Alcohol Withdrawal Timeline — Signs And Symptoms
Alcohol withdrawal begins six to eight hours after the last drink. It can cause physical and mental symptoms, ranging from anxiety and tremors to more serious complications like seizures.
People who consume alcohol on a chronic basis can become very sick and go into withdrawal, should they suddenly stop drinking. Many people begin to feel symptoms and exhibit visible signs of acute withdrawal in as little as six to eight hours after having their last drink.
Typically, acute withdrawal symptoms are at their most severe one to three days after a person first experiences them and wane around days five to seven, however, some people may have symptoms for weeks.
Not every person who struggles with a drinking problem or alcoholism will go into withdrawal, although some experts suggest that roughly 50 percent of people with an alcohol use disorder will experience symptoms. Considering the fact that 20 percent of men and 10 percent of women are estimated to face an alcohol use disorder at some point in their life, this number can be great.
Symptoms of alcohol withdrawal can be minor, moderate or severe. Certain symptoms may only cause discomfort or be mildly annoying, such as tremors, while others, like delirium tremens or DTs, can endanger a person’s life.
Alcohol Withdrawal Timeline
The timeline of alcohol withdrawal and the symptoms that accompany it can vary from person to person, but generally, after a person’s last drink, the time it takes for symptoms to start is as follows.
Five to ten hours: Tremors or trembling, referred to as “the alcohol shakes,” can begin. These typically peak in one to two days.
Six to eight hours: Minor withdrawal sets in, lasting one to two days for most, though some people may have these symptoms for several days. Symptoms include:
- A headache
- Stomach upset
Twenty-four hours or less: Though rare, alcoholic hallucinosis, or hallucinations begin, with symptoms lasting 24 hours to six days. In very limited cases they may last a month or more. These hallucinations can change the way a person experiences certain things, including:
- Auditory stimulation (sound)
- Tactile stimulation (touch)
- Visual stimulation (sight)
Six to 48 hours: Seizures begin and typically slow down after day three. Characteristics of withdrawal seizures include:
- A person may have one or two generalized tonic-clonic seizures (grand mal seizures).
- Some people may have up to six seizures in six hours.
- Seizures can indicate a high risk of delirium tremens.
Two to four days: Withdrawal delirium or delirium tremens starts. This state may also begin seven to 10 days after a person has their last drink. Symptoms last up to two weeks and can include general symptoms of alcohol withdrawal. In addition to delirium, or severe confusion that hits quickly, symptoms of DTs are:
- Agitation or irritability
- Increased sensitivity to light, sound or touch
- Excitably or bursts of energy
- Restlessness or fearfulness
- Sleeping deeply for a day or more
- Sudden mood shifts
- Trouble thinking straight
Four to six weeks: Certain people experience protracted alcohol withdrawal syndrome, or post-acute withdrawal syndrome (PAWS), long after acute withdrawal fades. Symptoms include:
- Decreased interest in sex
- Inability to feel pleasure
- Mood instability
- Pain that can’t be explained
- Poor concentration
- Trouble thinking
Not every person will experience all of these symptoms or these stages of withdrawal. Some people may see symptoms improve after only a few days of withdrawal, whereas other people’s symptoms may get progressively worse to the point of DTs.
Alcohol Withdrawal Explained
Alcohol withdrawal occurs when a person is physically dependent on alcohol. In this state, chronic alcohol use has upset the balance of important neurotransmitters or chemicals in a person’s brain so severely that they become sick if they don’t drink.
- Some people will experience withdrawal even when they have a detectable blood alcohol level.
- People who drink large amounts of alcohol on a regular basis experience withdrawal more severely.
- Heavy drinkers can go into withdrawal even if they drastically reduce the amount they drink.
- If a person has had withdrawal before, the odds that they’ll experience it in the future rise.
- People with serious medical concerns may have more intense symptoms.
While alcohol withdrawal happens more frequently in adults, teens and children who drink may face this risk as well.
Signs And Symptoms Of Alcohol Withdrawal
Alcohol withdrawal attacks a person on two fronts, both mentally and physically. This combination of symptoms makes relapse a tempting alternative to many people. Without professional, medical care, a person may be tempted to take a drink to reduce these intolerable feelings.
Resorting to drinking as a “cure” for withdrawal is just a temporary fix. Returning to a life of alcohol abuse and addiction only serves to place a person squarely in the face of the many dangers related to an alcohol use disorder.
In order to help protect a person from this risk, and to seek help in a timely manner, it’s helpful to understand the signs of alcohol withdrawal so that proper treatment can be sought.
Psychological symptoms of alcohol withdrawal may include:
- Cognitive impairment
- Mood swings
- Poor focus
- Vivid dreams
Physical symptoms of alcohol withdrawal include:
- Clammy and pale skin
- Enlarged (dilated) pupils
- A headache
- Fever or raised body temperature
- Increased heart rate
- Nausea and vomiting
- Pale skin
- Poor appetite
- Rapid breathing
- Shaky hands
Alcohol withdrawal isn’t something to be taken lightly. While some people’s symptoms may be mild and only bothersome, other people have life-threatening symptoms that require emergency medical care.
Withdrawal From Alcohol Can Be Deadly
Alcohol withdrawal stands apart from many other drugs in the fact it can be deadly. The New England Journal of Medicine reports that 3 to 5 percent of people suffering from withdrawal will have grand mal convulsions, delirium or both. Without prompt medical help, withdrawal-induced seizures and delirium tremens could take a life.
Heavy drinkers have a higher risk of delirium tremens. According to MedlinePlus, DTs occur frequently in people who drink the following amounts on a daily basis for several months:
- 4 to 5 pints (1.8 to 2.4 liters) of wine
- 7 to 8 pints (3.3 to 3.8 liters) of beer
- 1 pint (1/2 liter) of “hard” alcohol or liquor
- People who have gone through withdrawal in the past have a higher risk of DTs.
- DTs are common in people who have been drinking for 10 years or more.
- The risk goes up if a person hasn’t eaten.
- People with a history of heavy drinking could have DTs because of a head injury, infection or illness.
Delirium tremens is a medical emergency. The New England Journal of Medicine cautions that roughly 1 to 4 percent of people experiencing withdrawal delirium in a hospital pass away. However, they do note that a prompt diagnosis and medical care could decrease the number of these deaths.
Seeking guidance from a medical professional prior to quitting drinking could help to reduce the severity of withdrawal symptoms and save a life. Choosing a professional, medical detox program can help a person to more safely and comfortably progress through withdrawal.
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Treating Alcohol Withdrawal: Medically Supported Detox Programs
Though mild withdrawal may be successfully treated in an outpatient program, moderate to severe cases may be best treated in inpatient medical detox programs. This can be especially true for individuals who have other existing health problems, such as mental health (dual diagnosis) or medical problems.
Inpatient detox programs deliver around-the-clock care that focuses on reducing or alleviating withdrawal symptoms. To achieve this goal, various medications may be used to help a person’s body stabilize and safely adjust to sobriety.
Many practitioners consider benzodiazepine drugs as the first line of defense against alcohol withdrawal symptoms, due to their sedative and calming properties. Benzodiazepines that may be used to treat withdrawal include:
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
Other medications may be used as needed, such as anticonvulsants, antipsychotics and beta blockers. In severe cases of withdrawal, intravenous therapy may be used to help deliver medications, fluids and nutritional support.
Clinicians may deliver therapies to help balance a person’s fluid, electrolyte or vitamin levels, things that can become greatly imbalance by both chronic alcohol use and withdrawal. Multivitamins and thiamine, a B vitamin, are common treatments during this time.
Choosing an inpatient detox program can reduce the amount of stress a person experiences as they transition to inpatient drug rehab. Selecting a facility that offers both detox and rehabilitation services under one roof reduces the risk of a person dropping out of treatment.
Residential care continues to provide greater protection from outside influences and temptations that can threaten a person’s sobriety goals and recovery. These programs can also be valuable to a person who is working to overcome and cope with the challenges of protracted alcohol withdrawal syndrome.
Contact Addiction Campuses for more info on alcohol withdrawal and medical detox programs.
- Harvard Health Publishing — Alcohol Withdrawal
- MedlinePlus — Alcohol Withdrawal, Delirium Tremens
- The New England Journal of Medicine — Recognition, and Management of Withdrawal Delirium (Delirium Tremens)
- PubMed Health — Acute Alcohol Withdrawal
- Substance Abuse and Mental Health Services Administration — Substance Abuse Treatment Advisory: Protracted Withdrawal
- US National Library of Medicine — Clinical Management of Alcohol Withdrawal: A Systematic Review