Alcohol Withdrawal

Common symptoms of alcohol withdrawal

Alcohol withdrawal timeline

The timeline of alcohol withdrawal can vary. Typically, mild symptoms begin within hours after the last drink and can become progressively more severe. If you are experiencing mild and moderate symptoms of withdrawal, it's important to seek medical attention before more severe and potentially life-threatening symptoms occur.

Mild Symptoms

Mild symptoms can begin within hours of the last drink and usually include minor physical discomfort and changes in mood. These symptoms can feel similar to a hangover. But for people who have consumed a significant amount of alcohol every day for a few weeks or longer, it’s important to not disregard these symptoms but rather work with a medical professional to treat them immediately to prevent progression to more severe symptoms.

Common symptoms include: 

• Anxiety
• Depression
• Irritability
• Restlessness
• Shaking
• Headache
• Sweats
• Elevated heart rate
• Loss of appetite
• Upset stomach

Moderate symptoms

Moderate symptoms can begin within six hours after the last drink. During this stage, the mild symptoms listed above may intensify. Other moderate symptoms include higher blood pressure, fever, irregular heartbeat, and difficulty breathing. It is important that these signs are closely monitored by a medical professional to reduce the likelihood of severe symptoms.

Severe symptoms

Also known as "complicated withdrawal," severe symptoms can begin between six hours and four days from the last drink. 

Severe symptoms include:

Seizures: These seizures can present as a single uncontrolled jerk or brief flurry of jerking of the extremities, accompanied by confusion. It is rare to have continuous uninterrupted seizures.

Alcoholic hallucinosis: Alcoholic hallucinosis is a rare side effect that consists of seeing things that others cannot, hearing things that others cannot, or experiencing creeping-crawling sensations. These hallucinations are more mild then delirium tremems. The typical onset is 12-48 hours from the last drink. 

Delirium tremens: DTs is one of the most severe consequences of alcohol withdrawal. Unlike alcoholic hallucinosis, a person experiencing DTs will become disoriented, not know what day it is or where they are. Their vital signs become unstable with fast heart rate, high blood pressure, sweats, or fever. Typically, DTs begins two to four days after the last drink.

DTs is the most dangerous stage of alcohol withdrawal, and it can be life-threatening. Usually, other more mild sypmtoms precede DTs, which is why seeking treatment early is important. After two to three days, if a person experiences no or minimal withdrawal symptoms, they are considered to have a low risk for DTs. 

Because these symptoms pose serious health risks and can be fatal, it is very important that individuals be closely monitored by a medical professional.

More about delirium tremens 

While most symptoms of alcohol withdrawal tend to ease within a week, for some people these symptoms can become more severe.

Individuals who have been drinking for a long period of time, have experienced alcohol withdrawal in the past, or have a seizure disorder are at a higher risk of developing delirium tremens (DTs). While only 5% of people going through withdrawal experience DTs, the symptoms are serious and potentially fatal:

• Fever 
• Extreme agitation 
• Seizures 
• Extreme confusion 
• Hallucinations 
• High blood pressure 

Seeking treatment 

The severity of alcohol withdrawal symptoms ranges from person to person. If symptoms are difficult to control or affecting someone’s daily life, medication and detox can help the body overcome the chemical dependence. If withdrawal symptoms are severe, such as delirium tremens, hallucinations, seizures, high blood pressure, fever, or heavy sweating, hospitalization may be necessary to help start the detox process, whether through inpatient rehab or medication- assisted therapies.

Working with a medical professional can help make the process of quitting alcohol easier and safer. There are numerous resources available to ensure those in recovery remain safe during the process and in a supportive environment that helps them refrain from drinking.

Whenever possible, those in recovery should work with a licensed professional to determine which approach or approaches are best, based on needs and circumstances. Those without a primary care provider can use the Substance Abuse and Mental Health Services Administration’s National Helpline for treatment information and a referral.

Life after withdrawal  

For some people, withdrawal symptoms such as cravings and depression may never fully subside, but they will become less severe. After six to 12 months of abstaining or substantially reducing alcohol consumption, managing these symptoms and triggers will become more natural and less recurring.

Some may start drinking alcohol again, colloquially known as a relapse. This doesn’t mean failure or having to start all over again. Knowing what to expect and how to manage alcohol withdrawal symptoms will prepare individuals who resume drinking. 

Recovery is a lifelong process, and there are many resources and communities available to help people stay on that path.