Timeline of Alcohol Withdrawal Symptoms | Wellness Retreat

Timeline of Alcohol Withdrawal

Alcohol addiction affects millions of Americans, and only a small percentage actively seek help. The National Institute on Alcohol Abuse and Alcoholism estimates that 15.1 million adults suffer from alcohol use disorder. However, only 6.7% of these people will seek professional support to heal the addiction.

Timeline of Alcohol Withdrawal Symptoms

Timeline of Alcohol Withdrawal

Alcohol addiction affects millions of Americans, and only a small percentage actively seek help. The National Institute on Alcohol Abuse and Alcoholism estimates that 15.1 million adults suffer from alcohol use disorder. However, only 6.7% of these people will seek professional support to heal the addiction.

Table of Contents

Even a casual drinker will experience the symptoms of alcohol withdrawal after having a few drinks.  These symptoms get more severe based on the amount of alcohol that a person consumes and how long they have been drinking to that extent.  In cases where a person has become physically dependent on alcohol, these symptoms can be life-threatening if not overseen by a trained medical professional.

 

Without detox and therapeutic support, it’s almost impossible for an individual to recover from alcohol addiction fully. The first step in healing from the physical, mental, and emotional impacts of alcohol abuse is to detox. The detox process requires the body to withdraw from alcohol use entirely. 

 

So, alcohol detox and withdrawal information are vitally important for individuals (and their loved ones) struggling with alcohol addiction.

Alcohol Addiction: Why It's So Dangerous

Alcohol addiction—also known as alcohol use disorder, alcoholism, and alcohol dependency—is unique among addictions and can be particularly dangerous.

 

What makes alcohol dependency so dangerous?

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

1. Alcohol is Legal and Socially Acceptable

Because alcohol is legal to consume and socially acceptable, physical and psychological dependence can develop quickly. People may drink heavily in the normal course of one’s social engagements. Since alcohol is socially acceptable, people may not view their drinking as problematic.

 

When the addictive substance is illegal, it’s clear from the start that there is a problem. From the beginning, the secrecy and obvious danger of procuring street drugs offer a clue that the person is “playing with fire.”

 

In contrast, a person may develop a severe alcohol habit before their friends, family, colleagues—or even themselves—notice it. And they can hide their dependence, for a long while, under the guise of “heavy drinking.” That’s what makes alcohol sneaky-dangerous.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

2. Alcohol Contributes to a Variety of Illnesses

An alcohol use disorder can contribute to a wide variety of physical illnesses, mental disorders, and emotional disturbances, including:  

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

3. Alcohol Withdrawal Symptoms Can Be Fatal

Another reason alcohol dependence is so dangerous is that the withdrawal symptoms from alcohol can be fatal. For this reason, professional support for alcohol detox is highly recommended, particularly for those suffering from long-term alcohol dependency.

Signs of Alcohol Dependence

The Department of Health and Human Services dietary guidelines recommend that adults of legal drinking age choose not to drink or drink in moderation. 

 

Drinking in moderation means:

There isn’t an objective measure of when someone is classified as an alcoholic. However, a person with an alcohol dependency will almost certainly exceed these drink-per-day recommendations. In addition, a person with alcohol use disorder will find their lives disrupted by the alcohol habit. 

 

An alcoholic, for instance:

If a person notices themselves engaging in any of the following behaviors, they may be suffering from alcohol use disorder:

If an individual is experiencing some or most of these symptoms, they may have alcohol dependence. If this is the case, entering a detox and recovery program would be in their best interest.

What is Alcohol Withdrawal?

The first step in the journey of recovery from alcohol use disorder is to complete a detox. This means that the person needs to eliminate alcohol from the body entirely.

 

With long-term alcohol consumption, the brain and entire central nervous system become accustomed to the presence of the substance. So, as the body and mind withdraw from their dependency upon alcohol, specific withdrawal symptoms are likely to appear.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

The Biochemistry of Alcohol Withdrawal

Alcohol is a depressant that slows down central nervous system functioning.

 

When individuals use alcohol over a long period, their brain chemistry changes. Because alcohol is a depressant, the body responds by producing more stimulating chemicals. This includes the neurotransmitters dopamine and gamma-aminobutyric acid (GABA). This creation of stimulating neurotransmitters temporarily restores chemical homeostasis. It is the body’s attempt to counteract the effects of long-term alcohol use.

 

But over time, the body builds up a tolerance to alcohol. And this means that an individual needs to consume larger and larger quantities to achieve the same feeling of being intoxicated. At the same time, the brain is producing more and more stimulating neurotransmitters to “keep up” with the increased alcohol intake. As this cycle continues, the person’s biochemistry becomes increasingly imbalanced.

 

When a person stops consuming alcohol, there’s a period when their brain hasn’t fully registered this sudden cessation. As a result, the brain so continues to produce stimulating neurotransmitters. And this is what causes withdrawal symptoms.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

The Dangers of Alcohol Withdrawal

A person who has a long-term dependency on alcohol will almost certainly experience uncomfortable withdrawal symptoms. And without professional supervision during the detox process, some withdrawal symptoms could be fatal.

 

For this reason, medical and psychiatric supervision of the alcohol detox process is necessary. Professionals can help people safely detox from alcohol and move forward with their recovery.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms—physical, mental, and emotional—can range from mild to severe.

 

Generally, the level of dependency on alcohol will correlate to the severity of symptoms. Those whose dependence is deep and long-term will typically experience the most severe withdrawal symptoms.

Mild Withdrawal Symptoms

Mild symptoms of alcohol withdrawal that a person in detox may experience include:

Severe Withdrawal Symptoms

Some of the more severe symptoms of alcohol withdrawal may include the following:

The most dangerous of these severe symptoms are seizures associated with alcohol withdrawal. Without proper medical supervision in a detox facility, these seizures can be fatal.

Delirium Tremens (DTs)

Delirium tremens (DTs) is a severe syndrome that occurs in about 2% of people with alcohol use disorder during alcohol withdrawal.

 

Delirium tremens includes the severe symptoms of alcohol withdrawal (listed above), as well as:

Delirium tremens may also result in further medical complications such as cardiac arrhythmia, respiratory arrest, oversedation, or aspiration pneumonitis. These conditions all have the potential to be fatal—or to cause serious infections.

 

An individual is at greater risk of delirium tremens if:

Alcohol Withdrawal Timeline

There is no exact timeline for alcohol withdrawal because each person is different. The unique circumstances of each person going through detox will influence how long it takes and which withdrawal symptoms are experienced.

Factors That Affect an Alcohol Withdrawal Timeline

Individuals may experience alcohol withdrawal differently depending on several factors, such as:

Overview of Alcohol Withdrawal Timeline

As mentioned above, the exact timing depends upon several individual factors. But typically, a person undergoing alcohol detox can expect a few things.

 

Alcohol withdrawal symptoms include:

First 4 and 12 hours

The first alcohol withdrawal symptoms appear between 4 and 12 hours after taking the last drink.

First 4 and 12 hours

First 24 to 72 hours

The alcohol withdrawal symptoms will peak during the first 24-72 hours—and tend to be the worst at around 48 hours: the second day without a drink.

First 24 to 72 hours

Day 3 and 4

For individuals who experience delirium tremens (DTs)—these symptoms usually appear 48-72 hours after heavy drinking has ceased. They typically continue for 3-4 days though they may last up to 8 days.

Day 3 and 4

Day 4 and 5

Most withdrawal symptoms will be gone by day 4 or 5. However, in some extreme cases, some less severe symptoms may last from one week to a month.

Day 4 and 5

Stages of Alcohol Withdrawal

The severity of alcohol withdrawal can be categorized into three levels or stages—mild, moderate, and severe. This framework can be used to assess and describe the symptoms that a person is experiencing.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

Stage 1 (Mild)

Mild withdrawal consists of less severe symptoms such as headaches, anxiety, irritability, and insomnia.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

Stage 2 (Moderate)

Moderate withdrawal includes stage 1 symptoms, sweating, rapid heart rate, lower fever, and slight confusion.

Timeline of Alcohol Withdrawal Symptoms - Alcohol Withdrawal Symptoms

Stage 3 (Severe)

As its name implies, severe stage 3 withdrawals are the most severe and include serious symptoms such as hallucinations, extreme disorientation, and seizures. A stage 3 withdrawal has the potential to be fatal.

Alcohol Withdrawal Timeline by Hour

There are a few common symptoms that appear during the alcohol withdrawal process. Each case is unique and may differ slightly from this timeline.

The First 8 Hours of Alcohol Withdrawal

For most people going through detox, alcohol withdrawal symptoms will begin within the first eight hours.

 

These first symptoms are typically mild at first and begin gradually. They can include:

 

• Restlessness

• Irritability

• Nervousness

• Pale or clammy skin

• Loss of appetite

• Nausea

• Mild shakiness

Hours 12 to 24 of Alcohol Withdrawal

The alcohol withdrawal symptoms wi

During the 12-24 hours after the last drink, most people undergoing detox will experience more noticeable symptoms. These symptoms may still be mild or might increase in severity. For instance:

 

• Depression

• Mood swings

• Night sweats

• Nightmares

• Headaches or migraines

• “Brain fog” (not thinking clearly)

• Insomnia or difficulty sleeping

• Vomiting

Hours 24 to 72 of Alcohol Withdrawal

Alcohol withdrawal symptoms typically peak during this time frame: as early as 24 hours or closer to 72 hours. The symptoms of this period are the most uncomfortable and severe and may include the following:

 

• Nausea

• Vomiting

• Tremors

• Agitation

• Seizures

• Hallucinations

 

This is also the period in which delirium tremens are most likely to occur, which requires immediate medical attention.

The Final Few Weeks of Alcohol Withdrawal

For most people, alcohol withdrawal symptoms will begin to subside after 72 hours. A “new normal”—physically and psychologically—will be established over the next few weeks.

 

It’s also possible, however, for withdrawal symptoms to continue for several weeks. In rare cases, a person undergoing alcohol detox may experience more persistent withdrawal-related symptoms. These may include sleep disturbances, fatigue, and mood changes—that last for months.

The Importance of Detoxing from Alcohol

Going through detox is the vital first step in recovering from alcohol use disorder. While the journey includes many other steps, they can’t be completed until this first one is completed. The recovery can’t move forward until a person has reduced their physical dependence and overcome the alcohol withdrawal symptoms.

 

The first few weeks after detox has been completed are also critical. This is because this is when the risk of relapse is highest. So, the person must formulate a plan of how they will abstain from alcohol during this crucial time.

 

Once alcohol is fully cleared from an individual’s system, they can begin to address the issues that fuel the addiction. And, ultimately, regain their health, freedom, and genuine enjoyment of life.

Treatment Options for Alcohol Withdrawal

Alcohol withdrawal can be a scary and unsettling experience. For this reason—and because there are genuine dangers involved—a person should never attempt to detox from alcohol alone.

 

In a medical setting, trained professionals can monitor the withdrawal symptoms and be prepared to administer any necessary medications. Medical professionals can provide patients with a safe and comfortable detox experience.

 

Medical treatment may also help a person with alcohol use disorder prepare to quit drinking. The Food and Drug Administration (FDA) has approved three nonaddictive medications for alcohol use disorder. These medications can help people reduce their alcohol intake and prevent relapse after detox. These medicines include:

Behavioral therapies can be successful in helping to prevent relapse and establish new healthy habits and self-care rituals. 

 

Such therapies include:

Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

 

Centers for Disease Control and Prevention. Dietary Guidelines for Alcohol.

https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm

 

Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series 45, DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration.

https://www.ncbi.nlm.nih.gov/books/NBK64115/pdf/Bookshelf_NBK64115.pdf

 

Gortney, J.S., Raub, J.N., Patel, P., Kokoska, L., Hannawa, M., & Argyris, A. (2016). Alcohol withdrawal syndrome in medical patients. Cleveland Clinic Journal of Medicine, 83(1), 67-79.

https://www.ccjm.org/content/ccjom/83/1/67.full.pdf

 

Grover, Sanseep & Ghosh, Abhishek (December, 2018). Delirium Tremens: Assessment and Management. Journal of Clinical and Experimental Hepatology, 8:4. 

https://www.jcehepatology.com/article/S0973-6883(18)30056-2/fulltext

 

Muncie Jr., H. L., Yasinian, Y., & Oge, L. K. (2013). Outpatient management of alcohol withdrawal syndrome. American Family Physician, 88(9), 589-595.

https://www.aafp.org/pubs/afp/issues/2013/1101/p589.html

 

National Institute on Alcohol Abuse and Alcoholism. (April, 2021). Understanding Alcohol Use Disorder.

https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder

 

Sachdeva, Ankur; Choudhary, Mona Choudhary, & Chandra, Mina (September, 2105). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research, 9:9.

https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&volume=9&issue=9&page=VE01&issn=0973-709x&id=6538

 

Saitz, Richard. Introduction to Alcohol Withdrawal. Alcohol Health Res World. 1998; 22(1): 5–12.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761824/

 

Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf