Excessive drinking is a consistent problem in the United States. Alcohol is legal for adults ages 21 years and older, and it is part of normal socializing for many individuals. The majority of people have, at one time or another, had too much to drink and woken up with a hangover. Problem drinking, including heavy drinking, binge drinking, and alcohol use disorders, contributes to about 88,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC).

How can a person know when they develop a problem with alcohol? One of the ways for a person to determine if they need help overcoming an alcohol use disorder is if they experience withdrawal symptoms and cravings when they attempt to stop drinking regularly. But what is alcohol withdrawal? Is it the same as a hangover?

A Hangover from Too Much Alcohol

Although feeling terrible after drinking too much is a commonly reported phenomenon with clear physical effects, the actual cause of a hangover is not understood completely by scientists. Hangover symptoms persist even when all alcohol has been eliminated from the body. Currently, symptoms are believed to be caused by a combination of dehydration and toxic byproducts produced as the liver metabolizes alcohol. Hormone disruption could be a factor in mood as well.

Symptoms

After a night of heavy drinking, a person may experience hangover symptoms, including:

  • Thirst
  • Headache
  • Muscle aches
  • Nausea, vomiting, or stomach pain
  • Reduced appetite
  • Poor quality sleep
  • Fatigue or exhaustion
  • Dizziness
  • Sensitivity to light, sound, or touch
  • Shaking or tremors
  • Reduced ability to think or concentrate
  • Rapid heart rate
  • Depression, anxiety, or irritability

Causes

There is no clear process behind an alcohol hangover; however, medical researchers have theories about how the body develops a hangover. They believe that a combination of problems leads to hangover symptoms. Some of these are outlined below:

  • Stimulation of the kidneys leads to increased urine production, which leads to dehydration.
  • The immune system attacks parts of the body due to an inflammation response.
  • The stomach produces more acid to digest food that isn’t really there, leading to irritated stomach and intestines.
  • Reduced blood sugar and thiamine levels can reduce memory, cognition, and neurotransmitters, which can lead to difficulty thinking, trouble remembering what happened the night before, and mood swings.
  • Expanded blood vessels can cause headaches.
  • Chemicals called congeners are part of the flavoring in alcohol, and they can contribute to toxicity in the body that leads to a hangover.

Treatment

There are no prescription medications to treat hangovers since the symptoms last about one day and dissipate over the course of the day. Experiencing a hangover is akin to experiencing a stomach flu or a cold, so most of the remedies involve relieving symptoms with comfort foods, vitamins, and over-the-counter medications. Frequently cited remedies include:

  • Over-the-counter pain relievers like ibuprofen or Tylenol, as well as over-the-counter anti-nausea medication like Alka-Seltzer
  • High-vitamin liquids like tomato juice or orange juice, depending on stomach irritation
  • Foods high in carbohydrates and protein, such as toast, eggs, meat, fish, yogurt, potatoes, and fruit (Many people opt for the proverbial “greasy breakfast” to cure a hangover, which includes bacon, eggs, potato hash, cheese, and more.)
  • Water to stay hydrated
  • Small amounts of coffee to open blood vessels in the body and brain
  • Gentle exercise, such as stretching and walking
  • A bath or shower to relax muscles
  • Sleep
Vs.

Alcohol Withdrawal

When a person struggles with drinking too much on a regular basis, especially if they are unable to stop, they may have developed an alcohol use disorder. Attempting to stop this addiction can lead to alcohol withdrawal syndrome, which is a cluster of physical symptoms as the body attempts to regulate itself without the influence of alcohol. This condition can be physically dangerous. To successfully detox from alcohol without putting oneself at risk of relapse or delirium tremens, it is important to work with a medical professional.

Symptoms

Alcohol withdrawal symptoms can present in a few different ways. Common, uncomfortable but not dangerous symptoms include:

  • Anxiety, irritability, or mood swings
  • Depression
  • Jumpiness
  • Shaking, tremors, or weakness
  • Not thinking clearly
  • Fatigue or exhaustion
  • Nightmares
  • Insomnia

These symptoms may appear similar to a hangover, although they will persist much longer than 24 hours. Additionally, a person experiencing alcohol withdrawal syndrome may develop symptoms like:

  • Pallor
  • Clammy skin
  • Headache
  • Loss of appetite
  • Nausea
  • Vomiting
  • Rapid heartbeat
  • Sweating

These symptoms can last up to two weeks, and overall, they feel like a strong flu. However, people who drank consistently high volumes of alcohol or who struggled with alcohol use disorder for a long time are at risk of developing delirium tremens. This is an increase in the severity of withdrawal symptoms, as well as dangerous symptoms like:

  • Agitation
  • Delirium
  • Hallucinations
  • Severe confusion
  • Fever
  • Seizures

Causes

The symptoms of alcohol withdrawal are caused by the brain’s and body’s dependence on, and tolerance to, alcohol’s presence in the system. Without alcohol, brain and body chemistry must normalize on its own, and that can lead to symptoms as the body attempts to recover routine processes. For example, the neurotransmitter gamma-aminobutyric acid (GABA) is suppressed by alcohol when a person drinks regularly. As the neurotransmitter is able to be absorbed by neuron receptors more readily, the brain becomes excited. This can lead to anxiety, panic attacks, agitation, paranoia, and seizures.

The neurotransmitter glutamate is also suppressed by the presence of alcohol when a person drinks heavily and consistently. When alcohol is no longer present, glutamate can cause excitability and irritability. Changes in other neurotransmitters affect mood, visual processing, and memory. The structures of the brain may also have been damaged due to consistent changes in brain chemistry over a long period of time, so a person ending their struggle with an alcohol use disorder may have cognitive difficulties or personality changes that persist after detox.

Treatment

The most common and effective treatment to assist in detoxing from alcohol is a benzodiazepine taper. Many clinicians will prescribe a long-acting benzodiazepine like diazepam (Valium) to maintain processing of the GABA neurotransmitter. The doctor will then work with the patient to taper the benzodiazepine dose; this helps to reduce withdrawal symptoms, especially anxiety and insomnia, and it has the added benefit of preventing seizures. The taper allows the individual’s body to slowly adjust to working without the presence of alcohol.

In some cases, a person may receive a prescription for an antidepressant or an antipsychotic medication, which can improve mood while the individual enters rehabilitation to overcome the addiction.

Do You Want to Stop Drinking?

Very Different Conditions

While both a hangover and alcohol withdrawal involve the body’s reaction to alcohol in some capacity, these conditions are ultimately very different. Anyone who drinks too much for their specific physiology may experience a hangover; however, a person who struggles with an alcohol use disorder will experience withdrawal when they attempt to stop drinking, and those symptoms are due to the lack of alcohol in the body, not the residual presence of it.

A 2010 study investigating the link between hangovers and alcohol use disorder found that, in some instances, experiencing a hangover was a deterrent to drinking; in others, the low mood and other side effects associated with a hangover propelled the person to drink more when they felt up to it. This could create a cycle of abuse in order to avoid experiencing hangovers. Ultimately, people who drink heavily, or develop alcohol use disorders, are not exempt from experiencing hangovers; the issue is when the person needs alcohol to feel normal or to feel like they can perform daily functions.

The symptoms of a hangover resemble some of the less dangerous symptoms of alcohol withdrawal, but duration and intensity are different. A hangover lasts for one day, with cognitive and motor difficulties perhaps lasting into a second day. Alcohol withdrawal lasts for about two weeks, or longer in some cases, like other types of drug withdrawal. Unlike a hangover, alcohol withdrawal is physically dangerous, and relapse can lead to alcohol poisoning and death.