Alcohol withdrawal refers to a condition that may occur when an individual with alcohol use disorder suddenly stops or significantly reduces their alcohol consumption. A person may notice initial symptoms after a few hours that could last for up to a week or longer.

Individuals with alcohol withdrawal syndrome may experience nausea, anxiety, extreme fatigue, and even seizures and hallucinations. These symptoms occur as a person’s body adjusts to the absence of alcohol in their system. And while symptoms typically improve within 5 days, some individuals may experience prolonged symptoms.

In this article, we will discuss the alcohol withdrawal timeline, factors that can influence the timeline, and treatment options for withdrawal symptoms.

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Alcohol withdrawal symptoms occur when an individual dependent on alcohol stops or significantly reduces their alcohol consumption. In many people, mild symptoms may appear within hours of their last drink. Common symptoms can include:

In some cases, symptoms may progress to severe withdrawal with seizures and delirium tremens.

Ethanol is the key ingredient in many alcoholic beverages, such as beer, wine, and spirits. As a depressant, alcohol can suppress the central nervous system (CNS), making the body reliant on it with prolonged exposure. It does this by reducing the excitatory portion of the CNS called the glutamate receptors while increasing the inhibitory portion called the gamma-aminobutyric acid receptors.

When a person ceases their consumption of alcohol, their CNS becomes overexcited, causing symptoms that have associations with alcohol withdrawal.

Individuals experiencing alcohol withdrawal syndrome should receive treatment according to the severity of their condition. Those with very mild symptoms can receive treatment as outpatients but may require the support and help of family and close friends for help.

People with moderate symptoms may require admission to a hospital so that a doctor can assess their symptoms and recommend an appropriate treatment plan. Research suggests indicates that individuals experiencing the following need hospital treatment:

  • absence of support systems
  • atypical laboratory results
  • high risk of delirium tremens
  • history of withdrawal seizures
  • accompanying psychiatric problems
  • other substance use disorders
  • suicidal ideation

If an individual is experiencing any symptoms associated with alcohol withdrawal syndrome, they can seek help from a healthcare professional.

Click here to learn more about helping someone with alcohol use disorder.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Symptoms of alcohol withdrawal can occur as early as a few hours after a person’s last drink. For some, these symptoms may peak within the first 24–48 hours after alcohol cessation, but they may continue after this point in others. And while symptoms generally improve within 5 days, some may experience prolonged symptoms.

According to a 2016 review, the usual alcohol withdrawal timeline and associated symptoms may occur as follows:

Minor withdrawal symptoms: 6–12 hours

Minor symptoms will start approximately 6–12 hours after the last drink. Symptoms can include tremors, excessive sweating, nausea and vomiting, hypertension, elevated heart rate, elevated body temperature, and rapid breathing.

Alcoholic hallucinosis: 12–24 hours

Some individuals may start experiencing hallucinations. They might start seeing and hearing things that are not there and experience sensations, such as pins and needles. While this is unusual, experts do not consider them severe.

Alcohol withdrawal seizures: 24–48 hours

At 24–48 hours after their last drink, some individuals may start experiencing seizures and some milder symptoms. If they are not already at the hospital, it is advisable to seek immediate medical attention.

Delirium tremens: 48–72 hours

This is where symptoms are usually the most severe, with some individuals displaying delirium tremens — hyperactive autonomic activity that can lead to cardiac collapse. Delirium tremens can last up to 5 days, with a mortality rate of up to 37%. This highlights the severity of the condition and the need for immediate medical attention.

Currently, health experts do not know if any factors influence the timeline of alcohol withdrawal syndrome aside from how much alcohol an individual typically consumes. More studies are necessary to better understand this condition and how certain factors may affect the timeline and severity of symptoms.

Some evidence suggests the following factors can affect the severity and duration of symptoms:

  • frequency of drinking
  • the amount they consume during drinking
  • length of time drinking
  • medical history
  • co-occurring health conditions
  • if they have other substance use disorders

Individuals experiencing mild symptoms could receive home treatment with the help of close friends and family members. However, if symptoms worsen, it is advisable to seek immediate medical attention so that individuals receive appropriate treatment.

A doctor can perform a typical checkup and a blood test to see if the individual is still in good health or needs a treatment plan or medication. Others experiencing more severe symptoms may require hospitalization to avoid life threatening conditions. A doctor may also need to administer fluids intravenously to prevent dehydration and correct electrolyte abnormalities. They may also need to give medications to help reduce the severity of the symptoms.

Most treatment options may include the administration of long-acting benzodiazepines. A common benzodiazepine that a doctor may prescribe includes diazepam. During initial treatment, a person may receive a higher dosage of benzodiazepines to reduce symptoms and the urge to drink alcohol. After symptoms subside, a doctor will taper the dose until they determine the individual no longer requires medication.

Some of the alcohol withdrawal symptoms that benzodiazepines can help prevent and treat include:

  • headaches
  • nausea and vomiting
  • insomnia
  • aggravation and irritability
  • chills and sweats
  • seizures

Research also notes that an intravenous administration of benzodiazepines can help decrease the risk of delirium tremens.

In addition to benzodiazepines, a person may also require other medications, such as phenytoin, barbiturates, and sedatives, which include propofol, ketamine, or dexmedetomidine.

Many people experiencing symptoms associated with alcohol withdrawal syndrome will likely recover with suitable treatment. However, it is important for individuals to receive medical attention if symptoms are severe or worsen over time.

Some symptoms, such as irritability, fatigue, and sleep disturbances, may persist over time while the body adjusts to the lack of alcohol. Individuals may also want to consider maintenance medications, a support group, or enlisting the support of friends.

Alcohol withdrawal syndrome is a condition that occurs when an individual stops consuming alcohol after a long-term dependence. Symptoms that have associations with this condition can be mild, severe, or in some cases, life threatening.

Symptoms usually begin within 6–12 hours of the last drink and can last for a few days. For most people, symptoms will typically improve within 5 days. Individuals experiencing severe symptoms may require immediate treatment at the hospital treatment to minimize the risk of potential complications.