Acute alcohol withdrawal occurs when a person abruptly stops or reduces his or her drinking after a period of heavy use. It can include a series of unpleasant and, in some cases, dangerous symptoms. Alcohol withdrawal can range from mild to severe depending on certain factors, such as frequency or amount of drinking.
Signs and symptoms of alcohol withdrawal may include changes in sleep, anxiety, shaking, seizures, and sensory distortions.2 In some cases alcohol withdrawal may lead to delirium tremens, a serious condition that involves loss of consciousness, sweating, nausea, heart palpitations, shaking, and anxiety.3 Seizures and delirium tremens may result in death.
The timeline for alcohol withdrawal typically begins 6 to 48 hours after the last drink. The acute withdrawal phase usually lasts 5-7 days. But some users may experience lingering symptoms for up to 2 years.
Medical detox is a treatment for alcohol withdrawal that involves safely clearing the body of alcohol and minimizing the risk for dangerous withdrawal symptoms. Seeking professional help for withdrawal may be necessary for people with significant alcohol dependence because of the risk of complications and death.
Signs, Symptoms, and Effects
Learn more about alcohol withdrawal, including causes, treatment, and how to recover from alcoholism.
The alcohol withdrawal syndrome may consist of both an acute period and in some cases, a more prolonged phase, both with their own set of characteristic symptoms.
Acute alcohol withdrawal occurs after heavy drinkers abruptly stop or attempt to decrease their alcohol use.4 The acute alcohol withdrawal period may arise within hours after the last drink and persist, on average, for a few days to a week. 4
Signs and symptoms of acute alcohol withdrawal may include:1,2
- Sleep difficulties
- Elevated heart rate, blood pressure, and body temperature
- Tremors and shaking
- Stomach problems, including nausea and vomiting
- Poor appetite
Certain factors may put people at risk of more severe acute withdrawal symptoms, including:
- Severity of dependence. People with severe dependence on alcohol and those who have experienced prior withdrawals are at a higher risk of experiencing the more dangerous effects of alcohol withdrawal.1,3
- Heavy alcohol use. People with a history of heavy and chronic alcohol use are more likely to experience severe withdrawal and require medical detox.3
- Illicit drug use. Combining alcohol with other drugs may increase the likelihood of severe withdrawal.3
- Medical conditions. Current or previous medical conditions can put people at risk for seizures during withdrawal, including certain infections, low blood sugar, and a history of seizures.3,5
Protracted withdrawal, also known as post-acute or prolonged withdrawal, is a set of signs and symptoms that continue beyond the acute withdrawal period.4
Common signs and symptoms of post-acute withdrawal can include:4
- Changes in mood
- Low energy
- Poor concentration
- Low libido
- Unexplainable physical pain
Effects of prolonged alcohol withdrawal may persist for up to two years or more.4Treatment for acute and prolonged withdrawal symptoms can reduce discomfort and minimize the risk of relapse, serious health complications, and death.
Alcohol withdrawal follows a general timeline that includes the following:
|Duration of Symptoms||Symptoms|
|6 to 48 hours after the last drink||Alcohol withdrawal typically begins.1,3 Withdrawal may even begin when there is still a large amount of alcohol in the body.1,3|
|5-7 days||During this time, users may experience effects such as increased heart rate, restlessness, and nausea and vomiting.4 The acute withdrawal period is the most dangerous, since seizures and/or delirium tremens may occur during this time. In some cases, medical detox is necessary.|
|Up to 2 years||Protracted withdrawal symptoms, such as depression, fatigue, and concentration difficulties, may last up to 2 years.4 People in the protracted withdrawal period often benefit from inpatient and/or outpatient treatment, since the discomfort may increase the risk of relapse.|
Medical complications include seizures, hypoglycemia, cardiomyopathy, and pancreatitis.
Medical complications associated with alcohol withdrawal and alcoholism include:1,3
- Seizures, which can involve loss of consciousness, inadequate breathing, and muscle rigidity and jerking, followed by severe confusion.
- Delirium tremens, a dangerous condition that includes significant confusion, changes in mood, hallucinations, and seizures.
- Unstable heart rate, body temperature, and blood pressure.
- Hypoglycemia, or low blood sugar.
- Gastrointestinal bleeding.
- Hepatic or liver failure, which may include liver tenderness and enlargement, accumulation of fluids in the stomach, jaundice, fever, and frequent nausea and vomiting.
- Cardiomyopathy, which involves enlargement of the heart and problems with pumping. It can cause shortness of breath and swelling.
- Pancreatitis, an inflammation of the pancreas.
- Encephalopathy (impaired brain function).
Seeking professional help is necessary if medical complications arise during alcohol withdrawal. Failure to treat certain medical issues can lead to lasting consequences and even death.
Read next: Alcohol Withdrawal Medications and Help
. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
. McKeon, A., Frye, M. A., & Delanty, N. (2008). The alcohol withdrawal syndrome. Journal of Neurology, Neurosurgery & Psychiatry, 79(8), 854-862.
. Center for Substance Abuse Treatment. (2010). Protracted Withdrawal.
. U.S. National Library of Medicine. (2015). MedlinePlus, Alcohol withdrawal.