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Alcohol Withdrawal and Nightmares

September 6th, 2023


Beginning the journey of recovering from alcohol use disorder can be daunting. Many unknowns exist in the space of recovery, and some are downright scary. As a substance abuse professional, when working with folks considering sobriety, a common fear that is mentioned is having to experience withdrawal. These fears are normal, as withdrawal is often painful and sometimes life-threatening; however, getting to the other side is absolutely worth it.

One way to assuage the fears that come with facing early recovery and withdrawal is being prepared for what can happen. Being prepared will allow the person seeking recovery and their support systems to know what to expect and when and how to seek expert support if needed. Common symptoms of acute withdrawal and post-acute withdrawal for alcohol use disorder and tools to manage these symptoms can be found below.

Why does Withdrawal Happen?

Alcohol withdrawal happens due to the complex impact that alcohol has on our brains and bodies. A less severe withdrawal experience, like a hangover, happens due to dehydration, irritation to the stomach lining, and the body’s adjustments to how alcohol interacts with various bodily systems. Hangovers are like a mini-withdrawal that can last for 24 to 48 hours.

A more typical withdrawal experience occurs in people with a long-term and excessive history of alcohol consumption. This type of alcohol consumption disrupts typical brain activity and impacts the balance between excitatory and inhibitory neurotransmitters like glutamate and GABA respectively. The brain becomes accustomed to this disruption, so if alcohol use stops, the brain will go into a hyper-aroused state to compensate for its adjustments.

What to Expect During Acute Withdrawal from Alcohol

What to Expect During Acute Withdrawal from Alcohol

Acute withdrawal occurs when someone has initially stopped consuming alcohol after prolonged use and is “sobering up.” Withdrawal occurs in three potential stages (though not everyone will experience all three stages).

  • Stage 1: This stage is mild in relation to the other two stages of withdrawal. Stage 1 symptoms include headaches, anxiety, insomnia, hand tremors, gastrointestinal issues, and heart palpitations.
  • Stage 2: This stage of withdrawal is more moderate, and symptoms include: increased heart rate and blood pressure, increased body temperature, rapid abnormal breathing, and confusion.
  • Stage 3: This stage of withdrawal is the most severe and includes the symptoms from stage 2. Additionally, someone in stage 3 of withdrawal may experience hallucinations, seizures, impaired attention, and disorientation.

Each person’s process through the stages of withdrawal will look different depending on that person’s body and mental health composition. If someone tries to detox from alcohol without the support of a trained healthcare professional, they will likely move from stage 2 to stage 3 of withdrawal quickly and are at a higher risk of death or injury. If you plan to detox from alcohol, it is safest to do so under the care of a professional.

How to Treat Acute Withdrawal Symptoms

How to Treat Acute Withdrawal Symptoms

As said before, the safest way to treat acute alcohol withdrawal symptoms is under the care of a trained healthcare professional. Medical detox is typically facilitated at a treatment center for substance abuse or a hospital. While engaging in medical detoxification, patients may receive benzodiazepines to help prevent moderate withdrawal symptoms from progressing to severe. Patients may also be prescribed other medications, vitamins, and fluids to treat their symptoms.

Medical detox typically takes five to seven days, depending on each person’s experience of withdrawal symptoms. Once someone completes medical detox, it is highly recommended that they engage in treatment to support their continuing sobriety and to manage any experience of post-acute withdrawal syndrome (PAWS).

What is Post-Acute Withdrawal Syndrome (PAWS)?

PAWS refers to the lingering impacts of substance abuse and addiction after acute withdrawal has occurred and the brain continues to recalibrate. While acute withdrawal symptoms tend to be more physical, symptoms of PAWS tend to be more emotional and psychological. Additionally, these symptoms can last anywhere from a few weeks to a few months and do not always occur immediately after acute withdrawal.

Awareness of PAWS is highly important as PAWS is often a driving force behind relapses to use. Knowing what to expect from PAWS and managing the symptoms of PAWS effectively can help prevent relapse.

What Are Typical Symptoms of PAWS?

While the symptoms of PAWS can vary from person to person, the most common symptoms of PAWS are:

  • Challenges with memory
  • Increased cravings
  • Heightened anxiety
  • Nightmares from alcohol withdrawal or vivid dreams
  • Insomnia
  • Fatigue
  • Mood swings
  • Increased panic
  • Increased depression
  • Challenges with focus
  • Low motivation
  • Challenges with fine motor coordination

These symptoms may show up over the course of a few weeks to a few months, which can feel disheartening for someone in early recovery. Having awareness that these symptoms are a part of early recovery and are temporary can support someone’s continued recovery and can support the avoidance of relapse. That said, awareness is not the only way someone can manage PAWS.

How Can Someone Best Cope with PAWS?

How Can Someone Best Cope with PAWS?

As PAWS can be an ongoing experience, it is important to have support in place to manage it. One way to get support is to engage with therapists and psychiatric providers who are trained in addiction medicine. These providers can support mood and medication management while teaching skills that support PAWS management. Additionally, attending group therapy and other support groups can offer those recovering from PAWS spaces to connect with their peers about their experiences. Other tools for managing PAWS include:

  • Engage in a daily self-care routine, including sleep, nutrition, and daily movement.
  • Limit caffeine intake to manage insomnia.
  • Set reminders and reasonable time limits on activities to support memory and concentration.
  • Utilize a journal to document experiences and track patterns
  • Practice adaptive coping skills to manage mood-related challenges

Most importantly, remember to not rush recovery. Though it may take the brain time to heal, it will eventually heal from the damage that was done while drinking. Most people report a full recovery within a year or two of their last drink, so while these experiences are difficult, they do not last forever.

Every person’s journey of recovery has its own unique challenges, withdrawal, and PAWS being one of them. Know that working through the difficulty of withdrawal will bring you closer to healing, which is truly worth the effort.

*If you or someone is struggling with substance abuse, it’s important that you know you’re not alone. At Clarity Clinic, our early recovery support group can help you effectively navigate these symptoms. The support group offers a safe space to process the experiences that come with early recovery from addiction and learning to live life without substances. This group is facilitated by Sarah Beerman weekly every Thursday from 5 p.m to 6 p.m. Join us.

Written By: Sarah Beerman, LCSW, CADC

Clarity Clinic

At Clarity Clinic, we have highly trained staff who specialize in therapy and psychiatry services. To learn more about how we can support your mental health, call Clarity Clinic at (312) 815-9660 or schedule an appointment today.

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