Alcohol Withdrawal Timeline


Someone who engages in heavy, chronic alcohol use may become physiologically dependent on alcohol to feel okay and function as normal. When an alcohol-dependent person attempts to stop drinking or drastically reduce how much they drink, they will experience an alcohol withdrawal syndrome.1

Withdrawal symptoms can arise and resolve quickly due to the relatively rapid rate at which alcohol gets metabolized in the body. However, while the withdrawal period may be brief, it can also be very dangerous and may bring about life-threatening symptoms in some individuals, such as withdrawal delirium and seizures.1

When attempting to detox after heavy alcohol use, going it alone and stopping your use cold-turkey is not a safe decision. In a medical detoxification program, doctors and nurses can usher you through the acute withdrawal phase, monitoring your health and helping to prevent the most severe, potentially life-threatening symptoms.2

How Long Does Alcohol Withdrawal Last?

Withdrawal usually begins within about 4-12 hours of ending or significantly reducing alcohol use, as the blood alcohol level declines significantly.1

Acute alcohol withdrawal symptoms tend to be the most severe around the second day of sobriety and will often improve significantly by day 5.1

Some symptoms, such as anxiety and insomnia, may persist at a lower intensity for up to 6 months after the resolution of acute withdrawal.1

What Are the Symptoms of Alcohol Withdrawal?

The symptoms of the alcohol withdrawal syndrome range from mild to very severe. Each detoxing individual may experience different symptoms along this spectrum.2

Mild alcohol withdrawal symptoms may include:2

  • Restlessness.
  • Insomnia.
  • Decreased appetite.
  • Irritable mood.
  • Anxiety.
  • Impaired thinking and judgment.

Symptoms indicative of a more severe alcohol withdrawal include:1,2,3

  • Trembling of the arms and hands.
  • Sweating.
  • Rapid pulse.
  • Rapid breathing.
  • High fever.
  • Increased blood pressure (hypertension).
  • Hypersensitivity to noise and light.
  • Visual and/or auditory hallucinations.
  • Generalized tonic-clonic seizures (rare).
  • Delirium tremens (rare).

While life-threatening symptoms such as seizures and delirium tremens are uncommon,1 the Substance Abuse and Mental Health Services Administration states that the presentation and resolution of withdrawal symptoms is “extremely variable” and unpredictable.2 It is a challenge for medical professionals to determine with confidence who will and will not suffer life-threatening symptoms during acute withdrawal.

The presentation and resolution of withdrawal symptoms is “extremely variable” and unpredictable.

Seizures from Alcohol Withdrawal

Seizures are one of the more concerning risks of alcohol withdrawal. More likely after years of chronic alcohol abuse, withdrawal seizures tend to occur in patients over the age of 40. The tonic-clonic seizures associated with alcohol withdrawal will usually begin within 12 hours to 2 days of the time of the last alcoholic drink, although they will sometimes occur earlier, within just a few hours.4

Withdrawal seizures that go untreated may progress to a very serious condition known as delirium tremens.4

Delirium Tremens

Delirium tremens, or alcohol withdrawal delirium, is a rare but very serious condition that occurs in a small percentage of individuals going through alcohol withdrawal.5 Delirium tremens (commonly referred to as DTs) represents the most severe manifestation of alcohol withdrawal.6 Among heavy alcohol users, the lifetime risk of developing delirium tremens is  approximately 5-10%.5 It is estimated that death may occur in up to 5% of people who experience DTs.3

Symptoms of delirium tremens (DTs) include:5

  • Profound agitation and confusion (delirium).
  • Hallucinations (visual, tactile, and/or auditory).
  • Autonomic hyperactivity (may produce symptoms like rapid pulse, sweating, high fever, and high blood pressure).
  • Cardiovascular collapse.

Should delirium tremens occur, it will usually appear 2-4 days after the discontinuation of alcohol use, though it may take up to 10 days for it to manifest.7

DTs may last up to 5 days,5 and it is considered a medical emergency that requires immediate treatment, as it has the potential to be fatal.6

Risk Factors for Severe Alcohol Withdrawal Symptoms

Detox from alcohol is a process that in some cases may be mild but in other cases may be life threatening and even deadly. It is not possible to accurately predict who will have a complicated withdrawal and who will not.2 However, there are some factors that tend to influence the severity of alcohol withdrawal.8

Individuals with the following may be more likely to suffer more rare, severe complications of alcohol withdrawal including seizures or DTs during alcohol withdrawal:2,8

  • History of alcohol detoxification and/or withdrawal seizures.
  • Having had DTs in the past.
  • Comorbid illness or medical conditions, especially infection or physical trauma. Pneumonia and pancreatitis, also common in alcoholics, may add to the risk.
  • Presence of one or more mental health disorders.
  • Regular, heavy alcohol use.
  • Having been dependent on alcohol for several years.
  • Poor general health.
  • Nutritional deficiencies.

How to Detox from Alcohol Safely

Nurse comforting patient

Alcohol withdrawal should be taken seriously by anyone who is dependent on alcohol or has been abusing alcohol for a long period of time, due to the risk of serious or life-threatening symptoms during detox.2,8 Medical assistance may be required to avoid the potentially deadly symptoms of moderate to severe withdrawal.2

For many people, help for alcohol withdrawal is sought in the form of a medical detoxification facility. Through medical detox, medications and the supervision of medical staff help to keep patients safe and comfortable through what can be a very difficult and sometimes dangerous process.

Medical detox also serves as a starting point for alcohol addiction treatment, as many facilities are attached to larger inpatient rehabilitation programs. Should you enter detox, you may be able to move right into rehab once acute withdrawal ends and you are stable enough to participate in treatment. Because detox is rarely enough for a person to sustain recovery, continuing on in treatment is essential in preventing relapse back to alcohol use.9 Detoxification deals with physical dependence only—rehabilitation teaches coping skills and tools to abstain from alcohol after treatment ends.

Recovery First offers a whole continuum of care for individuals who are considering treatment for alcoholism, from medical detox to inpatient rehab to outpatient programming. To learn how we can help you get sober safely, call us today at 954-526-5776.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  2. Center for Substance Abuse Treatment. 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, 2006.
  3. Trevisan, L., et. al. (1998). Complications of Alcohol Withdrawal: Pathophysiological Insights. Alcohol Health & Research World, 22(1), 61–66.
  4. Hoffman, RS & Weinhouse, GL. (2020). Management of moderate and severe alcohol withdrawal syndromes.
  5. Rahman A, Paul M. Delirium Tremens (DT) [Updated 2019 Dec 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  6. Medscape. (2019). Delirium Tremens.
  7. U.S. National Library of Medicine. (2019). Delirium Tremens.
  8. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  9. National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction Treatment and Recovery.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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