings, fatigue, irritability, or difficulty sleeping. Even after the physical symptoms begin to improve, these emotional and sleep-related difficulties may continue for some time.
When Anxiety Signals Something More Serious
Anxiety is often one of the earliest withdrawal symptoms, and its intensity alone can’t reliably show whether withdrawal symptoms will stay mild. Someone who feels merely on edge in the early hours can still go on to more serious complications. A clinical review of alcohol withdrawal syndrome on NCBI Bookshelf reports that withdrawal seizures typically occur between 8 and 48 hours after drinking stops.
The same review describes delirium tremens as the most severe form. It has been estimated that approximately 3 to 5 percent of individuals suffering from alcohol withdrawal syndrome develop delirium tremens, based on studies performed on clinical populations which may not be typical of all situations. The authors emphasize that historically its mortality rate was as high as 20 percent and is currently around 1 percent. Delirium tremens is associated with a sudden onset of a severe confusional state, agitation, hallucinations, and fever, which requires medical assessment whenever alcohol dependence is suspected.
MedlinePlus advises calling 911 or your local emergency number for any of the following:
- Seizures
- Fever
- Severe confusion
- Hallucinations
- An irregular heartbeat
Risk Factors That Call for Closer Supervision
Not everyone carries the same risk. The NCBI review names several risk factors that weigh against managing withdrawal without hospitalization:
- A history of withdrawal seizures or withdrawal delirium
- Medical comorbidities, meaning other significant health conditions
- Age over 65
- Physical dependence on benzodiazepines, a class of sedatives
Clinicians will consider additional considerations as the list is not complete. The report indicates clearly that prior experiences with complicated withdrawal make it likely that the person will experience complicated withdrawal again in the future. A person who has had seizures or been hospitalized after previous attempts to quit drinking will face a risk with another attempt to do so.
Withdrawal Anxiety or Anxiety Disorder?
At this point, things might get tricky. Anxiety and heavy drinking often go hand in hand, and people do not have a clear line between them. It makes it hard to differentiate if the person is experiencing withdrawal symptoms or persistent symptoms that have existed prior.
Timing may, however, provide some insight, although it should not be seen as a diagnostic criterion. Anxiety symptoms occurring within a few hours after the last drink and fading within days or weeks are thought to be due to withdrawal, but withdrawal symptoms vary widely in their sequence and duration. In contrast, anxiety symptoms appearing before the onset of drinking or that linger long after withdrawal is over may point to something other than withdrawal as the underlying issue.
A psychiatrist can help understand this situation after the acute withdrawal is addressed. Alcohol addiction is often self-medication for underlying mental health conditions. Reputable providers such as GABA Telepsychiatry are very experienced in treating alcohol addiction and its causes. Seeing a psychiatrist for anxiety or depression greatly reduces the risk of relapse.
Is It Safe to Stop Drinking at Home?
That isn’t something a person can reliably judge on their own. The decision depends on a clinical assessment before stopping, which looks at drinking history, past withdrawal, other health conditions, and current symptoms.
For certain people, outpatient management can be an option. The NCBI review notes that mild withdrawal without added risk factors may be managed outside a hospital with a support person present, and MedlinePlus describes someone staying with the person plus daily provider visits until symptoms settle.
A support person on their own doesn’t make withdrawal safe, though. The arrangement works only when a clinician has judged it appropriate and is monitoring progress.
If the symptoms are from moderate to severe, the authors of the study recommend inpatient treatment with frequent monitoring, while outpatient treatment is only for those whose symptoms are mild and who have no additional risk factors. This entails the use of either a hospital or some sort of supervised medical alcohol detox center where the treatment staff can observe the symptoms every hour of the day and make necessary changes to the treatment. Ultimately, the main thing to be considered is the risk level of a person rather than how much determination they have.
How a Psychiatrist Fits Into Recovery
Withdrawal is considered a medical procedure. It may require various medical steps, including administering medications and monitoring. Alcohol detox is an important part of the process of treating withdrawal. When a patient is considered to be in danger, further considerations must be taken into account. Most of all, they are connected to the psychiatric aspect.
- Why does alcohol perform this function?
- Is there something else going on?
A psychiatric examination should combine all the aspects connected to the problem, including anxiety, depression, sleep disorders, and trauma history. Then a patient can go for a treatment plan, including a therapy session with the proper medications prescribed if needed.
Taking the Next Step
Alcohol withdrawal anxiety is real, and it isn’t a sign of weakness. It is the nervous system reacting to a sudden change. If you’re dependent on alcohol, or the anxiety comes with shaking, confusion, a racing heart that won’t settle, or any history of seizures, treating this medical condition first is a must.
Speaking with a mental health professional specialized in addiction treatment, before you stop, or as soon as symptoms start, gives you a clearer picture of the safest setting. The aim isn’t just getting through the next few days. It’s building a recovery that holds once they’re over.
