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Alcohol Withdrawal: Symptoms and Timeline

Read on to learn more about the signs and symptoms of alcohol withdrawal, as well as alcohol withdrawal timeline and how it can be treated.

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Alcohol withdrawal can occur when someone who has used alcohol heavily for an extended period of time stops using it or significantly reduces their drinking.1The symptoms of alcohol withdrawal typically start a few hours to a few days after the last use of alcohol.1Alcohol withdrawal symptoms can vary widely in intensity, from mild and moderate to severe.3 Severe symptoms occur in less than 10% of people who undergo alcohol withdrawal, but can be especially damaging, and possibly even life-threatening.2 Understanding what the symptoms of alcohol withdrawal are and what a general timeline for the process looks like can help you be prepared for detox, the first step in recovery from alcohol use disorder.2

What Is Alcohol Withdrawal?

Alcohol withdrawal is a condition that results from the abrupt cessation or reduction of alcohol use, especially after prolonged and heavy drinking.1 Alcohol withdrawal symptoms can range from mildly uncomfortable to severe and potentially life-threatening. Around 50% of people with an alcohol use disorder (AUD) will develop some symptoms of alcohol withdrawal.5 However, it is difficult to predict who will have alcohol withdrawal symptoms and who will not. There are some cases where a person with a long-term, heavy pattern of drinking will develop seizures and other serious outcomes during withdrawal and some people with a severe AUD may show only a few mild symptoms.2

Generally, certain factors do influence the likelihood of alcohol withdrawal symptoms and their severity, including:1; 2

  • How many prior episodes of alcohol withdrawal a person has been through.
  • What alcohol withdrawal symptoms were present during the person’s last withdrawal. The severity of symptoms in future withdrawal episodes often masks
  • Withdrawal is relatively rare in individuals younger than 30 years old, with risk and severity increasing as age increases.
  • Overall health.
  • Genetics and family history of alcohol withdrawal.
  • Other medical or mental health conditions a person may have.
  • Nutritional deficiencies.
  • The person is dependent upon other sedatives, hypnotic, or anxiolytic drugs.

Causes of Alcohol Withdrawal

Chronic alcohol use can lead to significant alcohol dependence, which builds as a result of certain types of adaptations in the brain. Over time, after the brain has made these adaptations to the regular presence of alcohol, should one slow or stop their use of alcohol abruptly, the balance of certain types of brain cell signaling tips towards a hyper-excitable state.6 With this abnormally elevated excitatory tone in the brain, a person may be at increased risk of seizures and certain other acute alcohol withdrawal symptoms. To put things simply, alcohol withdrawal symptoms are a result of characteristic, but maladaptive changes in brain chemistry.6

Symptoms of Alcohol Withdrawal

Alcohol withdrawal symptoms can vary from person to person, both in terms of what symptoms one experiences and how severe they are.2 Mild to moderate alcohol withdrawal symptoms may include:1,8

  • Anxiety.
  • Insomnia and vivid dreams.
  • Nausea and/or vomiting.
  • Headache.
  • Sweating.
  • Increased pulse and blood pressure.
  • Tremors.
  • Perceptual distortions of sight, sound, and touch.

Life-threatening symptoms indicate severe alcohol withdrawal, which can include the following symptoms:1, 8

  • Hyperthermia.
  • Extreme tremors in the hands and arms.
  • Significantly elevated pulse and blood pressure.
  • Hallucinations (often visual).
  • Agitation.
  • Confusion and disorientation.
  • Seizures.
  • Delirium tremens.

Alcohol Withdrawal Timeline

The timeline for alcohol withdrawal varies, but usually, most people will experience:1; 2, 8

  • A few hours after the first drink a person will usually experience the first signs of alcohol withdrawal. Sometimes symptoms appear as early as 4-6 hours, before the body’s blood alcohol level has returned to zero. This can also take longer, sometimes around or even beyond 24 hours.
  • Symptoms of alcohol withdrawal usually peak on the second day, or two days after the last drink.
  • Seizures, when they occur, usually begin within 8 to 24 hours after the last drink.
  • Delirium tremens, the most severe and potentially life-threatening manifestation of alcohol withdrawal, generally appear 72 to 96 hours after the last drink.
  • By day 4–5, the acute phase is largely over for most people.

Alcohol Withdrawal Medications

When a person goes through alcohol detox, medications may be given to help control or reduce the risk of experiencing certain severe symptoms of alcohol withdrawal. The most commonly used class of medication for alcohol withdrawal is benzodiazepines.2 Benzodiazepines help to control seizures during alcohol withdrawal. 2 Sometimes, people have to be given barbiturates instead of benzodiazepines. Certain anticonvulsants are also used to prevent seizures.2

When someone experiences hallucinations or delirium during alcohol withdrawal, they may also benefit from antipsychotic medications.2 You may have heard of medications that are used to treat alcohol use disorder, such as acamprosate, naltrexone, and disulfiram. While these drugs can help to prevent relapse or a return to drinking alcohol, they are not used during alcohol detox to manage withdrawal symptoms.2

Can You Quit Alcohol Cold Turkey?

It is generally not advisable to quit the regular, heavy use of alcohol abruptly, or “cold turkey,” due to the unpredictable nature of alcohol withdrawal and the potential mortality risk of severe withdrawal symptoms, such as seizures or delirium tremens. 2

As noted earlier, around 50% of people with alcohol use disorder will experience at least some symptoms of alcohol withdrawal, but it can be difficult to predict who will experience symptoms and their severity.5 Seeking the advice of a doctor or  the clinical staff at a medically supervised detox program  can be beneficial, as they can best assess your individual risk.2 There is no need to try to go through an alcohol withdrawal alone or at home, as there are many treatment options available that can assure your safety and maximize your comfort.

Alcohol Withdrawal Treatment

Medical detox programs for alcohol withdrawal can offer you medical oversight and support to help you rid your body of alcohol as well as position you for further treatment if you’re interested in quitting drinking. It is important to note that detox alone is often not sufficient for a person with a moderate to severe alcohol use disorder to achieve sobriety. Medical detox can be thought of simply a first step on your journey through addiction care and into recovery.2 Detox can help you with the medical and psychological support you need during alcohol withdrawal, including helping to control medical complications that threaten your safety, in order to stabilize you for inpatient or outpatient rehab treatment.2

Finding Alcohol Detox Programs

Once you’ve decided to commit to alcohol addiction treatment, you’ll need to find a rehab that offers medical detox. A good first step would be to reach out to your doctor. They can help you determine your medical needs and may be able to refer you to nearby treatment facilities. You may also consider visiting the SAMHSA treatment locator for help finding nearby alcohol detox programs.

Addiction helplines can also connect you with life-saving care. American Addiction Centers (AAC) operates a 24/7 helpline. Our professional staff can answer questions you may have about alcohol detox, help you find a detox facility near you, and help you determine how much of a detox program is covered by your insurance. Don’t delay critical care, call us today at .