Alcohol Withdrawal Symptoms, Timeline, Detox, and Treatment
What is Alcohol Withdrawal Syndrome (AWS)?
Alcohol withdrawal syndrome is a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking or drastically reduces their alcohol intake.
Alcohol Withdrawal Symptoms
Signs and symptoms of the various stages of alcohol withdrawal may include:
- Tremors or shakes.
- Mood changes.
- Gastrointestinal disturbances.
- Heart palpitations.
- Increased blood pressure or heart rate.
- Hyperthermia (i.e., overheated body).
- Rapid abnormal breathing.
Alcohol Misuse and Binge Drinking
The National Dietary Guidelines recommend a cautious approach to alcohol consumption, with women limiting themselves to 1 drink daily (7 per week) and men consuming no more than 2 drinks per day (14 per week). Consuming more than this level of alcohol increases a person’s risk of liver disease, cardiovascular disease, and other injuries. Even drinking within the recommended limits or at lower levels may increase a person’s cancer risk and can increase their risk of physiological dependence.1
Misuse of alcohol refers to alcohol use that places you at risk for experiencing physical health problems, mental health issues, and social problems.2
Having more than the aforementioned dietary guidelines is generally considered alcohol misuse.2 Binge drinking, a form of alcohol misuse, is when a man has 5 or more drinks or a woman has 4 or more drinks within a short period of time.2,3
Binge drinking and/or alcohol misuse can increase someone’s risk of developing an alcohol use disorder (AUD).4 An AUD is a disease characterized by the inability to control alcohol use despite negative, harmful consequences. Craving alcohol, having a tolerance to the effects of alcohol, and experiencing withdrawal symptoms when you try to stop drinking are some of the criteria that point toward having an AUD.2,4
When a person has a physiological dependence on alcohol, the withdrawal symptoms that are experienced after they significantly reduce or stop drinking can be extremely distressing and uncomfortable, and people commonly return to drinking alcohol as a way of relieving their discomfort.4
What Causes Alcohol Withdrawal?
Alcohol withdrawal is thought to arise as a function of various changes in brain activity caused by prolonged and excessive alcohol use. Though the neurochemical details of alcohol withdrawal syndrome are somewhat complicated, its associated symptoms reflect a compensation for previous disruptions in both excitatory and inhibitory neurotransmitter activity—the balance between the two having been upended to begin with as a result of prolonged alcohol use.5
The effects of alcohol on the body are complex, but two particular neurochemicals contribute to both short-term effects of drinking as well as the development of alcohol withdrawal syndrome when someone stops drinking: the brain’s main inhibitory chemical, gamma aminobutyric acid (GABA) and the brain’s main excitatory chemical, glutamate.6 When a person drinks alcohol, it changes the functioning of GABA receptors as well as certain glutamate receptors, resulting in a slowdown of brain functioning that a person typically experiences as decreased anxiety and sedation. The brain reacts by decreasing the amount of GABA being released and increasing glutamate signaling to compensate for how alcohol alters these levels.6 This adaptation functions as long as you continue to drink alcohol—this is known as “tolerance.”
If you stop or significantly reduce alcohol intake, it disrupts your brain activity, causing a hyper-aroused state, which leads to a range of withdrawal symptoms that can appear within hours after your last drink.4,7 The withdrawal symptoms a person experiences, as well as the severity of each, may vary greatly from one person to the next, and it has been estimated that more than 80% of those with an alcohol use disorder may experience withdrawal symptoms.4
When To Seek Help for Alcohol Addiction
Generally, you may need treatment for alcohol misuse when you can no longer control the amount you drink or how long you drink. You may also know that you need help with alcohol misuse when you begin experiencing consequences directly related to your alcohol misuse—but you still can’t stop or cut back on the amount that you’re drinking. To learn more about when you may need help for alcohol misuse, visit our informational page on helping someone with an alcohol use disorder or take our alcohol misuse self-assessment.
Take Our Alcohol Misuse Self-Assessment
Take our free, 5-minute alcohol misuse self-assessment below if you think you or someone you love might be struggling with an alcohol use disorder (AUD). The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of an AUD. The test is free, confidential, and no personal information is needed to receive the result.
Alcohol Withdrawal Stages and Severity
What happens to your body when you give up alcohol hinges on a variety of factors. Depending on the level of physiological alcohol dependence, the severity of acute alcohol withdrawal varies for different individuals.3,8
The American Academy of Family Physicians outlines 3 potential stages that a person in withdrawal may experience. These include:9
- Stage 1 (mild): Symptoms may include headache, insomnia, anxiety, hand tremors, gastrointestinal disturbances, and heart palpitations.
- Stage 2 (moderate): Symptoms may include Stage 1 symptoms in addition to increased blood pressure or heart rate, confusion, mild hyperthermia (i.e., excessive body temperature), and rapid abnormal breathing.
- Stage 3 (severe): Symptoms include Stage 2 symptoms in addition to visual or auditory hallucinations, seizures, disorientation, and impaired attention.
How Long Does It Take to Detox From Alcohol?
When trying to detox from alcohol without treatment by a healthcare professional, some people can progress from Stage 2 to Stage 3 rapidly.8
While a precise timeline for alcohol withdrawal varies from person to person based on several factors (e.g., average quantity and duration of heavy drinking behavior, the concurrent presence of physical and mental health issues, etc.), a general symptom timeline for alcohol detox may look something like this:7,9
Alcohol Withdrawal Timeline
- From 6 to 12 hours after the last drink, the relatively mild symptoms of early withdrawal may begin, including headache, mild anxiety, insomnia, small tremors, and stomach upset.
- Within 24 hours, some people may begin to experience visual, auditory, and/or tactile hallucinations.
- Between 24-72 hours, various symptoms may have peaked and begun to level off or resolve, though some more protracted symptoms that may stick around for weeks or longer. Seizure risks may be highest from 24 to 48 hours after the last drink, requiring close monitoring and seizure prophylaxis. Withdrawal delirium tremems (i.e., DTs) may appear from 48 to 72 hours after the last drink.
Though rare, some individuals experience more persistent withdrawal related symptoms—such as sleep disturbances, fatigue, and changes in mood—that can last for months.9 It is important to note, however, that most people recover fully with proper medical detox and withdrawal management services.11
Alcohol Detox for Withdrawal
Medical detox is often considered the first stage of treatment.9 It will help you navigate the difficult process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use.6,11 Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.5,9
- Inpatient and residential treatment involve living at a facility for the duration of treatment while you receive around-the-clock support and intensive therapy in group and individual sessions.
- Outpatient treatment involves living at home or in a sober living environment and attending group and individual therapy sessions at regularly scheduled appointments. This allows you to practice what you learn in treatment in real-world situations while managing stressors.
In general, the course of alcohol withdrawal is highly variable and somewhat unpredictable. Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms. Those experiencing mild alcohol withdrawal symptoms or who are concerned about experiencing withdrawal symptoms will benefit from the advice of a physician or clinician trained to assess and treat patients in alcohol withdrawal.
Those experiencing moderate to severe symptoms of alcohol withdrawal or those who are at risk of experiencing moderate to severe symptoms (i.e., if you’ve had severe alcohol withdrawal symptoms in the past) typically require inpatient monitoring and alcohol withdrawal treatment at an acute care hospital or detox-equipped facility. Outpatient treatment may be available for mild-to-moderate symptoms of alcohol withdrawal; however, should symptoms become severe, inpatient care may be required.
Other post-detox resources include:
- Therapies such as family therapy and cognitive-behavioral therapy (CBT).
- 12-step meetings such as AA.
- Participation with other mutual-help groups such as Smart Recovery.
- AAC’s free online virtual support meetings.
Medication for Alcohol Withdrawal
To prevent or lessen withdrawal symptoms or medical complications that can occur with severe alcohol withdrawal, doctors may prescribe benzodiazepines. These drugs can stop certain withdrawal reactions from proceeding to serious consequences.8
Other medications may also be used to stabilize patients or for supportive care (e.g., anticonvulsants, antipsychotics, beta blockers, and alpha-adrenergic agonists). Patients who are dehydrated or malnourished may be given fluids or certain vitamins.8
Dangers of Alcohol Withdrawal
Moderate-to-severe alcohol withdrawal can be extremely dangerous and sometimes life-threatening. Thus, there are legitimate danges associated with unmanaged alcohol withdrawal. The most severe form of alcohol withdrawal, delirium tremens, has a mortality rate of 1% to 4%.8,12
Experiencing severe alcohol withdrawal symptoms is somewhat rare. However, it can be difficult to predict those who will experience them and those who will only experience mild withdrawal symptoms.8 Despite this, studies have identified some predictors of severe alcohol withdrawal (e.g., withdrawal seizures or DTs). These include:5,13
- Heavy daily alcohol use.
- Being of an older age.
- A history of DTs or alcohol withdrawal seizures.
- Comorbid illnesses.
- Electrolyte disturbances.
- Brain lesions.
- Abnormal liver function.
How Much Do I Have to Drink to Experience Withdrawal?
It is impossible to accurately predict who will experience alcohol withdrawal, what the course of withdrawal may be, or the severity of withdrawal. Whether you develop alcohol withdrawal symptoms depends heavily on your body chemistry, the amount of alcohol you drink daily, how old you are, whether you have any other co-occurring physical or mental health conditions, and many other factors.8