Key Takeaways
- Alcohol withdrawal symptoms typically begin 6-12 hours after the last drink and can last 5-7 days for most people.
- The most dangerous phase is 24-72 hours after the last drink, when seizures and delirium tremens (DTs) can occur.
- Delirium tremens affects approximately 3-5% of people going through alcohol withdrawal and can be fatal without medical treatment.
- Post-acute withdrawal symptoms (PAWS) — including mood swings, sleep problems, and anxiety — can persist for weeks to months.
- Medical detox uses benzodiazepines and other medications to prevent seizures and manage withdrawal safely.
- Alcohol and benzodiazepine withdrawals are the only substance withdrawals that can be directly fatal.
The Alcohol Withdrawal Timeline
Alcohol withdrawal follows a generally predictable pattern, though individual experiences vary based on drinking history, overall health, and other factors.
Stage 1: Mild Withdrawal (6-12 hours after last drink)
The earliest symptoms are typically mild and may include:
- Anxiety and nervousness
- Headache
- Nausea and stomach upset
- Insomnia
- Mild tremors (shaky hands)
- Sweating
- Rapid heart rate
Many people dismiss these symptoms as a bad hangover, but they represent the beginning of withdrawal.
Stage 2: Moderate Withdrawal (12-48 hours)
Symptoms intensify and may include:
- Increased blood pressure and heart rate
- Moderate tremors
- Confusion and difficulty thinking clearly
- Irritability and mood swings
- Fever (low-grade)
- Increased sweating
- Seizures (typically occur 12-48 hours after the last drink)
Important: Alcohol withdrawal seizures can occur in people with no prior seizure history. This is one reason medical supervision is critical.
Stage 3: Severe Withdrawal / Delirium Tremens (48-72 hours)
This is the most dangerous phase. Delirium tremens (DTs) can develop 48-72 hours after the last drink:
- Severe confusion and disorientation
- Hallucinations (visual, auditory, or tactile)
- High fever (over 104°F)
- Profuse sweating
- Extreme agitation and anxiety
- Seizures (can be life-threatening)
- Rapid heart rate and dangerous blood pressure changes
- Cardiovascular collapse (in severe cases)
DTs is a medical emergency with a 5-15% mortality rate if untreated. With medical treatment, the mortality rate drops to less than 1%.
Stage 4: Resolution (5-7 days)
For most people, the acute physical symptoms resolve within 5-7 days:
- Physical symptoms gradually subside
- Sleep begins to normalize
- Appetite returns
- Mental clarity improves
- Energy levels start to recover
Post-Acute Withdrawal Syndrome (PAWS)
After acute withdrawal resolves, some people experience PAWS — a set of lingering symptoms that can persist for weeks to months:
- Anxiety and depression
- Sleep disturbances
- Difficulty with concentration and memory
- Emotional instability
- Fatigue
- Cravings for alcohol
PAWS is a significant relapse risk factor and underscores the importance of continued treatment after detox.
If you or a loved one is facing these challenges, learn more about professional alcohol addiction treatment in Salem, NH available at Trailhead Treatment Center in Salem, NH.
Risk Factors for Severe Withdrawal
Certain factors increase the risk of severe withdrawal:
- Heavy, prolonged drinking (years of daily use)
- History of previous withdrawal episodes
- Previous withdrawal seizures or DTs
- Co-occurring medical conditions
- Older age
- Poor nutritional status
- Concurrent use of other CNS depressants
Trailhead Treatment Center provides medically supervised detox and recovery programs to support lasting recovery and wellness.
Conclusion
Alcohol withdrawal can range from mildly uncomfortable to life-threatening. The timeline is generally 5-7 days for acute symptoms, but post-acute symptoms can linger for months. Medical supervision is essential, especially for heavy drinkers. If you are ready to stop drinking, Trailhead Treatment Center can connect you with safe medical detox and seamless transition into our outpatient treatment programs.