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Understanding Alcohol Withdrawal Timing Symptoms and Treatments

May 15, 20243 min read

Navigating the Complexities of Alcohol Withdrawal with Experts


In the latest enlightening episode of Cracking Addiction, Dr. Ferghal Armstrong and his guest, Dr. Richard Bradlow, delve deep into the intricacies of alcohol withdrawal. Their discussion offers vital insights into the timing, symptoms, and management of alcohol withdrawal, offering hope and guidance for those affected by alcohol use disorder. This blog post unpacks their expert analysis and advice, aiming to enhance understanding and provide practical solutions for managing withdrawal.

"Why we treat alcohol withdrawal is because untreated alcohol withdrawal can result in death". Dr Richard Bradlow

When Does Alcohol Withdrawal Begin?

According to Dr. Bradlow, alcohol withdrawal symptoms can appear as early as the first day of ceasing alcohol intake, typically referred to as "day two" in clinical terms. The initial 24 hours are crucial as the body begins to react to the absence of alcohol. Dr. Armstrong adds that in severe cases, symptoms might manifest within just 12 hours. This variation underscores the personalized nature of alcohol withdrawal, emphasizing the need for tailored medical approaches.

Recognising the Symptoms of Alcohol Withdrawal

Most individuals experience mild to moderate symptoms, but certain factors can precipitate severe complications. Common symptoms include tremors, anxiety, sweating, and increased heart rate. Dr. Bradlow and Dr. Armstrong discuss the critical point that severe symptoms such as seizures can occur even when alcohol is still present in the bloodstream, particularly if the blood alcohol content (BAC) decreases but hasn't fully cleared.

Managing Alcohol Withdrawal: Why and How?

The primary reason for treating alcohol withdrawal is to prevent potentially fatal outcomes. Dr. Bradlow explains the concept of "kindling" in neurological terms, where repeated alcohol withdrawal episodes make future withdrawals increasingly severe, possibly leading to seizures. By using medications like diazepam, doctors aim to moderate the brain's excessive neuronal activity during withdrawal, thus reducing the risk of severe complications and easing the transition out of dependency.

The Risk of Complicated Alcohol Withdrawal

Dr. Armstrong presents statistics suggesting around 10% of people who engage in heavy drinking might face complicated withdrawal. Risk factors include previous withdrawal complications and multiple substance dependencies. Addressing these risks early and understanding individual patient histories are critical for preventing severe outcomes.

Understanding Complications: Seizures and Delirium Tremens

The episode starkly highlights the most feared complications of alcohol withdrawal – seizures and Delirium Tremens. Seizures usually occur within the first 48 hours and require immediate medical attention. Delirium Tremens, marked by severe agitation and confusion, can follow and is potentially life-threatening. Both Dr. Armstrong and Dr. Bradlow stress the importance of rapid and effective treatment, including the review and adjustment of benzodiazepine dosages and supportive care in medical environments.


Dr. Ferghal Armstrong and Dr. Richard Bradlow's discussion in Cracking Addiction underlines the complexity and urgency of effectively managing alcohol withdrawal. By offering a deep dive into the timings, symptoms, and necessary medical responses, they provide a crucial educational resource for healthcare providers and those struggling with alcohol use disorder. Timely and personalized medical care is essential to mitigate risks and ensure recovery, highlighting the importance of specialized knowledge and patient-centered care in addiction treatment.

Remember, if you or someone you know is struggling with alcohol dependence, professional medical help is crucial. The journey to recovery is challenging but achievable with the right support and medical care.

Watch the episode below.

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