Alcohol Withdrawal Timeline
When someone is considering stopping alcohol, they often wonder how long it takes to detox from alcohol and when they should expect withdrawal symptoms to occur. An alcohol withdrawal timeline is different for each person, based on how much alcohol they typically use, how frequently they use alcohol and their overall medical health. The severity of withdrawal symptoms will also vary based on the amount of alcohol typically used. Your previous experience with alcohol detox may give an indication of how severe your withdrawal symptoms will be, but often withdrawal symptoms may be more severe in subsequent detoxes.
Stages of Alcohol Detox and Symptoms
The timeline for alcohol detox symptoms will start at the time of your last drink. The duration of alcohol detox symptoms will differ for each individual and may vary between detoxes for a single person. Typically, the severity and duration of alcohol withdrawal symptoms will be mainly influenced by how much alcohol is normally used. Mild to moderate drinkers (those who have one or less drinks per day for women or two or less drinks a day for men) will be more likely to experience milder withdrawal symptoms, while those who classify as heavy drinkers will be more likely to experience severe and dangerous symptoms.
The First Six Hours
The first six hours after stopping drinking, there will be no symptoms. During this timeframe, the body has not realized that there will not be any more alcohol and has not yet started to respond.
6 to 12 Hours After Last Drink
At six hours, minor withdrawal symptoms may start to occur. These symptoms can include:
- Fast heart rate
- Nausea and vomiting
As these symptoms start there should not be any confusion, disorientation or alcohol withdrawal hallucinations.
Someone who has more severe alcohol withdrawal symptoms may start to have seizures after six hours. If someone has seizures from alcohol withdrawal, emergency medical services should be contacted using 911, and the person should be hospitalized.
12 through 24 Hours Following Last Drink
Minor withdrawal symptoms will typically peak within this timeframe and will lessen in severity after the 24-hour mark. Alcohol withdrawal seizures are more likely to occur during this timeframe, although they may begin sooner.
24 through 48 Hours Following Last Drink
Moderate to severe symptoms are likely to appear during this timeframe. Someone who is going to have moderate to severe symptoms may still have minor symptoms that may appear earlier. Moderate to severe alcohol symptoms may include:
- Severe tremors
- Nausea and vomiting
- Fast heart rate
- Irritability or agitation
- Difficulty sleeping
- Elevated blood pressure
If you have been 48 hours without alcohol withdrawal seizures, it is unlikely that they will start after this time. While confusion and hallucinations may occur with severe withdrawal symptoms, they will typically be transient and the person going through withdrawals will still typically be aware of what is actually going on around them.
48 to 72 Hours Following Last Drink
The most dangerous condition that can occur during alcohol withdrawal is called delirium tremens (DT). DT may begin as soon as 36 hours after the cessation of drinking, but will normally begin within the 48-to-72-hour period. DT causes severe and persistent confusion and hallucinations. Someone with DT may not recognize where they are, what is happening or the people they are with, even if those people are close friends or family members. DT may cause people to act irrationally and in a way that could endanger themselves. While DT only occurs in about one in twenty cases of alcohol withdrawal, it can be fatal. Someone who is suspected of having DT should go to the hospital immediately.
Beyond 72 Hours After Last Drink
DT may occur after 72 hours and may start as long as a week after alcohol use has been discontinued. By 72 hours, most of the symptoms of minor withdrawal will be gone and will be replaced by the more severe symptoms. Moderate or severe symptoms will likely peak before or around 72 hours. Some symptoms should start to subside for those who do not have DT.
Protracted Withdrawal Symptoms
Post-Acute Withdrawal Syndrome (PAWS) is a description of a set of impairments that are reported to occur in the weeks or months after alcohol detox. The impairments that are reported include:
- Cognitive difficulty
- Anxiety or panic
- Depressed mood
- Obsessive-compulsive behaviors
- Difficulty maintaining social relationships
- Craving alcohol
- Difficulty sleeping
- Increased stress
PAWS is not a recognized syndrome by the medical community, and it is somewhat controversial whether these reported impairments are something that should be considered as potential, long-term withdrawal symptoms or not.
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Kattimani, Shivanand; Bharadwaj, Balaji. “Clinical Management of Alcohol Withdrawal: A Systematic Review.” Industrial Psychiatry Journal, 2013. Accessed August 31, 2019.
Legg, Timothy J. “Alcohol Withdrawal Syndrome.” Healthline, April 23, 2018. Accessed August 31, 2019.
Harvard Health Publishing. “Alcohol Withdrawal.” April 2019. Accessed August 31, 2019.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.
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