What Does Alcohol Withdrawal Feel Like? A Timeline.

Alcohol withdrawal happens when someone who’s been drinking a lot of alcohol over a period of time suddenly stops. Withdrawing from most types of drugs is uncomfortable. But alcohol is one of very few substances that can actually kill you during the withdrawal period.

It’s possible to get through alcohol withdrawal safely. But it’s important to get the right treatment and not try to quit drinking, especially cold-turkey, on your own.

Here’s everything you need to know.

What triggers alcohol withdrawal?

Why people go through withdrawal when they stop drinking is due to the way alcohol affects the brain. Withdrawal from any drug happens because your body has become physically dependent on the substance. For example, if you suddenly quit drinking coffee after drinking 10 cups a day, you might get a headache.

In the case of alcohol, this happens because it’s a central nervous system depressant, and it changes the way your brain works. Specifically, drinking alcohol causes your brain to produce more GABA (a neurotransmitter that makes you feel calm and euphoric) and less glutamate (a neurotransmitter that makes you feel excitable).

To make up for this, your brain starts producing less GABA and more glutamate to balance things out. When you suddenly stop drinking alcohol, your brain can’t catch up, and you feel the effects of these unbalanced neurotransmitters. This is what leads to withdrawal symptoms like jumpiness, tremors, and anxiety.

Whether or not you go through withdrawal when you stop drinking depends on many different factors. These include how much you usually drink, how long you’ve been drinking, and any other health conditions you have. In general, if you’ve been drinking heavily over a long period of time, you’re more likely to experience withdrawal when you stop.

How is alcohol withdrawal diagnosed?

Alcohol withdrawal is usually diagnosed in the hospital or a rehab center, where people might go intentionally to detox or because their withdrawal symptoms have become a medical emergency. Healthcare providers often use an assessment called the Clinical Institute Withdrawal Assessment for Alcohol, or the CIWA-Ar, to figure out how severe someone’s withdrawal symptoms are. The scale asks about different symptoms, including nausea, hallucinations, and anxiety.

Your healthcare provider might also conduct a physical exam to see how severe your withdrawal symptoms are. They may check for signs of dehydration, a fast or abnormal heart rate, and fever, among others.

Symptoms of alcohol withdrawal

The symptoms that can come along with alcohol withdrawal range from moderate to life-threatening. Some common mild symptoms include:

• Anxiety

• Tremors

• Changes in mood

• Sleep problems, including nightmares

• Jumpiness

• Upset stomach

• Headache

• Fatigue

• Sweating

• Loss of appetite

• Dilated pupils

Most people going through alcohol withdrawal only experience these mild symptoms. But around 10% of people with alcohol withdrawal get more severe and even life-threatening symptoms, including:

• Fever

• Fast breathing

• Severe sweating

• Mental confusion

• Seizures

• Hallucinations

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If you’re experiencing any of these serious symptoms after quitting alcohol, get medical care immediately. These symptoms can be fatal when they’re untreated.

Alcohol withdrawal timeline

When, for how long, and how severely you feel withdrawal symptoms will depend on your specific situation. Although your symptoms may not follow this timeline, many people experience withdrawal in three stages. Most people recover from their symptoms within a week.

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.

Second stage: Possible seizures and other serious symptoms

For most people who get them, serious symptoms, including seizures, come on within the first 48 hours after your last drink. Over 5% of people going through alcohol withdrawal will enter this phase and experience seizures. Symptoms usually peak between 24 and 72 hours after the last drink. If you haven’t developed any serious symptoms like seizures after 48 hours, then it’s likely that you’ll recover. However, it’s still possible you could develop them later on, so you should still seek medical care.

Third stage: Delirium tremens may begin

Around 50% of people who have withdrawal seizures will eventually develop delirium tremens, or DTs. Most people who develop DTs do so between 48 to 72 hours after they stop drinking. That makes the first few days after you quit drinking the most critical and dangerous time during the withdrawal period. It’s important that you seek medical care during this phase, especially if you’re presenting with symptoms of DTs.

Possible fourth stage: Post-acute withdrawal

Some people who go through alcohol withdrawal may experience symptoms for a longer time (from a week to months) after quitting drinking. This is called post-acute withdrawal syndrome, or PAWS. Symptoms of post-acute withdrawal include continued trouble sleeping and mood problems.

Can alcohol withdrawal be fatal?

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

Although they’re relatively rare, the following are three conditions related to alcohol withdrawal that can be life-threatening. If you notice any of their symptoms, it’s important to get medical care immediately.

Delirium tremens

Delirium tremens, or DTs, is the most severe form of alcohol withdrawal, and around 2% of people with alcohol dependence get it. Its symptoms include:

• Audio and visual hallucinations

• Mental confusion

• Rapid mood changes

• Energy bursts

• Severe sweating

• Fever/hyperthermia

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

• Agitation

• Sleepiness or fatigue

DTs aren’t always fatal, but they can be. Up to 25% of people who get DTs die from them. That number comes down to only 1% for people who get medical care for their symptoms. Going into DTs is considered a medical emergency. If you’re noticing any of these symptoms, call 9-1-1 or get to your nearest hospital right away.

Seizures

Alcohol withdrawal seizures usually come on before DTs. It’s rare, but possible, to die from seizures. And reports show that around half of people who start having seizures during withdrawal will develop DTs, so it’s an important symptom to pay attention to. 

Heart failure

Alcohol withdrawal (especially when you’re experiencing DTs) might also lead to heart problems because of the way alcohol affects your organs. More research is needed to be able to say for sure what the connection is between fatal heart failure and alcohol withdrawal.

Is it safe to go through alcohol withdrawal on your own?

The safest way to go through alcohol withdrawal is under the supervision of a healthcare provider. Being in a hospital or detox setting can make sure that qualified professionals are always around to help you be as comfortable and safe as possible during the withdrawal process.

You should especially be careful of going through alcohol withdrawal without medical supervision if you’re at high risk for developing DTs. Some factors that may put you at high risk include:

• You’ve been drinking alcohol every day over a long period of time (perhaps you might even be considered a “lifetime drinker”)

• You’ve gone through withdrawal before, and got DTs then

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

• You have an infection

Ultimately, the only person who can assess your risk for having alcohol withdrawal complications (like DTs) is a healthcare provider. They’re also the only ones who can adequately monitor you during withdrawal to make sure mild symptoms don’t become more serious. 

How to safely get through alcohol withdrawal

It’s 100% possible to get through alcohol withdrawal safely with the right medical care. There are many effective treatments available to get you through withdrawal and recover from alcohol altogether. Seeking treatment is always a much safer option than trying to go through alcohol withdrawal on your own. A healthcare provider can tell you whether you can go through withdrawal at home or if you should get medical treatment. As always, ask your doctor before attempting withdrawal.

Here are some of the most commonly used treatments to help people get through alcohol withdrawal and further recovery from alcohol addiction.

Medications for alcohol withdrawal syndrome

Medications are one of the first-line treatments to address serious alcohol withdrawal, and they can literally save your life if you have DTs. A class of anti-anxiety medication called benzodiazepines are often prescribed to treat DTs and help your brain adjust to the sudden absence of alcohol.

Other medications may also be prescribed to help you deal with symptoms and cravings. These include vitamins to fix nutrient deficiencies and anticonvulsants (medication to prevent seizures). After you’ve safely gotten through withdrawal, you might be prescribed other medications to curb alcohol cravings.

Detox

If your withdrawal symptoms are mild, you may stay in a detox facility. Detox is designed to help people going through the most uncomfortable parts of the withdrawal process, and it can range from detoxes in hospital settings to luxury detoxes in private homes. In detox, you’ll be provided with medical supervision as well as programs to help you get started on the road to recovery.

Note that people experiencing serious withdrawal complications like DTs need to be treated in a hospital setting. DTs are a medical emergency that needs immediate attention.

Continuing treatment

Once you’ve safely gotten through alcohol withdrawal, the rest of your recovery journey can begin. Options for continuing treatment include residential programs, intensive outpatient programs, and sober living facilities. This is what’s often called “rehab.” Rehab can lower the chances that you relapse ー because going through the pain of alcohol withdrawal once is enough.

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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.

Reviewed by:

Emily Guarnotta, PsyD

Emily Guarnotta, PsyD, is a licensed clinical psychologist and certified perinatal mental health professional with over 10 years of clinical experience.

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