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Alcohol Withdrawal: Symptoms, Timeline, and Treatment

Drinking too much can often lead to alcohol dependence, which goes hand-in-hand with alcohol withdrawal syndrome. Withdrawal symptoms can be dangerous or even deadly.5 In this article, you’ll learn about the signs and symptoms of alcohol withdrawal and how to get help.

What Is Alcohol Withdrawal Syndrome?

Alcohol withdrawal syndrome (AWS) is a set of symptoms that happen when you are physically dependent on alcohol and suddenly stop drinking or greatly reduce how much you drink.2,3 Dependence means that your body and brain have gotten used to the presence of alcohol and you need it to feel normal and to be able to function.

The National Survey on Drug Use and Health reports that in 2019, 14.5 million people age 12 and older had alcohol use disorder (AUD).4 And according to the Journal of the American Medical Association, around half of long-term, heavy drinkers will develop some form of mild withdrawal when they stop drinking.3

What Are the Signs and Symptoms of Alcohol Withdrawal?

The specific signs and symptoms of alcohol withdrawal depends on how much and how often you drink, how long you’ve been drinking, your overall level of health, and other factors.2,11 But in general, the severity of AWS symptoms are sorted into 3 different stages—mild, moderate, and severe.5 Without proper treatment, you can go from mild to moderate or severe AWS fairly quickly.5

Stage 1 (mild) AWS symptoms may include: 5

  • Anxiety.
  • Shakes (tremor).
  • Trouble sleeping (insomnia).
  • Headache.
  • Heart palpitations (feeling like your heart is skipping a beat or beating too fast).
  • Gastrointestinal problems (throwing up, diarrhea).

Stage 2 (moderate) AWS symptoms can include all of the above plus: 5

  • Sweating.
  • High blood pressure.
  • Breathing fast.
  • Fast heart rate.
  • Confusion.
  • Overheating.

Stage 3 (severe) AWS is also known as delirium tremens (DT) and can include all stage 2 symptoms as well as: 5

  • Sudden, severe confusion.
  • Not being able to concentrate or focus.
  • Hallucinations (seeing, hearing, or feeling things that aren’t there).
  • Seizures.

How Long Does Alcohol Withdrawal Last?

How long alcohol withdrawal lasts depends on many factors, including your overall health and how much and how often you drink. In general, AWS symptoms begin within 6 to 8 hours after your last drink.2 They slowly get worse, being most intense 1 to 3 days after your last drink, and may last for a few weeks.2,7

Minor withdrawal symptoms usually start 6 hours after the last drink and typically last up to 2 days.8 Moderate to severe symptoms such as hallucinations can last 24 hours to 6 days.8 In rare cases, they can last between 1 and 6 months.8

Seizures can begin anywhere between 6 hours and 2 days after the last drink.8 If you have seizures during withdrawal, you may have a higher risk of progressing to severe stage 3 AWS, or DT. DT can begin 2 to 3 days after the last drink and last up to 2 weeks.8

Can You Die from Alcohol Withdrawal?

Though rare, people who have severe alcohol withdrawal symptoms such as seizures or DT can die from alcohol withdrawal.9,11 About 3 to 5 in 100 people (3 to 5%) with a history of heavy alcohol use will develop DT, and about 1 in 20 people with DT die.10,14 But it’s important to note that proper medical care and support greatly reduce your risk of death during alcohol withdrawal.10 Since alcohol withdrawal can be dangerous, you should talk to a doctor before trying to quit drinking on your own.2,10,11

How Can I Find Treatment for Alcohol Withdrawal?

Detox is usually the first step in the recovery process. Detox helps you safely and comfortably withdraw from alcohol.11 During detox, your care team may give you medicines to to help ease withdrawal symptoms and lower the risk of seizures and DT.12

After detox, many patients transition to some form of rehab or aftercare program. This additional treatment can help you address the underlying causes of AUD and gain the skills you’ll need to prevent relapse.

American Addiction Centers (AAC) is a leading provider of medical detox for AUD and other substance use disorders. We also offer treatment centers across the country to support you on your ongoing post-detox recovery journey. If you are ready to stop drinking, please call our detox hotline at to talk about your recovery options.

Sources

  1. National Institute on Alcohol Abuse and Alcoholism. (2021, April). Understanding Alcohol Use Disorder.
  2. Newman, R., Stobart Gallagher, M. & Gomez, A. (2021). Alcohol Withdrawal. StatPearls. Treasure Island, FL: StatPearls Publishing.
  3. Wood, E., Albarqouni, L., Tkachuk, S., Green, C. J., Ahamad, K., Nolan, S.… Klimas, J. (2018). Will This Hospitalized Patient Develop Severe Alcohol Withdrawal Syndrome?: The Rational Clinical Examination Systematic Review. JAMA, 320(8), 825–833.
  4. National Institute on Alcohol Abuse and Alcoholism. (2021). Alcohol Facts and Statistics.
  5. Muncie, H., Yasinian, Y. & Oge, L. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. American Family Physician, 88(9), 589–595.
  6. Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M.…Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353–365.
  7. S. National Library of Medicine. (2019). MedlinePlus: Alcohol withdrawal.
  8. Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial psychiatry journal, 22(2), 100–108.
  9. Mainerova, B., Prasko, J., Latalova, K., Axmann, K., Cerna, M., Horacek, R., & Bradacova, R. (2015). Alcohol withdrawal delirium – diagnosis, course and treatment. Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 159(1), 44–52.
  10. Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol health and research world, 22(1), 61–66.
  11. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and substance abuse treatment.
  12. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research, 9(9), VE01–VE07.
  13. Winslow, B. T., Onysko, M., & Hebert, M. (2016). Medications for Alcohol Use Disorder. American family physician, 93(6), 457–465.
  14. Rahman A. & Paul M. (2020). Delirium tremens. StatPearls Publishing.
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