Alcohol Withdrawal Timeline, Symptoms & Treatment

Article at a Glance

• Alcohol withdrawal occurs when someone whose body has adjusted to alcohol use stops using alcohol.
• Alcohol withdrawal symptoms can start within 12–24 hours after you stop drinking.
• Alcohol withdrawal symptoms range from mild to life-threatening.
• It takes about a week for the physical symptoms of withdrawal to resolve.
• Professional treatment helps people to safely and comfortably stop using alcohol.

What Is Alcohol Withdrawal?

Alcohol withdrawal is characterized by a predictable set of symptoms that occur over several days to weeks. Learn why some symptoms last longer than others.

Alcohol is one of the most popular recreational drugs in the U.S. An estimated 15.1 million adults live with alcohol use disorder. People who have developed a dependence on alcohol experience uncomfortable physical and psychological symptoms when they discontinue alcohol use, which characterize alcohol withdrawal syndrome. Extreme cases of alcohol withdrawal can be fatal. People with moderate to severe alcohol use disorders should only undergo detox and withdrawal under the supervision of medical professionals.

Related Topic: Alcohol Use Disorder

Among the effects of alcohol abuse is the development of alcohol tolerance, meaning that ever-increasing amounts of alcohol are required to achieve the desired effect. If chronic alcohol use continues, physical withdrawal symptoms will occur when alcohol use is stopped. Symptoms and signs of alcohol dependence include an inability to stop drinking without physical and psychological symptoms, including trembling, nausea or vomiting and intense cravings that go away when alcohol consumption is resumed.

The alcohol withdrawal timeline is generally predictable and includes consistent signs and symptoms. Withdrawal symptom severity correlates with the degree of alcohol dependence.

What Causes Alcohol Withdrawal?

Chronic excessive alcohol use causes chemical changes in the brain, most notably to the inhibitory neurotransmitter GABA and the excitatory neurotransmitter NMDA. These changes lead to increased levels of dopamine, which drives addiction. If the brain adapts to these changes, a sudden absence of alcohol will cause physical and psychological signs and symptoms that are complications of alcohol withdrawal.

How Long Does Alcohol Stay In Your System?

Unlike many other drugs of abuse, the half-life of alcohol depends on the amount consumed. The more you drink, the longer it will stay in your system. This reaction is because the liver metabolizes alcohol at a constant rate of about one standard drink per hour and a half. If you have two drinks over 30 minutes, the liver will spend the next two and a half hours metabolizing them. If you continue to drink, additional alcohol will remain in your bloodstream until the liver can metabolize it.

Because of the constant metabolic rate of alcohol, there are no truly effective ways to sober up from alcohol quickly. Alcohol is rapidly transferred from the gastrointestinal system into the bloodstream, so even vomiting is unlikely to substantially change the intoxication level. Commonly cited remedies for drunkenness include drinking caffeine or taking a cold shower. While these may cause modest, transient changes in mental state and marginally increase alertness, they cannot address the root cause of intoxication, which is the accumulation of alcohol in the bloodstream.

Alcohol Withdrawal Symptoms

Even moderate alcohol consumption can cause the brain to adapt to the constant presence of alcohol. Withdrawal occurs when alcohol is suddenly unavailable, and the brain cannot maintain alcohol-induced changes in function.

Mild Alcohol Withdrawal Symptoms

• Approximately six to eight hours after the last drink, someone with alcohol dependence will begin to experience mild withdrawal symptoms that can include:
• Headache
• Irritability and anger 
• Anxiety 
• Cravings 
• Tremors 
• Insomnia 
• Restlessness 
• Nausea 
• Vivid dreams and nightmares 

Moderate Alcohol Withdrawal Symptoms

In addition to the symptoms of mild alcohol withdrawal, moderate withdrawal symptoms set in around 24 hours after the last drink and often include:

• Profuse sweating 
• Low-grade fever 
• Pronounced trembling 
• Vomiting or diarrhea 
• Rapid breathing 
• Rapid heart rate 
• Psychomotor agitation (repetitive, purposeless motions) 
• Increased anxiety and emotional stress 

Severe Alcohol Withdrawal Symptoms

Severe alcohol withdrawal symptoms include those listed for mild and moderate withdrawal but may also include dangerous symptoms, such as:

• Respiratory depression
• Seizures
• Delirium tremens (DTs)
• Severe alcohol withdrawal can be fatal. It is important that people with serious alcohol use disorders seek medical care before they undergo detox and withdrawal.

Delirium tremens (DTs)

DTs is a severe complication of alcohol withdrawal that is fatal up to 37% of the time without medical treatment. Anyone who may develop DTs should always be hospitalized due to the extreme risks associated with this condition. DTs can cause hallucinations, seizures, psychosis and vital sign changes that can be fatal if untreated.

Related Topic: Alcohol and Depression

People who undergo medically assisted detox may be candidates to receive prescription alcohol withdrawal medication that can mitigate their symptom severity and significantly reduce the chance that alcohol withdrawal-induced seizures will occur.

Alcohol Withdrawal Timeline

Mild, moderate and severe alcohol withdrawal duration can vary to some degree between individuals, but for the most part, the symptoms are reliable and consistent. Symptom onset is generally about six to eight hours after the last drink. Mild and moderate withdrawal symptoms peak around 72 hours after the last drink and acute withdrawal symptoms often resolve within about one week. However, severe withdrawal has a prolonged timeline and may include incredibly dangerous, even lethal, symptoms.

Even after the resolution of acute withdrawal symptoms, some people may experience fluctuating withdrawal symptoms for weeks, months or even years after their last drink. This phenomenon is called post-acute withdrawal syndrome (PAWS) and can be frustrating to manage. It is important that people in recovery understand that PAWS is normal and that the symptoms will subside as time goes on.

A Day-By-Day Alcohol Withdrawal Timeline

Although there is some individual variability, a general timeline of alcohol withdrawal involves:

First 24 Hours

Early symptom onset occurs six to eight hours after the last drink, including cravings, irritability, trembling, nausea and vomiting. People with severe withdrawal may experience seizures during the first day of withdrawal.

Day 2

Symptoms will become more uncomfortable. More severe symptoms like low-grade fever and pronounced trembling will set in. Severe withdrawal-associated seizure activity and DT-induced confusion or hallucinations may occur if severe symptoms occur.

Day 3

Moderate and severe symptoms will persist, peaking about this point. Severe DT-associated symptoms continue to develop if severe withdrawal is present, potentially peaking around this point.

Day 4

The peak of withdrawal is likely past by this point, and the severe symptoms begin to subside. Fatigue may be more pronounced as symptoms begin to fade.

Day 5

Moderate symptoms may subside. Severe withdrawal symptoms will likely be gone except for in extreme cases.

Day 6

Only mild symptoms should be present by this point, with all symptoms gradually subsiding in intensity.

After one week

Symptoms should be largely resolved by day seven, except in extreme situations. Psychological symptoms like cravings may become more noticeable as physical symptoms subside.

Factors Impacting Alcohol Withdrawal

While the most significant factor affecting alcohol withdrawal is the degree of alcohol dependence, other factors can contribute to withdrawal.

Factors that may lessen withdrawal severity include:

• Healthy diet
• Regular exercise
• Younger age (if dependence was established after adolescence)
• Good baseline health

Factors that may increase withdrawal severity include:

• Poor diet
• Lack of exercise
• Mental health disorders
• Alcohol dependence that began during adolescence
• Immune system dysfunction or other diseases

Related Topic: Alcohol Withdrawal

How To Cope With Alcohol Withdrawal

Alcohol withdrawal is an uncomfortable process, even in the best of cases, and there are no shortcuts or reliable home remedies for alcohol withdrawal. People with mild dependence may be able to somewhat lessen the severity of their withdrawal symptoms during home detox using the following tips:

• Stay hydrated.
• Maintain an appropriate electrolyte balance by sipping a sports drink.
• Try to eat healthy foods. If you cannot eat, drink soup or broth.
• Enlist a trusted friend or family member to check on you regularly.
• If possible, lightly exercising or walking can help with symptoms, including alcohol withdrawal insomnia.

It is important to remember that even if it may be possible to detox at home safely, you should always consult a doctor before trying to stop alcohol on your own.

Possible Treatments for Alcohol Withdrawal

Treatment for alcohol withdrawal is often symptomatic, where symptoms are treated as they develop. The specific treatments needed will vary based on the individual but can include:

• Benzodiazepines: These commonly used medications during withdrawal can help reduce the severity of withdrawal symptoms and prevent complications like seizures.
• Anticonvulsants: Some people in withdrawal might be given anticonvulsants to help stabilize their nervous system and prevent seizures.
• Beta-blockers: Medications such as propranolol or atenolol can help reduce some withdrawal symptoms like tremors, anxiety and rapid heart rate, but they do not prevent seizures.
• Antipsychotics: In cases where people experience severe agitation or hallucinations, medications like haloperidol may be used.
• Vitamin and nutrient supplementation: Chronic alcohol use can lead to nutritional deficiencies. Thiamine (Vitamin B1) is often given to prevent Wernicke-Korsakoff syndrome, a serious neurologic disorder caused by thiamine deficiency.
• Hydration and electrolytes: Alcohol withdrawal can lead to dehydration and electrolyte imbalances. Intravenous fluids may be given to restore hydration and correct these imbalances.

It’s important to remember that alcohol withdrawal can be life-threatening, and medical supervision is crucial during the detoxification process. Always consult a healthcare professional about the best treatment options for alcohol withdrawal.

When Professional Detox Is Needed

Regular excessive alcohol consumption rapidly produces physical dependence that can be challenging to overcome. Detox and withdrawal can be dangerous, even for people with mild or moderate dependence. To ensure safe detox and withdrawal, an assessment with a rehab professional should be sought before the detox begins.

Alcohol withdrawal delirium is associated with confusion and hallucinations. People experiencing these symptoms may not be able to seek medical help. If you or someone you know has a serious alcohol use disorder, quitting cold turkey without professional oversight can be dangerous, even lethal. By some estimates, up to 37% of untreated delirium tremens can be fatal. When appropriate, medically assisted detox can provide pharmacotherapies that attenuate the severity of withdrawal symptoms.

Related Topic: Ativan and Alcohol Detox

Where To Find Help in South Florida

There are several South Florida medical alcohol detox centers, but they are not all alike. When you are evaluating rehab facilities, look for experienced teams that provide multidisciplinary care and evidence-based treatment strategies to allow you to detox from alcohol safely. Rehab centers that can provide quality care during every stage of recovery, from the initial assessment to aftercare programs that support long-term recovery, provide the most reliable way to overcome an alcohol use disorder and maintain long-term sobriety.

Contact The Recovery Village at Baptist Health to speak with a Recovery Advocate about how professional treatment can address an alcohol use disorder and any co-occurring mental health conditions. You deserve a healthier future; call today.