What Is the Timeline for Alcohol Withdrawal?

Whiskey and alcohol withdrawalAlcohol abuse and alcoholism are common in our culture. According to the Results from the 2019 National Survey on Drug Use and Health, about 14.5 million people in the US have an alcohol use disorder, while millions of others engage in binge drinking or other forms of alcohol abuse. This is a major challenge both for personal reasons and at a family and community level. Alcohol abuse can lead to major issues, like withdrawal, not to mention interfere with the individual’s life and health, disrupting relationships, and creating risks for others in the community.

Nevertheless, it can be difficult for a person who is addicted to or abusing alcohol to quit. In many cases, these individuals have lost control over their ability to stop drinking. For others, the idea of where to start can be difficult because of the withdrawal symptoms that kick in when they attempt to stop drinking. However, knowing more about the timeline and how the symptoms are likely to manifest can help a person know what to expect and feel more comfortable through the process.

The following steps provide information about the timeline and various stages of alcohol withdrawal:

infographic of alcohol withdrawal timeline

Step 1: Decide to stop drinking.

Making the decision to stop drinking can be hard. Many times, people who have developed alcoholism or who engage in alcohol abuse are doing so to self-medicate, either to deal with disappointments or life challenges, or to help control the symptoms of other mental health disorders. While alcohol is not a solution to these problems, the temptation to numb negative feelings through alcohol abuse can be strong. Once dependence has developed, the person may even lose control over the ability to stop drinking. As stated above, even if the person does decide to stop, concerns about withdrawal may cause hesitation.

As explained in an article from Alcohol Health & Research World, there is good reason for this concern: Quitting drinking after developing alcohol dependence can be risky. Aside from the discomfort caused by the withdrawal symptoms, those who have been drinking heavily for a long time may also develop dangerous withdrawal symptoms when they quit. Some of these symptoms, which are described in detail below, can lead to severe illness or death if not treated by a professional. Nevertheless, there is also risk of illness or death if a person continues drinking, so it can seem like a choice between a rock and a hard place.

The good news is that, with professional detox treatment, even people who are struggling with heavy alcohol abuse or addiction can stop drinking safely. In fact, medical detox can ease some of the symptoms, making it easier to get through withdrawal without relapsing to alcohol use.

Step 2: Learn about the average timeline.

According to Medline Plus, the symptoms of withdrawal from alcohol generally start within eight hours of stopping drinking. For many people, these beginning symptoms can be enough to get them to go back to drinking. Early symptoms generally start out mild, but can quickly become severe, especially if the individual has a long history of heavy drinking.

Within 24-72 hours (1-3 Days) of the last drink, more severe symptoms will kick in. At this point, the individual may experience some of the Stage 2 and 3 symptoms below. If Stage 3 symptoms begin to occur, it is important to get the individual medical care to manage them, as they may lead to severe injury or death.
The general progression of symptoms follows the steps outlined below.

Step 3: Begin Stage One symptoms.

The preliminary symptoms of alcohol withdrawal are those that occur within the first eight hours after stopping drinking. They include:

  • Shakiness
  • Abdominal pain
  • Nausea
  • Vomiting
  • Fatigue
  • Muscle weakness
  • Depression
  • Loss of appetite

These symptoms can be familiar not just to alcoholics who try to quit, but also to those who have binged on alcohol. To varying degrees, they are the same as hangover symptoms.

Step 4: Progress to Stage Two symptoms.

In Stage 2 of alcohol withdrawal, the individual may experience:

  • Increase in blood pressure and body temperature
  • Mood swings
  • Anxiety and irritability
  • Quick or shallow breathing

Stage 2 quickly follows Stage 1, starting within about 24 hours of stopping drinking. These symptoms, along with the ones in Stage 1, can last up to 72 hours, depending on the individual and the degree of alcohol abuse.

Step 5: Expect potential Stage Three symptoms.

As described by the New England Journal of Medicine, Stage 3 symptoms are the most worrisome. These symptoms indicate that the person is experiencing delirium tremens (DTs), a life-threatening condition that requires immediate medical care. Medline Plus indicates that these symptoms include:

  • Seizures (which may also occur without DTs)
  • Trembling
  • Confusion, lack of focus, or stupor
  • Delirium
  • Hallucinations
  • Restlessness, agitation, or increased activity
  • Deep sleep for a day or more

These Stage 3 symptoms do not necessarily follow Stage 1 or Stage 2 symptoms. In fact, they may occur within 12 hours of the last drink. However, no matter when they occur, they indicate the need for immediate, emergency medical care. Just the potential that they may occur necessitates medical detox for all cases of alcohol withdrawal. Without intervention, these symptoms can lead to death. Even without DTs, alcohol withdrawal-related seizures can be life-threatening.

Step 6: Manage severe symptoms.

A study from CNS Drugs indicates that the main treatment for alcohol withdrawal in hospitals and other medical settings is the use of benzodiazepines. Through these drugs, doctors can help to lessen the intensity of the symptoms and potentially prevent or ease mild to moderate symptoms by tapering the person down during detox rather than quitting cold turkey. Other medicines, such as anticonvulsants or even phenobarbital, can be used in some people who have health issues that make it hard to use benzodiazepines.

However, this is something that should not be undertaken without medical care. The reason for this is that many of these medicines – especially benzodiazepines – are also dangerously addictive. In fact, benzodiazepines are another drug type that can create a life-threatening withdrawal syndrome. Because of this, a doctor’s care during this type of treatment is essential both to prevent transferring the addiction to another drug and to prevent missteps that could lead to worse symptoms.

Step 7: Engage in ongoing treatment.

Because of the risks of alcohol withdrawal, self-treatment is not recommended for those who want to quit, especially after long-term, heavy alcohol use. Thankfully, alcohol abuse treatment programs have the ability to provide or recommend medically supported detox programs to help the individual withdraw from alcohol use and potentially avoid some of the worst symptoms.

It is important to note that treatment is an ongoing process. According to research explained by the National Institute on Drug Abuse, substance abuse and addiction have relapses rate similar to those for other chronic illnesses like asthma and high blood pressure; between 40 and 60 percent of people who struggle with substance abuse or addiction will relapse.

This means that, like those conditions, alcoholism and alcohol abuse require continuing effort to maintain recovery. However, as an article from The Lancet explains, the therapy given through a high-quality treatment program can provide ongoing support that helps individuals maintain abstinence and move forward in recovery.

Related Reading
Drug Detox FAQ
How to Cope with Withdrawal
Hangover Vs. Drug Withdrawal