Chills, Stomach Pain, And Alcohol Withdrawal: What's The Link?

Alcohol withdrawal syndrome is a range of symptoms that can occur when a person with alcohol use disorder stops or significantly decreases their alcohol intake. The symptoms can range from mild to severe, with the most severe being life-threatening. Withdrawal symptoms are a sign of alcohol dependence, and they can cause physical and emotional stress, leading to discomfort and pain. So, are chills and stomach pain signs of alcohol withdrawal?

Alcohol withdrawal symptoms and causes

Alcohol withdrawal syndrome can pose a significant clinical challenge and affect a substantial portion of the population. The severity and length of alcohol withdrawal vary from person to person, but a general timeline can be observed. Within 6 to 12 hours of the last drink, mild symptoms such as headache, mild anxiety, and insomnia may appear. Within 24 hours, more serious symptoms like hallucinations can occur, and the risk of seizures is highest within the first 48 hours. Delirium tremens may appear between 48 to 72 hours after the last drink, and symptoms can continue for several days, with the highest intensity occurring around four to five days post-alcohol consumption. It is important to note that not everyone experiences alcohol withdrawal in the same way, and some people may experience prolonged withdrawal symptoms like insomnia and mood changes that can last for weeks or even months.

The causes of alcohol withdrawal symptoms are related to the body's physical and emotional stress response when someone stops drinking. Alcohol has a depressive effect on the central nervous system (CNS), slowing down brain function and altering nerve signalling. With prolonged heavy alcohol use, the CNS adjusts to the presence of alcohol. When alcohol consumption suddenly stops or is significantly reduced, the CNS becomes overexcited, leading to an overload of activity and resulting in withdrawal symptoms. This can include gastrointestinal discomfort, such as stomach aches, nausea, and vomiting, as well as muscle aches and pains.

Long-term alcohol use can also cause damage to the body, including liver disease and brain shrinkage. Additionally, alcohol can damage the lining of the gastrointestinal tract, leading to diarrhea. Other health complications that may arise include dehydration, electrolyte imbalances, liver function issues, heart problems, and gastrointestinal bleeding. It is crucial to seek medical attention if concerning symptoms of alcohol withdrawal occur, as severe presentations can lead to life-threatening complications requiring urgent intervention.

The prognosis and treatment of alcohol withdrawal syndrome depend on its severity and the promptness of treatment initiation. An integrated model of care involving physicians, nurses, pharmacists, and other professionals is beneficial for managing Alcohol Use Disorder (AUD) and its complications. Treatment settings can vary, including emergency rooms, outpatient clinics, intensive care units, or detoxification facilities. Treatment often includes medication and therapy, and planning ahead for potential relapses is essential. Tapering alcohol consumption slowly over weeks or months is another approach to help manage heavy alcohol use, although withdrawal symptoms may still occur during this process.

How to treat alcohol withdrawal

Alcohol withdrawal can be extremely uncomfortable and even fatal in some cases, so it is important to seek professional help and create a tailored treatment plan. The first step is to consult a healthcare professional to assess the severity of your withdrawal symptoms and the need for treatment. This can be done using the Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar).

If you are experiencing mild alcohol withdrawal symptoms, such as aches and pains, anxiety, tiredness, nausea, or vomiting, this can often be managed at home with a quiet, supportive environment, reorientation, and one-to-one contact. It is important to stay hydrated, eat healthily, and get plenty of rest. Techniques such as mindfulness, meditation, and gentle exercise can also help to alleviate stress and keep your mind occupied during withdrawal. However, it is crucial to have continuous monitoring and access to medical care as symptoms can quickly escalate.

For more severe alcohol withdrawal symptoms, pharmacologic treatment is usually required. Benzodiazepines are the drugs of choice for pharmacologic treatment and can be used to safely replace the alcohol-depressant effects on the CNS. Multiple randomized controlled trials have shown the superiority of benzodiazepines to placebo in the treatment of alcohol withdrawal. Other medications might include anticonvulsants, anti-nausea drugs, and sleep aids, depending on individual symptoms and medical history.

The key to successful withdrawal is to consult with an addiction treatment professional ahead of detox to understand the alcohol withdrawal timeline and detox strategies, like how to taper off alcohol. A medically supervised alcohol detox is the safest way to detox from alcohol as it allows for quick treatment and the use of effective IV medications that cannot be used at home.

The timeline of withdrawal

The timeline of alcohol withdrawal varies from person to person, but symptoms typically begin within the first eight hours after the last drink, peak at 12–72 hours, and ease off within 72 hours. However, some people can experience withdrawal symptoms for several weeks or months after their last drink, known as post-acute withdrawal syndrome.

Within the first six to 12 hours after the last drink, mild symptoms of alcohol withdrawal typically appear. These may include anxiety, headaches, nausea, and mild tremors. Some people may also experience tightness in the muscles or restless legs.

Between 12 and 48 hours after the last drink, symptoms may worsen, and new, more severe symptoms may develop. These can include vomiting, confusion, an elevated heart rate, increased blood pressure, seizures, and hallucinations.

At the 48- to 72-hour mark, the risk of delirium tremens (DTs) peaks. DTs are a severe form of alcohol withdrawal that can be life-threatening. Symptoms of DTs include severe confusion, fever, and seizures.

After 72 hours, the worst of the symptoms typically wear off. However, it is important to note that some people may still experience mild to moderate symptoms such as cravings for alcohol, irritability, and insomnia. These symptoms will resolve in time as long as the person remains alcohol-free.

Alcohol withdrawal and heart problems

Alcohol withdrawal can indeed lead to heart problems, including heart failure. Alcohol withdrawal syndrome can cause a racing heart, seizures, disorientation, and severe anxiety, and it has a 5-10% mortality rate.

Alcohol-induced cardiomyopathy is a condition that occurs when heavy alcohol use causes the heart to change shape, leading to long-term damage and heart failure. The heart stretches and enlarges, disrupting the timing of its beats and causing a condition called dyssynchrony. This can lead to arrhythmias or irregular heart rhythms, which can be life-threatening.

Drinking large quantities of alcohol in a short period can also have toxic effects on the heart muscle, leading to a disruption in heart rhythm called fibrillation. This is when the chambers of the heart try to beat so quickly that they only twitch or quiver.

It is dangerous for alcoholics to quit drinking abruptly or "cold turkey." Instead, experts recommend that people with substance abuse problems enter a treatment program where they can taper their alcohol use under medical supervision. Supportive care during withdrawal is essential as some symptoms can be severe or even life-threatening.

Alcohol withdrawal and mental health

Alcohol withdrawal can cause both physical and emotional stress. The body's natural chemical balance may be disturbed by alcohol use, resulting in mental health issues such as anxiety, restlessness, and trouble sleeping when an individual stops drinking.

Alcohol withdrawal symptoms can range from mild to severe and sometimes life-threatening. They can include aches and pains in the muscles, lack of energy, tightness in the muscles, and restless legs. Other symptoms include nausea, vomiting, and heart problems.

Treatment for alcohol withdrawal aims to manage withdrawal symptoms and prevent complications. Doctors may prescribe medications such as benzodiazepines, barbiturates, beta-blockers, or clonidine, especially for moderate to severe withdrawal, to reduce the risk of seizures and delirium tremens. Additionally, individuals may benefit from anger management classes, nutrition advice, and counseling to address underlying mental health issues and past traumas. Support groups and family therapy can also provide emotional support during recovery.

It is essential to seek medical help and monitor symptoms closely, as severe alcohol withdrawal may require hospitalization, sometimes in the ICU. Healthcare providers will assess an individual's overall health and recommend treatments for related health issues, such as dehydration and electrolyte imbalances.

If you or someone you know is experiencing alcohol withdrawal, various resources are available to help. SAMHSA's National Helpline offers free and confidential treatment referrals and information for individuals and families facing mental health and substance use disorders.

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