Timeline & Symptoms of Alcohol Withdrawal

Timeline & Symptoms of Alcohol Withdrawal

When discussing alcohol withdrawal, distinguishing between acute and post-acute withdrawal should be addressed is an important piece in understanding what you may be up against.

Acute withdrawal is composed of the symptoms that arise when an individual discontinues alcohol consumption after an excessive and lengthened period of time of alcohol abuse.1 In contrast, Post Acute Withdrawal Syndrome (PAWS) occurs when withdrawal symptoms continue for a longer period of time after stopping drug or alcohol use. PAWS has a tendency of occurring with individuals who discontinue opioid use, but is also common among those who stop using antidepressants, antipsychotics, benzodiazepines, and alcohol.2

Although lengthening the time it takes to taper off of alcohol may lessen symptoms, many have still reported experiencing symptoms months after consuming their last beverage. It may take a certain period of time for some individuals to fully recover after a timeframe of alcohol abuse.2

This page will present the facts about alcohol withdrawal, both acute and post-acute, and help you understand the timeline of withdrawal symptoms and the most appropriate way to manage those symptoms.

Common Alcohol Withdrawal Symptoms

Physical symptoms associated with acute withdrawal vary. Potentially within hours to a few days, an individual may experience hallucinations, insomnia, nausea or vomiting, hand tremors, anxiety, or psychomotor agitation like pacing or tapping their fingers on the surface of an object.3,4 However, the most serious–and potentially lethal– symptom would be a grand mal seizure, which could be associated with what is known as delirium tremens (DT).

Delirium tremens includes severe and abrupt mental or nervous system changes, and usually occurs after a timeframe of heavy drinking, but may also be brought on by an illness, head injury, or an infection with an individual who has a history of alcohol abuse.5 Delerium Tremens only occurs in a small subset of people who experience alcohol withdrawals and most often applies to people who have been considered “heavy drinkers” for over 10 years.5 For which, “heavy drinking” is generally considered one pint of “hard” alcohol (or liquor), 4-5 pints of wine, and 7-8 pints of beer per day for several months.

Whether the more common symptoms or the symptoms of delerium tremens, people are likely to begin withdrawing from alcohol within 48-96 hours after consuming their last alcoholic beverage, but may even happen as late as 7-10 days after the last drink.5

In addition, just as acute withdrawal symptoms, post-acute withdrawal symptoms are likely to vary due to factors like frequency, quantity, and duration of use. Some of these symptoms include:2

  • Cognitive Impairment
  • Anhedonia (inability to experience pleasure)
  • Concentration Problems
  • Depersonalization (not feeling like yourself)
  • Cravings
  • Depression
  • Fatigue
  • Emotional Instability
  • Hypersensitivity
  • Hypochondria (obsession of potential sickness)
  • Memory Impairment
  • Insomnia
  • Obsessive-Compulsive Behaviors
  • Motivational Deficits
  • Social Withdrawal
  • Suicidal Thoughts

Alcohol Withdrawal Timeline & Severity Scale

Alcohol withdrawal references symptoms that may develop as a result of an individual who has been regularly drinking too much, and then abruptly stops drinking. Alcohol withdrawal symptoms tend to occur within eight hours after consuming the last alcoholic beverage but may occur days later. Symptoms usually spike 24-72 hours afterward but may continue for weeks.7

Individuals with alcohol dependence who suddenly stop using alcohol are at risk for alcohol withdrawal syndrome (AWS). Approximately 2%-9% of individuals who see their family physician, battle with alcohol dependence. In many cases of alcohol withdrawal, AWS may begin roughly 6-24 hours after the last drink.6

Although withdrawal symptoms vary amongst individuals, there is a general timeline of the onset of these symptoms.3 Alcohol withdrawal impacts cognitive function, the central nervous system, and the autonomic nervous system.6 When the cessation of, or decrease in, an individual whose alcohol abuse has been extreme and for an extended period of time, two (or more) of the following symptoms develop within several hours to a few days:3

  • Automatic hyperactivity (pulse over 100 beats per minute/sweating).
  • Hand tremor.
  • Trouble sleeping (insomnia).
  • Nausea/vomiting.
  • Auditory, visual, or tactile hallucinations.
  • Engaging in movements without purpose (e.g., pacing).4
  • Anxiety.
  • Grand mal seizures.

These symptoms cause clinically significant impairment in home life, occupation, and social function, and personal safety. In order to better categorize the necessity of care for someone’s symptoms, alcohol withdrawal syndrome can be classified into three stages based upon the symptom severity:6

  • Stage 1(mild): Mild symptoms and are not usually linked with abnormal vital signs. This consists of palpitations, headache, anxiety, tremor, gastrointestinal disturbances, and anxiety.
  • Stage 2 (moderate): Symptoms are increasingly more intense and are linked with abnormal vital signs. This consist of elevated body temperature, blood pressure, tachycardia, confusion, tachypnea, and hyperthermia.
  • Stage 3 (delirium tremens): This consist of impaired attention, auditory and/or visual hallucinations, and disorientation.

Quitting Drinking Cold Turkey

It may be tempting to stop drinking alcohol altogether because you’ve realized that it’s negatively impacting your life. And although the first step towards recovery and sobriety is acknowledging that you have a habit of abusing alcohol to begin with, the safest way to do this is with licensed medical professionals in a safe environment.

Should an alcohol-dependent individual abruptly stop consuming alcohol on their own, they risk alcohol withdrawal syndrome without the aid of a physician or nurse to properly treat the symptoms. If alcohol withdrawal syndrome is not treated properly, or worse, not at all, this could lead to delirium tremens. Delirium tremens can consist of heavy sweats, above-average body temperature, dangerously high heart rates, and a heightened state of adrenaline. Additionally, individual can experience auditory and/or visual hallucinations, disorientation, and impaired attention and consciousness.6

Withdrawal symptoms themselves can cause an individual to relapse into drinking in the early stages of their recovery. If the symptoms from withdrawal become frustrating enough, this may cause the individual to return to drinking in an effort to alleviate their discomfort.8

Withdrawal symptoms vary, and depend on different factors, such as how long an individual has been drinking and how much over this period of time. It’s best to be monitored by a physician in order to be in the proper care in the event that withdrawal symptoms become serious and especially before they become fatal (e.g., DT).8

The management of alcohol withdrawal syndrome requires identification, assessment, and treatment. Identifying an individual’s condition, assessing their risk of complications, and treating the symptoms will increase the potential for long-term sobriety.6

Medical Detox for Alcohol Withdrawals

Medical detoxification focuses on stabilizing and ensuring the safety of the individuals undergoing care for alcohol withdrawal. Detox is a set of interventions with the goal of managing acute intoxication and withdrawal. It includes the removal of toxins from the body of the individual who is dependent on the substance of abuse and acutely intoxicated with it. The purpose of the process is to decrease physical harm to the individual.9

Supervised detoxification has the potential to prevent life-threatening complications that may arise if left untreated. Under the care of a medical professional, the intensity of the disorder will be decreased in the process and will help those seeking abstinence to reach sobriety.9

There are many medications that are used in the detox process, depending on how moderate to severe withdrawal symptoms are.10 The anticonvulsants and benzodiazepines prevent the progress of withdrawal symptoms and psychomotor agitation.Once the withdrawal symptoms are under control, a physician may prescribe preventative medications to decrease the chances of an individual from consuming alcohol again.10

  • Benzodiazepines: Chlordiazepoxide (Librium), Diazepam (Valium), Lorazepam (Ativan), and Oxazepam. These are used for withdrawal management and to reduce the risks of seizures.10
  • Anticonvulsants: Gabapentin (Neurontin), Carbamazepine (Tegretol), Oxcarbazepine (Trileptal). If individuals don’t respond to benzodiazepines, they may be placed on one of these medications.6
  • Beta-blocker: Atenolol (Tenormin). If individuals don’t respond to benzodiazepines, they may be placed on this medication.6
  • Alpha-adrenergic agonist: Clonidine (Catapres) If individuals don’t respond to benzodiazepines, they may be placed on this medication.6
  • Neuroleptic medications: These may help prevent agitation and seizures linked to alcohol withdrawal, as well as depress nervous system activity.10
  • Nutritional support: In order to replenish nutrient deficiencies and to decrease withdrawal symptoms, physicians may provide magnesium, folic acid, and thiamine.1

  • Naltrexone (ReVia): This reduces cravings for alcohol and helps maintain sobriety.10
  • Disulfiram (Antabuse): This reduces cravings for alcohol and causes the individual to be sick if they were to consume alcohol while taking this medication.10
  • Topiramate (Topamax): This decreases alcohol consumption and extends the timeframe of abstinence from alcohol.10

Alcohol Detox & Rehab at American Addiction Centers

There is promise in finding the right treatment program for alcohol withdrawal and addiction.  For patients experiencing moderate symptoms, outpatient treatment services can be safe and effective. Plus, they offer the added benefits of costing less than inpatient treatment services and allowing the individual to continue to work and function within their family life.6

Those with serious medical conditions or psychiatric problems should be treated within an inpatient environment. Immediately undergoing the proper treatment can decrease the likelihood of drinking alcohol once again and the severity of withdrawal episodes.6

In either case, mild or severe, maintaining sobriety is often best achieved through therapy in either an inpatient or outpatient setting. American Addiction Centers is a leading provider of all the aforementioned levels of care and operates nationwide. No matter where you are, there’s always a local option available for you. For more information, you can reach us using our confidential helpline at 1-888-935-1318.

  • [1]. Heilig, M., Egli, M., Crabbe, J. C., & Becker, H. C. (2010). Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked?Addiction biology, 15(2), 169–184.
  • [2]. Mental Health Daily. (2019). Post-Acute Withdrawal Syndrome: Causes, Symptoms, Treatment.
  • [3]. Bayard, M., McIntyre, J., Hill, K. R., & Woodside, J., Jr (2004). Alcohol withdrawal syndrome. American family physician, 69(6), 1443–1450.
  • [4]. Healthline. (2017). Everything You Should Know About Psychomotor Agitation.
  • [5]. National Library of Medicine. (2020). Delirium Tremens.
  • [6]. Muncie, H., Oge, L., & Yasinian, Y. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. American family physician, 88(9):589-595.
  • [7]. National Library of Medicine. (2020). Alcohol withdrawal.
  • [8]. Very Well Mind. (2020). Common Alcohol Withdrawal Symptoms.
  • [9]. National Library of Medicine. (2006). Overview, Essential Concepts, and Definitions in Detoxification.
  • [10]. Healthline. (2019). How Long Does It Take to Detox from Alcohol?