What to Expect From Alcohol Withdrawal Symptoms (2024)

Alcohol withdrawal can be fatal and may require medical supervision. Alcohol withdrawal causes physical and emotional symptoms like shaking, sweating, headache, nausea, agitation, irritability, and anxiety.

The timeline for alcohol withdrawal varies. Symptoms can begin a few hours or a few days after you stop drinking. Heavy drinkers—defined as 15 or more drinks a week for males and eight or more drinks a week for females—are at a higher risk for alcohol withdrawal and the complications that come with it.

This article discusses alcohol withdrawal, its symptoms, and potential complications. It also provides an overview of the alcohol withdrawal timeline process and when to discuss your drinking with your healthcare provider.

What to Expect From Alcohol Withdrawal Symptoms (1)

What Causes Alcohol Withdrawal Symptoms?

When someone drinks alcohol for a prolonged period of time and then stops, the body reacts to its absence. This is alcohol withdrawal, and it causes uncomfortable physical and emotional symptoms.

Chronic drinking causes brain chemistry changes. Alcohol is a depressant, so the body responds by producing more stimulating chemicals, including the neurotransmitters dopamine and gamma-aminobutyric acid (GABA).

This process temporarily restores homeostasis, or chemical balance, in an effort to counteract the impact of long-term alcohol use on the brain.

Over time, however, the body builds a tolerance to alcohol, and a person may have to drink more and more to get the same feeling. Meanwhile, the brain is producing more and more neurotransmitters, making a person further imbalanced.

When that person cuts out alcohol, there is a period when their brain hasn't yet received the message and still overproduces the stimulating chemicals. With alcohol out of the equation, though, these chemicals cause withdrawal symptoms.

You don't need to be diagnosed with alcohol use disorder in order to quit drinking. If alcohol is interfering with your health or your personal, financial, or professional life, consider quitting.

How Long Does It Take to Sober Up After Drinking?

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms range from mild but annoying to severe and life-threatening.

Mild Symptoms

If you have ever had a hangover, you have experienced mild symptoms of alcohol withdrawal. Mild alcohol withdrawal symptoms include:

  • Anxiety
  • Brain fog
  • Depression
  • Fatigue
  • Headaches
  • Insomnia
  • Irritability
  • Mild to moderate tremors
  • Nausea
  • Nightmares
  • Night sweats
  • Restlessness

Severe Symptoms

There are also more severe symptoms of alcohol withdrawal. These are more common among heavy drinkers and include:

  • Enlarged pupils
  • Increased agitation
  • Increased heart rate
  • Loss of appetite
  • Nausea and vomiting
  • Pallor (paleness)
  • Seizures
  • Severe tremors
  • Sweating, clammy skin
  • Tremors of the hands or other body parts

Delirium Tremens

A rare but very serious syndrome called delirium tremens can occur during alcohol withdrawal. Also known as DTs, an estimated 2% of people with alcohol use disorder and less than 1% of the general population experience them.

Signs of delirium tremens include the severe alcohol withdrawal symptoms as well as:

  • A sudden and severe change in mental status (delirium)
  • Fever
  • Hallucinations
  • Seizures
  • Severe agitation

Delirium tremens is a medical emergency that can result in death. If you or someone you know shows signs of delirium tremens, go to the emergency room immediately.

Who Experiences Alcohol Withdrawal Symptoms?

Anyone can experience alcohol withdrawal symptoms, but they typically correlate to the degree of alcohol dependence. Excessive drinking is defined as:

Binge drinking

  • Men:Five or more drinks on a single occasion
  • Women:Four or more drinks on a single occasion

Heavy drinking

  • Men:15 or more drinks per week
  • Women:Eight or more drinks per week

Alcohol Use Disorder

  • An inability to stop or control drinking, despite the negative impact it may have on relationships, health, work, school, and other areas of life
  • A built-up tolerance and need to drink more to get the same effect
  • Repetitive thoughts and difficulty thinking about anything other than alcohol

Daily, heavy drinkers and people with alcohol use disorder are at the greatest risk for severe withdrawal symptoms and DTs. However, anyone can experience withdrawal after binge drinking

Timeline of Alcohol Withdrawal

There is no exact timeline for alcohol withdrawal, and individual factors, such as the level of dependence on alcohol, will influence it.

In the First 8 Hours

For most people, alcohol withdrawal symptoms will begin sometime in the first eight hours after their final drink.

Symptoms are usually mild at first and begin gradually. They can include:

  • Restlessness
  • Clammy or pale skin
  • Irritability
  • Nervousness
  • Loss of appetite
  • Shakiness
  • Nausea

Between 12 and 24 Hours

During the 12- to 24-hour time frame after the last drink, most people will begin to have noticeable symptoms. These may still be mild, or the existing symptoms might increase in severity.

A person may begin to experience:

  • Mood swings
  • Night sweats
  • Nightmares
  • Depression
  • "Brain fog" or not thinking clearly
  • Headache or migraine
  • Insomnia or difficulty sleeping
  • Vomiting

For people who experience hallucinations as part of alcohol withdrawal, these may begin in the 12- to 24-hour time frame.

From 24 to 72 Hours

Alcohol withdrawal symptoms typically peak during this time frame. They may peak as early as 24 hours in or closer to 72 hours. Expect the most severe symptoms at this stage, which can include:

  • Nausea
  • Vomiting
  • Tremors
  • Agitation
  • Seizures
  • Hallucinations

Individuals should be prepared to be uncomfortable during this period and have medical help available if needed. This is the period in which delirium tremens is most likely to occur, which requires immediate medical attention.

After 3 Days Without Alcohol

For most people, alcohol withdrawal symptoms will begin to subside after 72 hours. If you are still experiencing withdrawal symptoms after three days, talk to your healthcare provider.

Once a person starts feeling better, it can be common to forget the pain of withdrawal and why you went through it. This can put you at risk for a return to drinking. Now is a good time to make a plan for maintaining an alcohol-free lifestyle.

It can be helpful to write down your reasons for quitting and the difficulty of withdrawal while it is fresh in your mind.

In the Next Few Weeks

A "new normal" will begin over the next few weeks. However, try not to have too many firm expectations, as symptoms can continue for multiple weeks in some people. This is known as post-acute withdrawal syndrome (PAWS).

Symptoms of PAWS resolve gradually over time and include:

  • Anxiety
  • Cognitive dysfunction
  • Cravings for alcohol
  • Depression
  • Fatigue
  • Irritability
  • Sleep disturbances

For those with alcohol use disorder, withdrawal is just the first (but very important) step on a long journey to recovery. These first few weeks are critical because they are when the risk of relapse is highest.

You're Not Alone

Remember you are facing a difficult challenge during alcohol withdrawal, but you are not alone. There are many resources available to help, including peer support groups, counseling, therapy, and inpatient rehabilitation.

Risks and Complications

It can be dangerous to suddenly stop drinking: Alcohol withdrawal can be fatal. People with alcohol use disorder and heavy drinkers should not quit drinking without medical supervision.

Moderate or binge drinkers can likely quit alcohol on their own. However, medical complications can occur during the acute phase of withdrawal.

People who drink daily or almost every day should not be left alone for the first few days after stopping alcohol. Withdrawal symptoms can quickly go from a bad hangover to a serious medical situation.

If you are unable to stop drinking or experience more than mild withdrawal symptoms, talk to your healthcare provider. Seek medical care if you experience the following:

  • Hypertension
  • Rapid heart rate
  • Repeated vomiting and unable to keep fluid down
  • Severe headache
  • Shakes or tremors
  • Strong urge to drink alcohol

Call 911 or go to the emergency room if you experience:

  • Fever
  • Hallucinations
  • Irregular heartbeats
  • Seizures
  • Severe confusion

For help quitting, resources are available from the Substance Abuse and Mental Health Services Administration (SAMHSA) or the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Medical Supervision

People with alcohol use disorder should be monitored by a medical professional when withdrawing from alcohol. Moderate to heavy drinkers can also benefit from medical supervision in the acute withdrawal stage.

For people at low risk of complications, an office visit to your primary care provider, along with at-home monitoring and virtual office visits, may suffice. People at high risk of complications should enter a short-term in-patient detox program.

Medical supervision during alcohol detox includes monitoring your vital signs:

  • Blood pressure
  • Breathing rate
  • Pulse
  • Temperature

Unstable vital signs increase the risk of complications and can be managed with medications. People who experience severe withdrawal symptoms or DTs may require hospitalization or intensive care unit (ICU) treatment during alcohol.

Medications to Ease Withdrawal Symptoms

Acute withdrawal symptoms are managed with short-term use of medications, including:

  • Benzodiazepines
  • Carbamazepine
  • Gabapentin
  • Phenobarbital

Once through acute withdrawal, medication may be prescribed to help you stay stopped. The Food and Drug Administration (FDA) has approved the following nonaddictive medications for alcohol use disorder:

  • Vivitrol (naltrexone)
  • Campral (acamprosate)
  • Antabuse (disulfiram)

Social Support and Treatment Programs

There are many support options available that can help guide you through alcohol withdrawal, as well as abstaining from alcohol after withdrawal.

Social Networks

Tap into your social network to help support you through alcohol withdrawal. Find a supportive friend or family member to be with you while you withdraw and support your new non-drinking lifestyle.

Research shows people who have a supportive social network are more likely to remain alcohol-free after withdrawal. Those with a wider circle of support have a better chance of staying sober.

If you don't already have a supportive network, you can make new connections by joining social media communities dedicated to alcohol-free living.

Support Groups

Millions of people join support groups to help stop drinking and stay stopped. Studies show support groups play an instrumental role in helping people develop healthy social networks that result in continued sobriety.

The National Institute of Alcohol Abuse and Alcoholism recommends the following mutual support groups for people who want to stop drinking:

Many of these groups are free and available to the public; online support groups are also an option.

Behavioral Treatment

Behavioral treatment programs are helpful for people who want to quit drinking. These programs involve working with a team of mental health professionals in a group and individual setting.

Common treatments for people with alcohol use disorder include:

  • Inpatient rehab: These programs often include different levels of care, often starting with detox followed by less frequent medical monitoring and group therapy. An inpatient stay at a treatment center can last anywhere from a few days to get you through detox to several weeks or months depending on the level of care needed.
  • Partial hospitalization programs (PHP): This involves a full day of treatment similar to what you receive in an inpatient center, but you return home each night.
  • Intensive outpatient therapy (IOP): This provides similar treatment as PHP programs, but with fewer treatment hours of treatment sessions. IOP is often used as a transition or step-down from inpatient or PHP programs.

Behavioral health treatment for alcohol problems is often (but not always) covered by insurance. In the United States, most states have low-cost or free rehabilitation programs for those who are uninsured.

Summary

The alcohol withdrawal timeline varies, but the worst of the symptoms typically wear off after 72 hours. People who are daily or heavy drinkers may need medical support to quit. Stopping drinking abruptly can lead to seizures and can even be fatal.

Some people can experience withdrawal symptoms for several weeks or months after their last drink. Known as post-acute withdrawal syndrome, it includes cravings for alcohol, irritability, and insomnia. These symptoms will resolve in time as long as you remain alcohol-free.

If you are thinking about quitting drinking, talk to your healthcare provider. Medical supervision, behavioral health treatment, and mutual-aid groups can help you through alcohol withdrawal and stay stopped.

What to Expect From Alcohol Withdrawal Symptoms (2024)
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