Alcohol Withdrawal Symptoms: What to Expect

Alcohol withdrawal symptoms can include shaking, sweating, headache, nausea, and other physical symptoms. You may also experience mood and behavioral symptoms like agitation, irritability, or anxiety. The alcohol withdrawal timeline varies, but symptoms may begin a few hours to a few days after you stop drinking.

People who drink heavily are at greater risk for serious alcohol withdrawal symptoms. Males who have 15 or more drinks per week and females who have 8 or more drinks per week are considered heavy drinkers. 

This article will discuss the symptoms of alcohol withdrawal as well as the timeline and process of detox.

Symptoms of Alcohol Withdrawal

When someone drinks alcohol for a prolonged period of time, their brain chemistry changes. Alcohol is a depressant, so the body responds by producing more stimulating chemicals, including the neurotransmitters dopamine and gamma-aminobutyric acid (GABA).

This process temporarily restores homeostasis, or chemical balance, in an effort to counteract the impact of long-term alcohol use on the brain.

Over time, however, the body builds a tolerance to alcohol, and a person may have to drink more and more to get the same feeling. Meanwhile, the brain is producing more and more neurotransmitters, making a person further imbalanced.

When that person cuts out alcohol, there is a period when their brain hasn't yet received the message and still overproduces the stimulating chemicals. With alcohol out of the equation, though, these chemicals cause withdrawal symptoms.

Mild Symptoms

Mild symptoms of alcohol withdrawal experienced by excessive drinkers and those with alcohol use disorder alike include:

• Mild to moderate tremors
• Anxiety
• Night sweats
• Restlessness
• Irritability
• Nightmares

Severe Symptoms

There are also more severe symptoms of alcohol withdrawal. These include:

• Seizures
• Severe tremors
• Increased heart rate
• Fever
• Nausea or vomiting
• Hallucinations
• Increased agitation

Delirium Tremens

It is rare, but some people will experience a very serious syndrome during alcohol withdrawal, called delirium tremens.

Delirium tremens includes the severe symptoms of alcohol withdrawal, as well as a change in mental status, severe agitation, symptoms of delirium (sudden lack of awareness of their environment and reality), and occasionally hallucinations.

Delirium tremens occurs in 2% of people with alcohol use disorder and less than 1% of the general population.

Timeline of Alcohol Withdrawal

There is no exact timeline for alcohol withdrawal, and individual factors, such as previous level of dependence on alcohol, will influence it.

Alcohol withdrawal can be an unpleasant process, but there are things you can do to prepare. There are a variety of treatment options to ease this process and support you if your goal is to abstain from alcohol in the future.

The following is a general guideline of what you can expect from the alcohol withdrawal process. Since each case is different, don't be surprised if your own experience is slightly different from this.

First 8 Hours

For most people, alcohol withdrawal symptoms will begin sometime in the first eight hours after their final drink.

Symptoms are usually mild at first and begin gradually. They can include:

• Restlessness
• Clammy or pale skin
• Irritability
• Nervousness
• Loss of appetite
• Shakiness
• Nausea

12–24 Hours

During the 12- to 24-hour time frame after the last drink, most people will begin to have noticeable symptoms. These may still be mild, or the existing symptoms might increase in severity.

A person may begin to experience:

• Mood swings
• Night sweats
• Nightmares
• Depression
• "Brain fog" or not thinking clearly
• Headache or migraine
• Insomnia or difficulty sleeping
• Vomiting

For people who experience hallucinations as part of alcohol withdrawal, these may begin in the 12- to 24-hour time frame.

24–72 Hours

Alcohol withdrawal symptoms typically peak during this time frame. They may peak as early as 24 hours in or closer to 72 hours. Expect the most severe symptoms at this stage, which can include:

• Nausea
• Vomiting
• Tremors
• Agitation
• Seizures
• Hallucinations

Individuals should be prepared to be uncomfortable during this period and have someone on call in case medical help is needed. This is the period in which delirium tremens is most likely to occur, which requires immediate medical attention.

Next Few Weeks

For most people, alcohol withdrawal symptoms will begin to subside after 72 hours. A "new normal" will begin over the next few weeks. However, try not to have too many firm expectations, as symptoms can continue for multiple weeks in some people.

For those with alcohol use disorder, withdrawal is just the first (but very important) step on a long journey to recovery. These first few weeks are critical, because they are when the risk of relapse is highest. Prior to withdrawal, it's important to have a plan of how you will abstain from alcohol during this time.

Factors That Influence Withdrawal

There may be variations in how you experience the symptoms and timeline of alcohol withdrawal. Your symptoms may be more or less severe depending on a number of factors, such as:

• How long you've been drinking
• How much you typically drink
• Whether you stop suddenly or gradually
• Your general health

For example, a person who drinks heavily every day and has been doing so for many years is more likely to experience severe withdrawal symptoms than someone who has been drinking moderately to heavily for less than a year.

It's important to call out that withdrawal symptoms don't just affect people with alcohol use disorder (formerly known as alcoholism) who quit drinking. They can also affect those who drink excessively and stop.

This is because regularly consuming large quantities of alcohol—even if you are not dependent on it—still results in the production of too many neurotransmitters.

Excessive drinking is broken down into two categories, which are defined as:

Binge drinking

• Men: Five or more drinks on a single occasion
• Women: Four or more drinks on a single occasion

Heavy drinking

• Men: 15 or more drinks per week
• Women: Eight or more drinks per week

Alcohol use disorder, on the other hand, is defined by the following:

• An inability to stop or control drinking, despite the negative impact it may have on relationships, health, work, school, and other areas of life
• A built-up tolerance and need to drink more to get the same effect
• Repetitive thoughts and difficulty thinking about anything other than alcohol

It's estimated that 90% of people who drink excessively would not meet the diagnostic criteria of alcohol use disorder. But both binge and heavy drinking put a person at higher risk of developing it over time.

Choosing to Quit

You don't need to be diagnosed with alcohol use disorder in order to choose to detox. Ultimately, if you find alcohol is interfering with your health or your personal, financial, or professional life, then it's time to consider quitting.

Going Solo

Some people might choose to go through alcohol detox alone. The important thing is to stay safe in the case of a medical emergency.

You may choose to stay close to supportive family members or friends, or have an "accountability buddy," who is aware of what you're doing and can come assist you or call for medical help if needed. Keep a list of important phone numbers on hand, because you might not be thinking clearly during withdrawal.

Try to avoid negative influences (whether that is a person, group, activity, place, or something else) leading up to and throughout your detox.

You may also want to prep meals in advance or get other items that require energy and attention out of the way before you're going through detox.

Support

There are many support options available that can help guide you through alcohol withdrawal, as well as abstaining from alcohol after withdrawal. These include:

• Social networks: Find a supportive friend or family member to be with you throughout your detox. It may not be easy to find an individual who can support you in this way. Even those who do may find that an organized group or program may be more beneficial.
• Support groups: There are a variety of support groups that provide support from others who have gone through alcohol withdrawal and are in recovery. Many of these groups are free and available to the public, but online support groups are also an option.
• Behavioral treatment: Consider enrolling in a behavioral treatment program with a mental health professional before withdrawal. Programs may use different types of therapy or other techniques to help you prepare for and get through withdrawal.
• Inpatient rehabilitation facilities: Inpatient detox programs allow you to live in a rehabilitation facility throughout the course of your withdrawal and usually for a few weeks afterward, when the chance of relapse is high. These programs are not always covered by insurance, so check with your individual provider. In the United States, most states have low-cost or free rehabilitation programs for those who are uninsured.
  

Medical Help

In some cases, medical help may be required to get through alcohol withdrawal. There are medications that treat acute alcohol withdrawal syndrome. Antianxiety medications such as benzodiazepines are considered the gold standard.

In the case of severe symptoms or delirium tremens, a person may be admitted to a hospital ward or the intensive care unit (ICU) for medical treatment during alcohol withdrawal. While in the hospital, vitals are monitored and fluids will likely be administered.

Medical treatment may also help a person with alcohol use disorder prepare to quit drinking. Currently, the Food and Drug Administration (FDA) has approved three nonaddictive medications for alcohol use disorder. These medications help reduce alcohol intake and prevent relapse. They include:

• Vivitrol (naltrexone)
• Campral (acamprosate)
• Antabuse (disulfiram)

A Word From Verywell

Making the decision to stop drinking alcohol is a big step. Knowing you could experience alcohol withdrawal symptoms may feel daunting, or even deter you from trying. Remember that the worst of the symptoms typically wear off after 72 hours. In some people, symptoms may continue for a few weeks after their last drink, but they will lessen over time.

Gathering a supportive network of friends and family members, as well as an addiction support group or even an inpatient rehabilitation center, can help you through this process. For maintaining your abstinence from alcohol, you may benefit from support groups or resources from the Substance Abuse and Mental Health Services Administration (SAMHSA) or the National Institute on Alcohol Abuse and Alcoholism (NIAAA).