How Long Does Alcohol Withdrawal Last? Signs, Symptoms & When to Seek Help
Last Updated Dec 2, 2021
Alcohol withdrawal lasts for up to a week, and for some people, it can be fatal. If you have a years-long and intense relationship with alcohol, withdrawal could be part of your future.
Alcohol withdrawal treatment usually consists of medication management and fluids. People typically need this treatment within a hospital setting.
When Does Alcohol Withdrawal Start?
Within hours of the last drink, alcohol withdrawal begins. People who drink heavily before bed may awaken in the morning in the throes of withdrawal.
Alcohol receptors dot the brain, slowing electrical activity from cell to cell. This is an artificial suppression, and those signals do not go away. When the alcohol wears off, all of that electrical activity springs back. Sometimes, all of that activity is overwhelming and triggers unpleasant symptoms.
A typical alcohol withdrawal timeline looks like this:
- Immediate: A sense of nervousness sets in. People may blink too frequently, discuss their discomfort, and feel a general sense of unease.
- Day 1: More significant symptoms begin, and they can involve hallucinations that are auditory, visual, or both.
- Day 2: Symptoms worsen. People may struggle to understand the difference between hallucinations and reality. Seizures may also set in.
- Day 3: If delirium tremens happens, it begins here. It can be life-threatening.
When Does Alcohol Withdrawal Stop?
The severity of alcohol abuse will determine how long symptoms last. In most people, however, withdrawal will last for about a week.
Symptoms progress very slowly and subtly. But significant symptoms that start at day two will last up to seven days. Severity peaks at day five.
What Does Alcohol Withdrawal Look Like?
It is important to recognize that true alcohol withdrawal is not the same as a hangover. Withdrawal is a significant medical condition that can impact your long-term health.
- Minor: Anxiety, insomnia, GI upset, headaches, and heart palpitations are among the symptoms an expert considers mild. To someone living through them, these symptoms can be more than uncomfortable. They can be terrifying. Your body may feel like it is out of your control.
- Moderate: These symptoms are added to the mild problems people are already experiencing. Seizures fall into this class. Some people experience seizures as mild tremors in the hands, feet, and head. Others have a sense of full-body trembles that they can’t control.
- Significant: Symptoms associated with delirium tremens fall into this class. People with these symptoms feel a lack of control over their bodies, and their symptoms may be visible to others. They may look like they’re flopping, rolling, or frothing at the mouth.
About half of all people with an alcohol abuse issue will develop withdrawal symptoms when they reduce or discontinue drinking. Everyone’s symptoms will look differently, but they all stem from the same cause.
Brain cells aren’t designed for suppression. Cells are made to trade electrical activity to stay connected and communicate. Alcohol stops that communication artificially. When the suppression is removed, those cells zoom back to life.
Sometimes, that can cause an electrical firestorm within the brain, leading to completely unpredictable communication. Seizures are a common result of that firestorm.
Delirium Tremens: What Is It?
Mild alcohol withdrawal symptoms can be frightening. Delirium tremens symptoms can be terrifying, both for the person going through it and those watching the problem unfold.
Delirium tremens sets in after mild and moderate symptoms are already in place. Think of these symptoms as a dramatic escalation in your body’s response to the lack of alcohol.
Delirium tremens symptoms include:
- Hallucinations. People may see or hear things that others can’t see or hear. People in the middle of delirium tremens may seem like they are in the middle of a psychotic episode, as they talk to or react to the invisible.
- Tremors. Shivers and shakes take over the entire body. People may struggle to walk. They likely cannot talk, eat, or drink without help.
- Digestive problems. People may vomit any fluids or foods they attempt to eat or drink.
- Sweating. As symptoms progress, people may look like they’ve been exercising heavily. They may soak through all of their clothing with sweat, and you may see rivers of sweat running down their bodies.
- Hypertension. When doctors take blood pressure measurements, they may notice incredibly high numbers. People may feel their hearts are beating quickly, and they’re right.
Delirium tremens does not happen to everyone in alcohol withdrawal. Typically, it only happens to people with a longstanding or significant relationship with alcohol.
Unfortunately, delirium tremens can be incredibly dangerous. Seizures can raise body temperature, which further harm brain cells. Without prompt treatment, people with these symptoms can die.
With proper management, only about 5 percent of people with delirium tremens die. But the right treatment is crucial.
How Alcohol Withdrawal Treatment Works
Doctors treat mild withdrawal much differently than they do delirium tremens. Each person is different.
For mild and moderate cases, a treatment plan involves:
- Hydration. People who can drink fluids and keep them down should do so. Those who cannot can benefit from IV fluids.
- GI protection. Anti-nausea medications can help some people to stop vomiting.
- Rest. Staying calm and collected in a dark room could help symptoms to subside.
In significant cases, a treatment plan involves:
- Hospitalization. Doctors need to monitor heart rate and breathing rates. That could mean staying in a hospital.
- Benzodiazepines. These medications slow electrical activity within the brain. A tapered dose can help to transition the brain from intoxication to sobriety.
- Phenobarbital. Some people don’t respond to benzodiazepines, and they need a stronger solution. Phenobarbital could be a good solution, and it can be provided in a tapering dose.
- Heart medications. People with a galloping heartbeat and high blood pressure may need a medication solution.
When alcohol withdrawal is complete, treatment is not done. People will still have an emotional connection to alcohol and need additional help to avoid returning to drinking.
People who go through multiple withdrawal episodes are at a higher risk of delirium tremens, so it’s critical to get help as quickly as possible.
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Use of Phenobarbital in Alcohol Withdrawal Management: A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. (September 2019). Psychosomatics.
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