Alcohol withdrawal syndrome is a medical condition that can be life-threatening, especially for people with long-term and intense alcohol abuse, dependence, and addiction. Alcohol withdrawal symptoms emerge within 4-12 hours after stopping drinking. Acute symptoms peak in intensity during day 2 and typically start to improve by day 4 or 5. However, this is just the acute alcohol withdrawal timeline—protracted withdrawal symptoms may last for up to six months. [1],[2]
Because alcohol withdrawal symptoms can be life-threatening, medical detox services are highly recommended. You can undergo alcohol detox in a hospital under 24/7 medical care, supervision, and monitoring to ensure your safety. The treatment team will administer medications like benzodiazepines to manage your symptoms. This treatment may affect the alcohol withdrawal timeline.
What is the Alcohol Withdrawal Seizure Timeline?
Quick Answer
Alcohol withdrawal seizures are most likely to happen between 12 and 24 hours after you stop drinking. About 3-5% of people going through alcohol withdrawal experience seizures or convulsions. [1],[2]
When Does Alcohol Withdrawal Start?
Within 4-12 of the last drink, alcohol withdrawal symptoms emerge.[1],[2] People who drink heavily before bed may awaken in the morning in the throes of withdrawal.
A typical alcohol withdrawal symptoms timeline looks like this:[1],[2],[3]
| Time Since Last Drink | Withdrawal Symptoms | Intensity |
|---|---|---|
| 4-12 hours | Insomnia, tremors, anxiety, nausea, heart palpitations, increased blood pressure | Mild |
| 12-48 hours | Hallucinations, delusions, seizures, agitation, tremors, confusion | High, peak intensity |
| 4-5 days | Sleep disturbances, alcohol cravings, anxiety, depressed mood | Moderate/mild, symptoms start to improve and disappear |
| 3-6 months | Insomnia, anxiety, autonomic dysfunction | Mild, fluctuating |
This withdrawal timeline is for individuals who quit drinking cold turkey without professional detox treatment or medical oversight. So this is how your body will naturally progress through alcohol withdrawal, without medications or care. However, everyone’s alcohol detox timeline is different, and many factors affect the duration.
What is the Timeline for Delirium Tremens?
Quick Answer
Delirium tremens is a life-threatening, severe form of alcohol withdrawal. Rapid heart rate, hallucinations, high blood pressure, high body temperature, intense sweating, and agitation are common symptoms associated with DTs. These symptoms can last longer than typical alcohol withdrawal, often for one week or even longer.[2]
When Does Alcohol Withdrawal Stop?
The severity of alcohol abuse will determine how long symptoms last. In most people, however, alcohol withdrawal will last for about one week.
Symptoms progress very slowly and subtly. However, significant symptoms that start at day two will last up to seven days. Severity peaks at day five.[1],[2]
Factors That Affect the Alcohol Withdrawal Timeline
The factors that affect the alcohol symptoms withdrawal timeline include:
- Your physiology
- Your liver and kidney functioning
- How much you drank and for how long
- Co-occurring mental health or medical conditions
- Your previous withdrawal experiences
- Whether you mix alcohol with other drugs
- Whether you quit drinking cold turkey or receive medical detox.
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 be life-threatening whereas a hangover refers to unpleasant symptoms experienced the day after alcohol consumption.
Hangovers don’t tend to be medically concerning whereas alcohol withdrawal often requires professional medical care or detox services. An estimated 50% of people with alcohol use disorder will develop alcohol withdrawal symptoms when they stop drinking.[4]
Three classifications of alcohol withdrawal symptoms exist, including:[1],[2],[3]
- Mild: Anxiety, insomnia, GI upset, tremors, headaches, twitching, elevated blood pressure, and heart palpitations are among the symptoms an expert considers mild. To someone living through them, these symptoms can be more than uncomfortable.
- Moderate: Hallucinations and withdrawal seizures are considered moderate symptoms. About half of people who have a seizure will progress to delirium tremens.
- Severe: Delirium tremens is considered the most severe type of alcohol withdrawal. It’s characterized by visual hallucinations, severe autonomic dysfunction, confusion, seizures, rapid heart rate, agitation, excessive sweating, and abnormally high body temperature.
Delirium tremens is a potentially fatal form of alcohol withdrawal that requires intensive medical care in a hospital. These symptoms may have a longer timeline than mild alcohol withdrawal, peaking around 5 days and resolving within about one week.[3]
About 3-5% of individuals going through alcohol withdrawal will experience dangerous withdrawal symptoms like delirium tremens and seizures.[2],[4]
How Long Do Post-Acute Withdrawal Symptoms Last?
Once acute alcohol withdrawal is complete, you may notice post-acute withdrawal symptoms or protracted withdrawal symptoms that last for weeks, months, or even one year after you’ve quit drinking. [5]
These symptoms may include: [5]
- Anxiety
- Panic attacks
- Depression
- Irritability
- Alcohol cravings
- Apathy
- Sleep disturbances
- Increased sensitivity to stress
- Difficulty with memory recall, problem-solving, and learning
It’s estimated that about 75% of people in recovery from alcohol addiction experience post-acute withdrawal symptoms.
How Alcohol Withdrawal Treatment Works
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.
Due to the risk of complicated and dangerous withdrawal, the Substance Abuse and Mental Health Services Administration (SAMHSA) strongly recommends 24-hour medical care for the management of alcohol withdrawal.[6]
The safest detox settings for alcohol withdrawal include:
- Acute care hospital
- Psychiatric hospital
- Free-standing detox center with 24/7 medical care
- Inpatient alcohol rehab center with medical detox services
Each of these settings can provide round-the-clock supervision, care, and oversight to ensure a person’s safety during alcohol withdrawal. Interventions may include:
- Supportive care, such as IV fluids
- Nutritional therapy or vitamins
- Calm, peaceful environment
- Withdrawal medications, such as benzodiazepines
- Additional medications like antipsychotics or anticonvulsants if needed
- Counseling
Once a person is stabilized and goes through acute withdrawal, treatment isn’t done. In most cases, the medical team will refer the patient to a longer-term alcohol addiction treatment program where they can address the underlying reasons they abused alcohol in the first place.
- Alcohol Withdrawal. (September 2021). StatPearls.
- Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013).
- PAWSS: Validation of the Prediction of Alcohol Withdrawal Severity Scale. (2019). Rowan University.
- Diagnosis and Treatment of Acute Alcohol Intoxication and Alcohol Withdrawal Syndrome: Position Paper of the Italian Society on Alcohol. (2019). Internal and Emergency Medicine.
- Post-Acute Withdrawal Syndrome (PAWS). SEMEL Institute for Neuroscience and Human Behavior.
- Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol TIP 45. Substance Abuse and Mental Health Services Administration.
- Delirium Tremens: Assessment and Management. (December 2018). Journal of Clinical and Experimental Hepatology.
- What Is the Mortality Rate for Delirium Tremens? (November 2020). Medscape.
- 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.