Alcohol Withdrawal Symptoms, Timeline & Detox Treatment

Alcohol withdrawal syndrome (AWS) occurs when a person who frequently drinks large amounts of alcohol suddenly stops. The more often a person drinks alcohol, the more likely they are to experience AWS. Alcohol withdrawal symptoms may vary depending on how long a person has been drinking and how much alcohol they drink. Some people may be able to manage alcohol withdrawal symptoms at home, while others may need medical supervision during alcohol detox.

Although alcohol withdrawal symptoms may vary, the alcohol withdrawal timeline remains fairly consistent. Withdrawal symptoms usually start within 24 hours and last for up to seven days. Several factors can affect the alcohol withdrawal timeline. For example, medical conditions such as liver disease can affect how quickly alcohol leaves a person’s body. 

What Happens When You Stop Drinking?

Alcohol is a central nervous system (CNS) depressant. CNS depressants slow brain function by affecting neurotransmitters, which are “chemical messengers” that carry signals from nerve cell to nerve cell. Regular alcohol use causes the body to adjust to changes in neurotransmitters like GABA, glutamate and dopamine. The body increases the amount of excitatory neurotransmitters to balance out the depressant effects of alcohol.

When a person suddenly stops drinking, the chemical balance in the brain is disrupted. Too many excitatory neurotransmitters are present, causing alcohol withdrawal symptoms to occur. People who frequently drink large amounts of alcohol are more at risk of severe, life-threatening withdrawal symptoms.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms can vary in severity depending on a person’s history of alcohol use. Common signs and symptoms of alcohol withdrawal include:

• Anxiety
• Confusion
• Dilated pupils
• Hand and body tremors
• Insomnia
• Irritability
• Nausea
• Rapid heart rate
• Sweating

Individuals with more severe symptoms of alcohol withdrawal may experience:

• Delirium tremens (DT)
• Hallucinations
• Seizures

Alcohol Withdrawal Seizures

Alcohol withdrawal seizures are a sign of severe alcohol withdrawal. An estimated 10% of people with alcohol withdrawal symptoms develop seizures. Alcohol withdrawal seizures are called tonic-clonic seizures. 

People suffering from alcohol withdrawal seizures will be unconscious and experience shaking of the arms and legs. Seizures typically start 24 to 48 hours after a person stops drinking. A person with alcohol withdrawal seizures may experience one seizure, but in extreme cases, they may experience multiple, continuous seizures.

Alcoholic Hallucinosis

Alcoholic hallucinosis can occur as a part of alcohol withdrawal syndrome. People with alcoholic hallucinosis see, hear or feel things that are not there. They are awake and fully aware that they are hallucinating. Hallucinations caused by alcoholic hallucinosis typically start 12 to 24 hours after a person stops drinking and last for 24 to 48 hours.

Delirium Tremens (DTs)

Delirium tremens (DTs) is the most severe symptom of alcohol withdrawal. DTs occur in an estimated 5% of people going through alcohol withdrawal. People suffering from DTs may have symptoms that include:

• Agitation
• Confusion/disorientation
• Excessive sweating
• Hallucinations
• High blood pressure
• Hyperthermia
• Rapid heart rate

DTs are different from alcoholic hallucinosis. The person experiencing DTs is disoriented and unaware that their hallucinations are not real. Someone with DTs may not recognize where they are, what is happening or who they are with, even if they are around close friends or family members. DTs may cause people to act irrationally and in a way that could endanger them. 

DTs typically occur after initial alcohol withdrawal symptoms have started. DTs can begin around 48 and 72 hours after a person stops drinking and may last for five to seven days. People with DTs require medical supervision, and someone who is suspected of having DTs should go to the hospital immediately.

Alcohol Withdrawal Timeline

The alcohol withdrawal timeline starts at the time of your last drink. Typically, how long you will have alcohol withdrawal symptoms and how severe they will be depends on the amount of alcohol you regularly drink. Mild to moderate drinkers (one or fewer drinks per day for women and two or fewer drinks per day for men) will be more likely to experience milder withdrawal symptoms. Those who classify as heavy drinkers will be more likely to experience severe and dangerous symptoms.

6 to 12 Hours After Last Drink

At six hours, minor withdrawal symptoms may start to occur. These symptoms can include:

• Tremors
• Sweating
• Fast heart rate
• Nausea and vomiting
• Anxiety

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 time frame and will lessen in severity after the 24-hour mark. Alcohol withdrawal seizures are more likely to occur during this time frame, although they may begin sooner.

24 through 48 Hours Following Last Drink

Moderate to severe symptoms are likely to appear during this time. Common symptoms during this time frame include: 

• Severe tremors
• Anxiety
• Nausea and vomiting
• Headaches
• Fast heart rate
• Sweating
• Irritability or agitation
• Confusion
• Difficulty sleeping
• Nightmares
• Elevated blood pressure
• Hallucinations
• Seizures

If you have gone 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 are typically temporary. The person going through withdrawals should still be aware of what is happening around them.

48 to 72 Hours Following Last Drink

During this time, delirium tremens (DTs) may occur. DTs are a dangerous condition that usually begins 48 to 72 hours after a person’s last drink. DTs cause severe confusion and hallucinations. A person experiencing DTs is at risk of injuring themselves or those attempting to help them because they are unaware of what is happening.

Beyond 72 Hours After Last Drink

By 72 hours, most of the symptoms of minor withdrawal will be replaced by more severe symptoms. Moderate or severe symptoms will likely peak before or around 72 hours. Those who have not experienced DTs in the earlier stages of withdrawal are still at risk for developing symptoms up to 10 days after alcohol use has been discontinued. Some symptoms should start to subside for those who do not have DTs.

Factors That Affect the Alcohol Withdrawal Timeline

Several factors can affect the alcohol withdrawal timeline and the severity of withdrawal symptoms. These factors may result in a prolonged timeline and more severe withdrawal symptoms:

• Abnormal liver function or liver disease
• Drinking larger amounts of alcohol for a longer time
• History of withdrawal symptoms
• More severe withdrawal symptoms at the start of detox
• Older age
• Other medical conditions
• Previous alcohol detox
• Previous history of seizures or DTs
• Use of other drugs with alcohol (polysubstance abuse)

Protracted Withdrawal Symptoms

Post-acute withdrawal syndrome (PAWS) is a set of impairments that are believed to occur in the weeks or months after alcohol detox. The reported impairments include:

• Cognitive difficulty
• Irritability
• Anxiety or panic
• Depressed mood
• Obsessive-compulsive behaviors
• Difficulty maintaining social relationships
• Alcohol cravings
• Apathy
• Pessimism
• Difficulty sleeping
• Increased stress

PAWS is not a recognized syndrome by the medical community, and there is debate on whether these reported symptoms should be considered potential long-term withdrawal symptoms or not.

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Treatment for Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms can be uncomfortable and even potentially life-threatening at times. While mild withdrawal symptoms can sometimes be managed at home, those who develop more severe withdrawal symptoms during alcohol detox require medical supervision. Depending on the situation, medication-assisted treatment may be necessary to manage severe symptoms like seizures, alcoholic hallucinosis and DTs. 

Some treatment centers, including The Recovery Village Ridgefield, offer medical detox and medication-assisted treatment as part of their rehab services. Medical detox offers 24-hour medical care and helps provide a better chance at recovery. Medical professionals develop individualized detox plans based on the needs of the person struggling with alcohol addiction.

Our licensed, accredited facility offers a full continuum of care to help you through the entire recovery process. From intake to long-term aftercare, our team of addiction specialists and medical professionals can help you on your journey to an alcohol-free life. 

If you or a loved one is struggling with alcohol addiction, The Recovery Village Ridgefield can help. Contact us today to speak with a representative about alcohol addiction treatment programs that can help you begin the path toward lifelong recovery.