Alcohol withdrawal timeline

Quick Overview

Alcohol withdrawal may vary individually, but the timeline can be distilled into three stages:

  • Stage 1: In the first 6-12 hours, users will experience headaches, anxiety, stomach pains and nausea.
  • Stage 2: In the next 12-48 hours, withdrawal escalates to confusion, increased body temperature, heart rate and blood pressure.
  • Stage 3: In that remaining 48-72+ hours, withdrawal symptoms include shakes and seizures, hallucinations, delirium tremens (dts), and even death.

For most people, symptoms generally disappear 7 days after cessation.

The decision to face alcohol dependence is tough, both for the patient and for the families and friends that love them. If you or a loved one are about to begin the journey to sobriety, you might have some questions about alcohol withdrawal.

What causes alcohol withdrawal?

According to the National Library of Medicine (NLM), if a person has been drinking alcohol for a long period of time suddenly stops drinking, the body can experience certain signs and symptoms of withdrawal. This is because alcohol enhances the effect of gamma-aminobutyric acid (GABA) to inhibit and reduce the excitability of the brain. Alcohol cessation results in the brain becoming overexcited since that inhibition is no longer in place.

Who is at risk for alcohol withdrawal?

Not everyone will go through withdrawal in the same way — and some people will experience it less severely than others. You are more likely to go through severe withdrawal if you are an adult who has been drinking heavily and/or for a long period of time and if you have other health conditions already.

What are the signs and symptoms of alcohol withdrawal?

Alcohol stays in your system for a certain amount of time based on your body weight, metabolism, and how many drinks you’ve had. Once you stop drinking, expect to experience certain symptoms, particularly if you are a chronic drinker.

According to the American Academy of Family Physicians (AAFP), there is a typical timeline for withdrawal symptoms:

Stage 1:
6-12 hours after alcohol cessation

Common symptoms include:

  • Minor hand tremors
  • Sleep disturbances
  • Low-level stress or anxiety
  • Stomach upset/loss of appetite
  • Sweating
  • Headaches

Stage 2:
12-48 hours after alcohol cessation

At this point, a patient may experience:

  • Hallucinations that may involve sight, hearing or touch
  • Withdrawal seizures
  • General tonic-clonic seizures

Stage 3:
48-72 hours after alcohol cessation

At this point, patient may experience:

  • Further hallucinations, mostly involving sight
  • Delirium tremens (see paragraph below for more information)
  • Disorientation
  • Increased heart rate, blood pressure and temperature
  • Sweating

Symptoms peak in the first several days after drinking cessation, but can go on, in less severe forms, for weeks.

alcohol withdrawal timeline and symptoms

What is delirium tremens?

Delirium tremens, also known as “the DT’s” or “alcohol withdrawal delirium”, is one of the more extreme signs and symptoms that can occur after alcohol cessation. The DT’s are marked by a change in the level of consciousness and delirium and can be fatal in 1-5% of cases. Older patients with poor liver function, a history of heavy alcohol use and more severe signs and symptoms of withdrawal at the outset are more likely to experience delirium tremens.

What is the long-term outlook for alcohol withdrawal?

Man experiencing withdrawal from alcoholThe NLM reports that the long-term outlook (prognosis) depends on the extent of organ damage and whether or not the person continues to drink after rehab. In the months after treatment, patients may still experience sleep disturbances, mood swings, and low energy levels.

A complete recovery is possible. However, if patients return to drinking, they are at risk for liver, heart and nervous systems disease/damage as they age.

What is the treatment for alcohol withdrawal?

Treatment for alcohol withdrawal symptoms and the beginning of the detoxification process is best handled by professionals and often takes place in an inpatient setting like a rehab center.

Typical treatments

According to the University of Maryland Medical Center (UMMC), treatment at this time may include:

  • Initial observation of the patient to determine severity of withdrawal symptoms
  • Anti-anxiety drugs like benzodiazepines to reduce anxiety withdrawal symptoms
  • Anti-seizures drugs like Depakote
  • Beta-blockers which can slow the heart rate, reduce tremors and sometimes also helping with the craving for alcohol.

The goal of treatment is to ease the symptoms of withdrawal and support the patient during this critical time.

Alcohol withdrawal is mentally, physically and emotionally exhausting. This is why skilled rehabilitation centers, where competent and compassionate professionals can supervise the detoxification process and manage withdrawal symptoms, is so vital for patient health and safety. These are the first, difficult steps towards sobriety — and as such is incredibly important.

[Video] Alcohol withdrawal

“Alcohol withdrawal in the ICU”

Bayard, Max et. al. “Alcohol Withdrawal Syndrome”. American Family Physician. American Academy of Family Physicians. March 15, 2004.

Martin, Laura. “Alcohol Withdrawal”. Medline Plus. United States National Library of Medicine. February 8, 2015. Web. February 16, 2016.

Simon, Harvey. “Alcoholism”. University of Maryland Medical Center. University of Maryland Medical Systems. March 8, 2013. Web. February 16, 2016.