[1] Symptoms typically include anxiety, shakiness, sweating, vomiting, fast heart rate, and a mild fever.

[1] More severe symptoms may include seizures, and delirium tremens (DTs); which can be fatal in untreated patients.

[3] Alcohol depresses the central nervous system, slowing cerebral messaging and altering the way signals are sent and received.

The drinker eventually must consume alcohol just to avoid the physical cravings and withdrawal symptoms.

[8] Signs and symptoms of alcohol withdrawal occur primarily in the central nervous system.

[2][3] To be classified as alcohol withdrawal syndrome, patients must exhibit at least two of the following symptoms: increased hand tremor, insomnia, nausea or vomiting, transient hallucinations (auditory, visual or tactile), psychomotor agitation, anxiety, generalized tonic–clonic seizures, and autonomic instability.

This occurs in 5–20% of patients experiencing detoxification and one third of untreated cases,[14][13] which is characterized by hallucinations that are indistinguishable from reality, severe confusion, seizures, high blood pressure, and fever that can persist anywhere from 4 to 12 days.

Studies have found that magnesium or trazodone can help treat the persisting withdrawal symptom of insomnia in recovering alcoholics.

Protracted delirium tremens has been reported in the medical literature as a possible but unusual feature of alcohol withdrawal.

Homocysteine levels, which are elevated during chronic drinking, increase even further during the withdrawal state, and may result in excitotoxicity.

[25] Kindling is a phenomenon where repeated alcohol detoxifications leads to an increased severity of the withdrawal syndrome.

[26] Kindling can cause complications and may increase the risk of relapse, alcohol-related brain damage and cognitive deficits.

Thus, the acute withdrawal syndrome appears to be the most important factor in causing damage or impairment to brain function.

[28] People in adolescence who experience repeated withdrawals from binge drinking show impairments of long-term nonverbal memory.

The CIWA has also been shortened (now called the CIWA-Ar), while retaining its validity and reliability, to help assess patients more efficiently due to the life-threatening nature of alcohol withdrawal.

[11] In those with lesser symptoms treatment at home may be possible with daily visits with a health care provider.

[11] Cohort studies have demonstrated that the combination of anticonvulsants and benzodiazepines is more effective than other treatments in reducing alcohol withdrawal scores and shortening the duration of intensive care unit stays.

[34] Benzodiazepines showed a protective benefit against alcohol withdrawal symptoms, in particular seizure, compared to other common methods of treatment.

However, evidence does exist that "symptom-triggered regimens" such as those used when treating with lorazepam, are as safe and effective, but have decreased treatment duration and medication quantity used.

To help to prevent Wernicke syndrome, these individuals should be administered a multivitamin preparation with sufficient quantities of thiamine and folic acid.

During alcohol withdrawal, the prophylactic administration of thiamine, folic acid, and pyridoxine intravenously is recommended before starting any carbohydrate-containing fluids or food.

[42] Paraldehyde combined with chloral hydrate showed superiority over chlordiazepoxide with regard to life-threatening side effects and carbamazepine may have advantages for certain symptoms.

[12] No conclusions can be drawn concerning the efficacy or safety of baclofen for alcohol withdrawal syndrome due to the insufficiency and low quality of the evidence.

Failure to manage the alcohol withdrawal syndrome appropriately can lead to permanent brain damage or death.