Alcohol Withdrawal: Symptoms, Timeline, and Detox Treatment

Chronic alcohol misuse can lead to many harmful consequences, a significant one being that of alcohol dependence. When you become dependent on alcohol, your body has grown used to its presence and requires continued alcohol consumption in order to function normally. If you suddenly quit drinking or greatly reduce your use, you will experience a set of alcohol withdrawal symptoms, which may range from mild and uncomfortable to potentially life-threatening.¹ For this reason, you should not attempt to quit drinking alone or at home. You should seek out professional alcohol detox services that can keep you safe and treat your distressing alcohol withdrawal symptoms.

What Causes Alcohol Withdrawal?

Long-term drinking can result in physiological dependence, a phenomenon caused by neuroadaptations, or changes in the brain, that occur from chronic exposure to alcohol. The brain begins to compensate for the ongoing presence of alcohol by modulating various neurotransmitter systems, such as serotonin, dopamine, opioid peptides, gamma-aminobutyric acid, and glutamate. These neuroadaptations help create stasis in the brain and body, but once an alcohol-dependent person stops drinking, these neurotransmitters are dysregulated and lead to alcohol withdrawal syndrome. Many symptoms associated with withdrawal from alcohol may motivate a person to seek out and drink more alcohol to alleviate this distress.²

Alcohol Withdrawal Symptoms

When you suddenly quit drinking or reduce your use, you may experience alcohol withdrawal symptoms, such as:^1,3

• Mood swings
• Depression
• Anxiety
• Irritability
• Tremors or shakiness
• Excessive sweating
• Rapid pulse
• Insomnia
• Nausea and vomiting
• Psychomotor agitation, or rapid, purposeless movements
• Pallor
• Nightmares

A severe form of alcohol withdrawal known as delirium tremens or withdrawal delirium may cause the following symptoms:^1,3

• Hallucinations
• Seizures
• Severe confusion
• Fever
• Agitation

Fewer than 10% of people who experience alcohol withdrawal symptoms experience severe, dangerous symptoms.³ However, that doesn’t mean the risk is zero, and you should receive an assessment from your medical provider so they can refer you to the appropriate detox and treatment setting.

Is Alcohol Withdrawal Dangerous?

Yes, alcohol withdrawal can be dangerous. Although many people may experience mild or irritating symptoms, others may experience life-threatening symptoms, such as grand mal seizures or tonic clonic seizures. Although hallucinations inherently are not life-threatening, they could lead to hazardous consequences, such as accidents or injuries.

Because of this risk of potentially fatal effects, alcohol withdrawal syndrome should typically be treated in an inpatient medical detox facility, where you receive 24/7 care, supervision, and monitoring to ensure your comfort and safety.

Risk Factors for Severe Alcohol Withdrawal

There are several risk factors for experiencing severe alcohol withdrawal or delirium tremens, including:^3,4,5

• History of seizures
• History of delirium tremens
• Chronic, heavy alcohol consumption
• Previous alcohol withdrawal experiences
• Older age
• People dependent on other depressants like benzodiazepines
• Conduct disorder or antisocial personality disorder
• Comorbid medical conditions
• Abnormal liver function

If you have one or more of these risk factors, you will want to be especially cautious when quitting drinking, avoiding quitting on your own at home without any supervision. The best course of action is to find a medical detox facility. For help finding an alcohol detox program, call our helpline at 866-968-5444Who Answers?.

Alcohol Withdrawal Timeline

Alcohol withdrawal timelines may vary from person to person, depending on individual factors like genetics, age, physiology, mental and physical health, length and frequency of drinking, amount typically consumed, and more. However, a typical alcohol withdrawal timeline may look something like this:^1,3

• Alcohol withdrawal symptoms emerge within 4-12 hours after your last drink.
• Symptoms tend to peak by 1-3 days.
• Within 4-5 days, alcohol withdrawal symptoms typically resolve.

Once acute alcohol withdrawal resolves, you may experience protracted withdrawal symptoms, such as insomnia, anxiety, rapid heart rate, high blood pressure, and sweating, for anywhere from three to six months. These symptoms tend to be milder in intensity than those of acute alcohol withdrawal.³

Medical Detox for Withdrawal from Alcohol

The safest form of treatment for alcohol withdrawal is medical detox, which involves around-the-clock medical care and supervision from a team of professionals, including nurses, doctors, and counselors. The treatment setting for medical detox is a hospital or hospital-based facility. The 24/7 treatment and monitoring can keep you safe by managing dangerous alcohol withdrawal symptoms with medications, intervening in the event of a medical emergency, and providing you with supportive care, such as IV fluids or nutritional therapy. People who struggle with alcohol addiction often have vitamin deficiencies so nutrition will typically be a focus point for medical detox.

Medications for alcohol withdrawal you may receive include:⁵

• Benzodiazepines: Benzodiazepines like Klonopin share pharmacologic properties with alcohol and relieve withdrawal symptoms and increase patient comfort. They are the gold standard for alcohol withdrawal treatment.
• Beta blockers: These adjunctive medications may relieve symptoms in those with coronary artery disease.
• Clonidine: This adjunctive medication can improve autonomic symptoms like rapid heart rate.
• Haloperidol: This antipsychotic can treat hallucinations and agitation, although it should be used with caution since it can lower the seizure threshold.
• Phenytoin: This adjunctive medication may be used for patients who have a pre-existing seizure disorder.

Other services you may receive during alcohol detox include:

• Counseling
• Assessment for co-occurring mental health disorders
• Referral to alcohol addiction treatment

The medical detox process may last between one and three weeks, depending on your symptom severity, duration, response to medications, medical complications, and more. It’s important to note that alcohol medical detox is not a substitute for comprehensive alcohol abuse treatment. Detox doesn’t address the underlying issues that influenced your alcohol misuse and addiction in the first place. Once you are stabilized and have achieved a substance-free state, you are ready to transition into an inpatient or outpatient alcohol addiction treatment program.

Transitioning to Alcohol Addiction Rehab

Alcohol addiction treatment occurs in two main settings: inpatient and outpatient. Inpatient involves living at the facility for the duration of your rehab program whereas outpatient involves attending scheduled treatment sessions at a facility then returning home during non-treatment hours.

Inpatient alcohol rehab is the more intensive option, providing 24-hour treatment. You follow a strict routine in a highly-structured setting, away from your everyday using environment. These treatment facilities often offer a peaceful and serene setting for you to recover from your alcohol addiction. Many people benefit from inpatient alcohol rehab because they are separated from alcohol-using triggers and stressors and are able to focus solely on their recovery process. Therapies and offerings utilized at inpatient care may include:

• Individual therapy, such as cognitive-behavioral therapy (CBT)
• Group counseling
• Family therapy
• Trauma-informed therapy
• Drug education classes
• Holistic or alternative treatments, like meditation and yoga
• Nutritional or recreational therapy
• Aftercare planning

Conversely, outpatient alcohol rehab is the more flexible option. Many people continue working, attending school, or fulfilling other life obligations while attending treatment. They don’t have to put their life on hold and make arrangements before beginning a recovery program. However, this option also means that patients will encounter more triggers and stressors that could lead to relapse. If you are interested in outpatient alcohol treatment, you will want to surround yourself with a sober support system who can provide you with encouragement and empowerment throughout this trying time.

Outpatient services may include:

• Group therapy
• Process groups
• Individual counseling
• Family therapy
• Relapse prevention and drug education classes
• Vocational training

If you are looking for an alcohol addiction treatment program for yourself or someone else, we can help. Call our confidential helpline at 866-968-5444Who Answers? to speak to a treatment support specialist.

Resources

1. National Library of Medicine. (2021). Alcohol withdrawal.
2. Gilpin, N. W., & Koob, G. F. (2008). Neurobiology of alcohol dependence: focus on motivational mechanisms. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism, 31(3), 185–195.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
4. Alcohol withdrawal syndrome: how to predict, prevent, diagnose and treat it. (2007). Prescrire international, 16(87), 24–31.
5. Bayard, M., Mcintyre, J., Hill, K.R., and Woodside, J. (2004). Alcohol Withdrawal Syndrome. American Family Physician 69(6): 1443-1450.