Alcohol Withdrawal Timeline: What To Expect and When To Seek Help

Alcohol withdrawal can occur when someone who struggles with alcohol abuse suddenly stops drinking. It can be uncomfortable or even dangerous, discouraging someone from quitting alcohol use. 

If you’re determined to overcome alcohol withdrawal symptoms, you’ve made an important first step. Understanding the timeline for the withdrawal and detox process can be helpful. Because success in sobriety is so closely tied to preparation, it is important to know what to expect when you quit drinking and how long it may take.

Alcohol Withdrawal Timeline

Although the exact timeline for alcohol withdrawal symptoms can differ by person, you can expect a general withdrawal process when you stop drinking. There are no specific, medically defined stages of alcohol withdrawal; however, there are stages that someone going through alcohol withdrawal can expect. Because the symptoms and the timeline can be unpredictable in some cases, people with moderate to severe alcohol addiction should only undergo alcohol withdrawal while under medical care:

Stage 1: 6–8 Hours After the Last Drink

Stage one starts six to eight hours after your last drink for heavier users. At this stage, mild withdrawal symptoms may appear and will be more irritating than uncomfortable.

Physical Symptoms

Headache, anxiety and tremors may develop as symptoms start. Initially, these symptoms will be more mild and irritating; however, they will slowly increase in intensity. Some people may not have any symptoms this early in the detox process.

Emotional and Mental Symptoms

As symptoms begin, there is little in the way of emotional and mental symptoms. Anxiety may start to develop; however, this will not be particularly severe compared to later stages.

Stage 2: 12–24 Hours After the Last Drink

Stage two begins 12–24 hours after your last drink and withdrawal symptoms can intensify during this stage. The end of this stage will be the peak of withdrawal symptoms for those with mild dependence. Those with severe dependence, however, will face continued worsening of symptoms.

Physical Symptoms

Any symptoms already present will continue to intensify. Anyone who experiences physical withdrawal symptoms will generally begin to have them within 24 hours of stopping alcohol. Symptoms can include:

• Tremors
• Agitation
• Insomnia
• Hallucinations
• Nausea 
• Vomiting  

Emotional and Mental Symptoms

As physical symptoms intensify, cravings will begin. Your body will subconsciously recognize that you need alcohol to avoid withdrawing and start craving it to end the physical symptoms. Anxiety and agitation are likely.

Stage 3: 24–48 Hours After the Last Drink

Stage three begins 24–48 hours after your last drink. During this stage, symptoms from stage two can continue to worsen. Serious alcohol withdrawal symptoms can begin 36–72 hours after stopping drinking, with around the 48-hour mark being the most common peak for symptoms.

Physical Symptoms

When alcohol symptoms peak, all symptoms will be present and at their worst. You will likely have tremors, vomiting and clammy, sweaty skin. Alcohol withdrawal seizures can occur around this time, and delirium tremens, the most severe complication of alcohol withdrawal, may manifest.

Emotional and Mental Symptoms

Some mental symptoms will peak when physical symptoms do. Anxiety, hallucinations, agitation and psychosis may be present at their worst during the peak of your symptoms.

Stage 4: 2–5 Days After the Last Drink

Stage four starts two to five days after your last drink. In this stage, withdrawal symptoms may have already peaked or will peak and then begin to resolve. Typically by day four, physical symptoms start to improve.

Physical Symptoms

After symptoms peak, they will gradually reduce in intensity but more slowly than they came on. New or worsening physical symptoms shouldn’t occur after the peak, and things should get progressively easier.

Emotional and Mental Symptoms

Severe mental symptoms like agitation and psychosis should also start to improve. As the more serious emotional and mental symptoms resolve, longer-lasting mental symptoms may become more obvious. Symptoms like alcohol cravings and depression that can last months may become clearer and more present.

Stage 5: 1–6 Months After the Last Drink

Stage five happens one to six months after your last drink. This stage is also called protracted withdrawal. Although acute withdrawal symptoms may be far behind you, you may still have lingering symptoms like increased anxiety and trouble sleeping. Sometimes, these symptoms can last for years.

Post-Acute Withdrawal Syndrome

Physical symptoms will completely disappear once detox is over; however, some can continue for months. Primarily these are mental symptoms and include depression and alcohol cravings. 

Lingering Effects

The most common lingering effect for many will be alcohol cravings. Alcohol is often used as a way to cope. Emotions that are hard to deal with may trigger the desire to use alcohol. Having to rely on something other than alcohol can also make it harder to cope with difficulty, leading to depression or anxiety.

How Long Do Alcohol Withdrawal Symptoms Last?

Immediately after you stop drinking, you may notice that acute withdrawal begins within six to eight hours after the last drink. This withdrawal phase may continue and worsen for around four days after you quit drinking.

After this acute phase of alcohol withdrawal is complete, a period of prolonged withdrawal is possible. This phase may last months, while often much less severe and only involving emotional symptoms.

When Does Alcohol Withdrawal Start?

Alcohol withdrawal symptoms can start within six to eight hours of the last drink. At that early stage, symptoms will likely be mild and may include tremors, nausea and anxiety. If left untreated, withdrawal symptoms can worsen significantly and become dangerous.

Factors That Influence the Alcohol Withdrawal Timeline

Different people may experience alcohol withdrawal differently. This includes not only the withdrawal symptoms but also the withdrawal timeline. Some factors that impact the alcohol withdrawal timeline include:

• Age: Younger people, especially those under 30, are less likely to experience severe alcohol withdrawal symptoms than older adults.
• Medications: People who take certain central nervous system depressants like sedatives may be at increased risk for withdrawal symptoms.
• Previous withdrawal attempts: A person who has previously gone through alcohol withdrawal may be more likely to have serious withdrawal symptoms when they go through it again. This phenomenon, called kindling, can exacerbate withdrawal symptoms.
• Other medical conditions: Other medical conditions can complicate withdrawal. Medical problems that can impact withdrawal differ widely and may sometimes be linked to alcohol addiction. Some complicating conditions can include stomach bleeding and liver problems.

Treatment for Alcohol Withdrawal

Alcohol withdrawal is uncomfortable and dangerous. Someone likely to experience moderate to severe alcohol withdrawal should always seek medical attention to avoid complications and ensure they are comfortable during the process. 

Medical Support for Alcohol Withdrawal

Alcohol withdrawal is the most dangerous form of withdrawal, even more than heroin withdrawal. Medical support can quickly recognize and treat complications before they become serious. Medical support offers three important things during alcohol withdrawal, including: 

• Increased safety
• More comfort 
• Support after withdrawal

Medications for Withdrawal

Several medications can be used to help reduce the severity of withdrawal and prevent serious complications. These include:

• Benzodiazepines: This class of drugs, including diazepam (Valium), chlordiazepoxide (Librium) and lorazepam (Ativan), is considered the first-line treatment for alcohol withdrawal. They reduce the severity of withdrawal symptoms and lower the risk of seizures and delirium tremens.
• Barbiturates: Drugs like phenobarbital are sometimes used in severe cases of alcohol withdrawal, particularly when benzodiazepine treatment is ineffective. They can control symptoms and reduce the risk of seizures but carry a risk of dependency and require careful monitoring.
• Anticonvulsants: Medications such as carbamazepine (Tegretol), gabapentin (Neurontin) and valproate (Depakote) can also manage alcohol withdrawal symptoms. 
• Adjuvant Medications: This includes many medications like beta-blockers (propranolol) or alpha-2 agonists (clonidine), which manage specific symptoms such as high blood pressure or rapid heart rate. They are generally used with other treatments.

Mental Health Counseling for Withdrawal

Mental health counseling is important in managing alcohol withdrawal and promoting recovery. It offers the chance to explore your struggles with alcohol, learn to identify triggers and form healthier coping mechanisms. Mental health counseling includes approaches such as cognitive-behavioral therapy and motivational interviewing or group therapies with peer support. While counseling is more important after detox, it can play an important role during withdrawal.

Alcohol Detox Treatment Programs

If you or a loved one struggles with drinking, help is here. Our medical detox program at The Recovery Village Columbus can help put you on the path to a better, alcohol-free life. Our facility not only offers around-the-clock medical detox care as you are gently weaned from drinking, but we also follow this with a full continuum of treatment options, including inpatient and outpatient rehab, to help keep you sober over the long term. Don’t wait: contact our Recovery Advocates today to learn more about how we can help.

Alcohol Withdrawal FAQs

Can You Die From Alcohol Withdrawal? 

Some alcohol withdrawal symptoms can be fatal if left untreated. For example, when untreated, the alcohol withdrawal complication delirium tremens is fatal in about 37% of cases.

What Does Alcohol Withdrawal Feel Like?

Alcohol withdrawal feels very uncomfortable. In mild cases, a person may only have symptoms like mild tremors, anxiety and nausea. However, in more severe cases, a person may have severe tremors, seizures, hallucinations, unstable blood pressure and may develop delirium tremens. 

What Helps Alcohol Withdrawal?

The gold standard treatments for alcohol withdrawal symptoms are low-dose, long-acting benzodiazepines like diazepam. However, a person must be closely monitored when receiving benzodiazepines during alcohol withdrawal, as symptoms can be unpredictable and may suddenly become severe.

Can Your Body Go Into Shock When You Stop Drinking?

Medically speaking, shock is a condition that develops when blood flow to your body is interrupted. Therefore, when you stop drinking, your body does not technically go into shock. That said, stopping alcohol when your body has become reliant on it to function normally can certainly feel like a shock to your system. 

What actually occurs is the neurotransmitters in your brain are attempting to rebalance themselves now that alcohol is no longer available. Specifically, alcohol increases the activity of the neurotransmitter gamma-aminobutyric acid (GABA). When you stop drinking, your brain must cope with sudden changes in the levels of GABA and other neurotransmitters.

How Long Do Alcohol Withdrawal Shakes Last?

Shakes, or tremors, are a common symptom of alcohol withdrawal. They can start within six to eight hours after the last drink and last for up to five days in severe cases.

What Medications Are Used For Alcohol Withdrawal?

Although many medications can help with alcohol withdrawal symptoms, the gold standard medications are long-acting benzodiazepines like diazepam (Valium) or chlordiazepoxide. Like alcohol, benzodiazepines enhance the level of GABA in the brain. This means they can help ease your transition to becoming alcohol-free while keeping GABA levels high enough in your brain to avoid or reduce withdrawal symptoms.