Alcohol Withdrawal Symptoms: What Does Detoxing Feel Like? A Timeline

Alcohol use disorder affects about 18 million adults in the U.S. This is a condition where heavy alcohol use causes emotional distress or physical damage. About half of people who drink alcohol excessively are at risk for developing life-threatening alcohol withdrawal syndrome when they stop drinking. Alcohol detoxification (detox) under medical supervision is the safest way to abstain from alcohol. 

Limiting how much alcohol you drink or stopping altogether has notable health benefits. Let’s take a closer look at the stages of alcohol withdrawal syndrome, its symptoms, and how long it takes to detox from alcohol. 

What is alcohol withdrawal?

Alcohol withdrawal happens when someone who has been drinking alcohol on a regular basis over an extended period of time suddenly stops. Withdrawing from most types of medications or substances can be uncomfortable. But alcohol is one of very few substances that’s potentially dangerous to detox from. 

Alcohol withdrawal symptoms can range from mild to life-threatening. But it’s possible to get through alcohol withdrawal safely. Make sure to get the right treatment from a qualified medical professional. It can be unsafe to try to quit drinking on your own.

Mild symptoms of alcohol withdrawal

Most people going through alcohol withdrawal only experience mild symptoms. Some common mild symptoms include:

• Anxiety

• Tremors

• Changes in mood

• Sleep problems, including nightmares

• Jumpiness

• Upset stomach

• Headache

• Fatigue (feeling tired)

• Sweating

• Loss of appetite

• Dilated pupils

Severe alcohol withdrawal symptoms

About 1 in 10 people have more severe or life-threatening symptoms while going through an alcohol detox. These include:

• Fever

• Fast breathing

• Very heavy sweating

• Mental confusion

• Seizures

• Hallucinations (hearing or seeing things that are not really there)

If you’re experiencing any of these serious symptoms after choosing not to drink alcohol, get medical care right away. These symptoms can be deadly if left untreated.

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What triggers alcohol withdrawal?

Withdrawal from alcohol happens because alcohol is a central nervous system depressant. It changes the way your brain works. Alcohol binds to neurotransmitters in the brain that cause a calming effect in your body. As a result, your body creates more excitatory neurotransmitters in order to maintain balance. 

When you stop drinking alcohol, your body is left with all the excitatory neurotransmitters, and none of the calming effects of the alcohol. This is what leads to the alcohol withdrawal symptoms like jumpiness, tremors, and anxiety when you suddenly stop drinking alcohol.

Whether you go through withdrawal when you stop drinking depends on many different factors, including:

• How much you usually drink

• How long you’ve been drinking

• How suddenly you stop drinking

• Other health conditions you may have 

In general, if you’ve been drinking heavily over a long period of time — like months or years — you’re more likely to experience withdrawal when you stop.

Alcohol withdrawal timeline and stages

When your alcohol withdrawal symptoms start, and how long they last, will depend on your specific situation. Many people experience three alcohol withdrawal stages:

• First stage: Beginning within 6 hours of abstaining from alcohol, the first stage can last up to 7 days.

• Second stage: This stage starts within the first 48 hours and can also last up to a week.

• Third stage: The third stage of alcohol withdrawal starts within 48 hours of your last drink and can last up to 3 days.

Although your symptoms may not follow this timeline, most people recover from their symptoms within a week. For symptoms that last even longer, it’s possible to experience a fourth stage of alcohol withdrawal. Let’s take a closer look at the typical alcohol detox timeline. Below are the symptoms you can expect with each stage.

1. First stage: Mild symptoms

Symptoms of alcohol withdrawal can begin within 6 hours of having your last drink. Usually, the first symptoms are uncomfortable but mild. They can include: 

• Nausea

• Tremors, often referred to as the “shakes”

• Changes in your blood pressure

• Anxiety

• Insomnia and other sleep problems

Most people will recover from alcohol withdrawal after going through these symptoms. This first stage of alcohol withdrawal can last up to 7 days.

2. Second stage: Possible seizures and other serious symptoms

Serious symptoms, including seizures, may begin within the first 48 hours after your last drink. Around 10% of people going through alcohol withdrawal without treatment will enter this phase and have seizures. 

If you haven’t developed any serious symptoms after 48 hours, then it’s unlikely that you will. But get medical attention if a seizure does occur.

This second stage of alcohol withdrawal symptoms usually peaks between 24 to 72 hours after a person’s last drink.

3. Third stage: Delirium tremens may begin

The third stage of alcohol withdrawal is marked by severe symptoms that affect many of the major body systems. Up to 5% of people who have alcohol withdrawal will eventually develop delirium tremens — also known as DTs. Symptoms of DTs include:

• Hallucinations

• Mental confusion

• Rapid mood changes

• Energy bursts

• Very heavy sweating

• Fever and/or hyperthermia (overheating)

• Grand mal seizures, which can cause muscle contractions and loss of consciousness

• Agitation

• Sleepiness or fatigue

Most people who develop DTs from alcohol do so within 48 to 72 hours after they stop drinking. This makes the first few days after you quit drinking the most critical and dangerous time of the withdrawal period. It’s important that you get medical care during this phase, especially if you have symptoms of DTs.

The third stage of alcohol withdrawal symptoms usually lasts for 2 to 3 days. But these symptoms may linger for up to a week. 

4. Possible fourth stage: Postacute withdrawal

Some people who go through alcohol withdrawal may experience symptoms for a longer period of time after they quit drinking. This is called postacute withdrawal syndrome, or PAWS. Symptoms of PAWS include continued trouble sleeping and mood problems. 

This fourth stage of alcohol withdrawal can last anywhere from 6 months to 2 years.

How long does it take to detox from alcohol?

How long it takes to detox from alcohol varies from person to person. And you can detox from alcohol in an inpatient or an outpatient setting. Medical supervision is necessary in both settings to make sure withdrawal symptoms are safely addressed. 

In an outpatient setting, detox treatment can take 3 to 14 days. About 1 week is the average, based on one study. People who are at higher risk for serious alcohol withdrawal syndrome — and those without social support — are more likely to be admitted for inpatient treatment. Inpatient treatment can take between 5 and 14 days.

Can you die from alcohol withdrawal?

Alcohol withdrawal can be deadly, especially if you try to go through it on your own.

Although rare, the following conditions related to alcohol withdrawal can be life-threatening. If you notice any of the symptoms of these conditions, it’s important to get medical care immediately.

Delirium tremens

Having DTs is the most severe form of alcohol withdrawal. DTs aren’t always deadly, but they can be. The mortality (death) rate for people who get DTs is almost 20%. But that number is much lower for people who get medical care for their symptoms. 

Having DTs is considered a medical emergency. If you notice any of the symptoms of DTs listed above, call 911 or get to the nearest hospital right away.

Seizures

Alcohol withdrawal seizures can be deadly in rare cases. Reports show that around 1 in 3 people who start having seizures during withdrawal will develop DTs. This is why it’s important to watch for and respond to seizures. 

Heart disease

Complications from alcohol withdrawal can lead to damage of the heart and circulatory systems, such as:

• High blood pressure

• Coronary artery disease

• Stroke

• Peripheral artery disease

• Cardiomyopathy

• Heart failure

• Arrhythmia

These forms of heart disease may occur if you have severe DTs as part of the acute withdrawal process. People who have underlying cardiovascular disease can also experience more serious and potentially deadly outcomes with acute alcohol withdrawal.

How is alcohol withdrawal diagnosed?

Alcohol withdrawal is usually diagnosed in a hospital or rehab center. These are places people go to detox or because their withdrawal symptoms have become a medical emergency. 

Healthcare professionals often use the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). This helps them figure out how severe someone’s withdrawal symptoms are. The scale looks at different symptoms like: 

• Nausea

• Hallucinations

• Anxiety

• Sweating

• Headache

• Confusion

A healthcare professional might also do a physical exam to see how severe your alcohol withdrawal symptoms are. They may check for:

• Signs of dehydration 

• A fast heart rate

• Fever

• Blood pressure changes

Is it safe to go through alcohol detox at home?

The safest way to stop drinking alcohol and detox from alcohol misuse is under the supervision of a healthcare professional. Being in a hospital or detox facility ensures that professionals are always around. They can help you be as comfortable and safe as possible during the process.

You may be able to detox from alcohol at home, but make sure to coordinate medical supervision. This is especially important if you have a high risk of developing DTs. You may have an increased risk of developing DTs if:

• You’ve been drinking alcohol every day over a long period of time, including lifetime alcohol use. 

• You’ve gone through withdrawal before and had DTs then.

• You’ve been having seizures or have a history of seizures.

• You have an infection.

How do I know if I need medical assistance for detoxing?

The best person to assess your risk for having alcohol withdrawal complications like DTs is a healthcare professional. Only a healthcare professional can monitor you during withdrawal to make sure mild symptoms don’t become more serious. 

How to safely get through alcohol withdrawal

With the right medical care, it’s possible to get through alcohol withdrawal safely. Getting treatment is always a much safer option than trying to go through alcohol withdrawal on your own. A healthcare professional can tell you whether you can go through the process at home or if you should get treatment at a facility.

Alcohol withdrawal syndrome medication

Medications are one of the first-choice alcohol withdrawal syndrome treatments. Medications are tailored to treat both the uncomfortable and potentially life-threatening alcohol withdrawal syndrome symptoms. They can save your life if you have DTs. 

Benzodiazepines, an antianxiety medication, are often prescribed to treat DTs. They can also help your brain adjust to the sudden absence of alcohol and prevent the onset of more serious withdrawal stages.

During your recovery, your healthcare professional may prescribe other medications if you’ve had long-term alcohol use. These include vitamins for nutrient deficiencies and anticonvulsants, or anti-seizure medications. After you’ve safely gone through withdrawal, you may be prescribed other treatments that curb alcohol cravings.

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Written by:

N. Saya Des Marais, MSW

Saya is a masters-level social worker, mental health clinician, trainer, and mental health content writer. She's worked as a therapist and trainer at public schools, community mental health clinics, and digital health start-ups.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Farzon A. Nahvi, MD

Dr. Nahvi is an emergency medicine physician and author of “Code Gray: Death, Life, and Uncertainty in the ER.” He works clinically at Concord Hospital in Concord, New Hampshire, and is a clinical assistant professor of emergency medicine at the Geisel School of Medicine at Dartmouth. Prior to this, he worked as an ER physician and clinical assistant professor of emergency medicine at the Mount Sinai Health System, NYU Langone Health, NYC Health + Hospitals/Bellevue, and the Manhattan VA. He is a graduate of Cornell University and NYU School of Medicine.

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