Alcohol Withdrawal Timeline: How Long Does Each Stage Last?

Get Help. Talk To Someone Now!

Call toll free to:

Find Meeting Information
Access help and resources
Get 24-hour guidance & information

What Is Alcohol Withdrawal Syndrome?

A natural “high tolerance” to alcohol does not exist. This concept of tolerance—generally thought of as how much alcohol a person can consume before feeling the effects or before becoming highly intoxicated—actually refers to the differences in how bodies process alcohol. A person who is known to have a “high tolerance” of this kind is more likely to exhibit age, height, metabolic and body composition characteristics that result in their body processing alcohol efficiently, leading to the appearance of lower effects.

Clinical tolerance to alcohol refers to the decreased neurochemical activation that you experience when using alcohol chronically. As you use alcohol over a sustained period of time, your brain reacts less intensely to it. This alteration in brain chemistry leads to a need to use more alcohol or to use alcohol more frequently to feel the same effects.¹

Physical dependence is more likely to occur as your tolerance to alcohol, and therefore the amount you use, increases. Dependence occurs when your brain and body begin to need a minimum level of alcohol to function normally.¹ A person with alcohol dependence often experiences difficulty with focus, sleep and emotional regulation.

When you are physically dependent on alcohol, you will experience withdrawal symptoms, refered to as alcohol withdrawal syndrome, if you use less alcohol, go longer between drinks than usual or attempt to stop using alcohol entirely. The symptoms can range from mild to severe, depending on how long and how much you have been drinking.²

Very often a person with dependence will use again to alleviate these uncomfortable symptoms thus creating a cycle that only worsens outcomes.

Alcohol withdrawal syndrome occurs in three stages, with the first symptoms typically appearing within 8 to 10 hours after your last drink.

Who Is at Risk for Severe Withdrawal Symptoms?

Risk factors for experiencing severe symptoms of alcohol withdrawal include:³

A history of seizures or delirium tremens
Recent use of large amounts of alcohol in the days or weeks before detox begins
Chronic alcohol misuse over a period of years or decades
Underlying mental or physical health issues
Previous head trauma
Mixing alcohol with other substances, including prescription and over-the-counter medications, that amplify withdrawal symptoms

What Are the Stages of Withdrawal?

How long alcohol withdrawal lasts depends on a variety of factors and can range from uncomfortable to potentially life-threatening.

Do not hesitate to seek medical attention during any phase of alcohol withdrawal. A medical evaluation can determine if your symptoms need close monitoring or even intervention. If your current symptoms are not dangerous, a care team may offer measures, such as medication-assisted therapy, to reduce the severity of your symptoms.⁴

Call 800-839-1686 Toll Free. Privacy Guaranteed. No Commitment.

Help is standing by 24 hours a day, 7 days a week.

Stage One of Alcohol Withdrawal

For most people, stage one symptoms appear within 8 to 10 hours. In the most severe cases, symptoms can appear as soon as six hours after the last drink.⁴

Mild symptoms may include:⁴

Difficulty concentrating
Shakiness
Anxiety
Depression
Mood swings
Nausea
Vomiting
Heart palpitations
Sleep disturbances

Moderate symptoms may include:⁴

Itchy, tingling feeling in legs and feet
Brain fog
More severe shaking
Increased heartrate
More severe nausea and vomiting

Severe symptoms may include:⁴

Inability to sleep
Dry heaves
Extreme shakiness
Profuse sweating
High anxiety
Hallucinations
Tunnel vision
Pins and needles in legs and feet
Diarrhea

Stage Two of Alcohol Withdrawal

Stage two starts within 24 hours of the last time you took a drink of alcohol. It can last two to three days with varying levels of intensity. Below are examples of mild, moderate and severe symptoms during stage two of withdrawal.

Mild symptoms of withdrawal:^4,5

Headaches
Trouble sleeping
Anxiety
Sweating
Lightheadedness
Irritability
Obsessive thinking about using alcohol

Moderate symptoms of withdrawal:^4,5

Heartburn and indigestion
Sweating
Shakiness
Trouble sleeping
Minor hallucinations
Headaches
Fever
Mood swings
Thoughts of wanting to drink again
Fatigue
High anxiety
Racing heartrate

Severe symptoms of withdrawal:^4,5

Major sweating
More severe hallucinations involving multiple senses
Tremors
Seizures
Confusion
Dehydration
Panic attacks
Achy muscles and bones
Nightmares and vivid dreams
Strong urges to drink
Delirium tremens

During this stage, and especially if the withdrawal symptoms are moderate to severe, medical support is often necessary. During a medically supervised detox these symptoms will be evaluated using the Clinical Institiute Withdrawal Assessment (CIWA-AR). This assessment tool helps your addiction care team to determine the severity of your symptoms and to develop a treatment plan to make the process safer and more comfortable. This may include the use of medications to help you sleep, ease headaches, nausea and anxiety, as well as, IV fluids to treat dehydration or electrolyte imbalance, and more.⁵

Stage Three of Alcohol Withdrawal

For some, stage three means things are getting better. Your withdrawal symptoms are easing, your mind is less foggy and you see the light at the end of the tunnel. For others, stage three can bring on potentially life-threatening symptoms—for example, delirium tremens—that may not have appeared in previous stages.^4,5

Delirium tremens (DTs) is a condition that combines tremors, hallucinations, disorientation and anxiety and is sometimes referred to as “the shakes.”⁴ DTs can also present with other symptoms, including seizures, stomach pain, restlessness, anxiety, increased startle reflexes, delusions and other symptoms you may have experienced in earlier stages.⁵

As the days progress, physical symptoms will subside. However, it can take weeks for psychological symptoms to improve. You may experience:⁵

Strong urges and cravings to drink alcohol
Obsessive thoughts about alcohol
Anxiety and depression
Fatigue
Irritability

What Are the Treatment Options During Withdrawal?

A medically supervised detoxification is the safest option for alcohol withdrawal. These programs offer 24/7 support and monitoring from a highly trained care team that includes, doctors, nurses and therapists. In addition to emotional support. You may benefit from medications to help you sleep,lessen nausea and vomiting, decrease your anxiety and curb cravings for alcohol.

Medications that are commonly used during a medically supervised detox include:

Benzodiazepines are sedatives used to treat anxiety and some seizures. Librium and Valium are common benzodiazepines used for treating alcohol withdrawal. Because benzodiazepines have a high risk of misuse, they will likely only be used temporarily.⁷
Anti-seizure medications may be prescribed for both anxiety disorders and for preventing seizures. They have less potential for misuse and can be used instead of benzodiazepines.⁷
Disulfiram (Antabuse®) creates negative symptoms when someone drinks alcohol. As soon as 10 minutes after drinking alcohol, a person taking disulfiram can become nauseous, vomit, have headaches, sweat, and have blurred vision. The medicine acts as a deterrent for people who do not want to experience those symptoms.⁸
Naltrexone (Vivitrol® or Revia®) is a medication that reduces a person’s desire to drink. Vivitrol® is given by injection monthly. Revia® comes in pill form and can be taken daily. Neither are meant for long-term use.
Acamprosate is used to restore brain chemical balance that is often disrupted from alcohol abuse. It is best used during the later part of the detox program and can be continued as an important tool to support long-term recovery.

What Are the Treatment Options After Withdrawal?

Many individuals experience better recovery outcomes when they continue with intensive treatment after detox.

Inpatient Rehab

Inpatient rehab—or residential treatment—for AUD offers continued medical supervision and care, as well as individual and group counseling and education classes.⁹

Working with licensed mental health and addiction treatment specialists, you can learn early recovery skills, relapse prevention skills, self-care, relationship skills and life skills. An inpatient program can give you the opportunity to put more time between yourself and alcohol. You also get to work on mental health issues that may have worsened once you stop drinking.⁹

Sober Living

A sober living facility allows you more freedom than an inpatient rehab facility, but provides a more recovery-focused environment than you would have if you lived at home. In sober living, you get to practice the skills you learned while in inpatient rehab while still allowing for the flexibilty to work.⁹

Intensive Outpatient Programs

Intensive outpatient programs (IOP) provide 10 or more hours a week of individual and group counseling.⁹ You will continue learning early recovery and relapse prevention skills. If needed, you can continue medication management to help with alcohol withdrawal symptoms. An outpatient programs allows for the most flexibility allowing you to maintain your work, school or family responsibilities.

Continued Support

Continued support—which may consist of a formal aftercare plan created by your inpatient or IOP care team typically involves individual counseling, social support groups, 12-step groups and recovery activities. These can continue for as long as you feel you need extra support.⁹

If you want to stop using alcohol but are not sure where to start, call 800-948-8417 Sponsored and get help today.

Resources

National Institute on Drug Abuse. (2017). Tolerance, Dependence, Addiction: What’s the Difference?
Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben-Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta neurologica Scandinavica, 135(1), 4–16.
Wood, E., Albarqouni, L., Tkachuk, S., Green, C. J., Ahamad, K., Nolan, S., McLean, M., & Klimas, J. (2018). Will this hospitalized patient develop severe alcohol withdrawal syndrome?: the rational clinical examination systematic review. JAMA, 320(8), 825–833.
Mirijello, A., D’Angelo, C., Ferrulli, A., Vassallo, G., Antonelli, M., Caputo, F., Leggio, L., Gasbarrini, A., & Addolorato, G. (2015). Identification and management of alcohol withdrawal syndrome. Drugs, 75(4), 353–365.
Heilig, M., Egli, M., Crabbe, J. C., & Becker, H. C. (2010). Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked? Addiction Biology, 15(2), 169–184.
Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment – 1 Overview, Essential Concepts, and Definitions in Detoxification. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). Treatment Improvement Protocol (TIP) Series, No. 45.
Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of Clinical and Diagnostic Research: JCDR, 9(9), VE01–VE07.
Crowley P. (2015). Long-term drug treatment of patients with alcohol dependence. Australian Prescriber, 38(2), 41–43.
Substance Abuse and Mental Health Services Administration. (2014). What is Substance Abuse Treatment? A Booklet for Families.