A timeline of symptoms to expect during alcohol withdrawal and how to get proper treatment
Mild to moderate symptoms of alcohol withdrawal include irritability, anxiety, and tremors.
More severe symptoms of alcohol withdrawal include hallucinations, seizures, and disorientation.
To reduce alcohol withdrawal symptoms, it's best to detox from alcohol under medical supervision.
An estimated 15 million people in the US have alcohol use disorder, a condition marked by physical and mental dependence on alcohol.
Alcohol withdrawal is a severely uncomfortable and debilitating condition that occurs when people who are physically dependent on alcohol attempt to quit. And unlike other drug withdrawals like tobacco or cocaine, alcohol withdrawal can cause life-threatening symptoms although these are rare.
Here are the most common symptoms of alcohol withdrawal, when they occur, and how to deal with them safely.
Understanding alcohol withdrawal
Alcohol withdrawal is the mental and physical changes that occur when a person who is physically dependent on alcohol suddenly stops drinking. Alcohol dependence develops over time and is the result of heavy, prolonged alcohol use. The CDC defines heavy drinking as consuming 15 or more drinks a week for men, or 8 or more drinks a week for women.
Important: If you are concerned about your alcohol consumption and want resources for recovery, contact the Substance Abuse and Mental Health Services Administration's (SAMHSA) free, 24/7 helpline at 1-800-662-HELP (4357).
Alcohol is a central nervous system depressant, which produces feelings of euphoria and relaxation by increasing and decreasing levels of neurotransmitters like GABA and glutamate. While alcohol increases GABA in the brain, it decreases glutamate - the neurotransmitter believed to be the most important for normal brain function.
"Think of GABA and glutamate like a see-saw; when one goes up, the other goes down," says Joseph DeSanto, MD, an addiction specialist for the BioCorRx Recovery Program. "If you're [drinking heavily] on a regular basis, your see-saw tends to go in one direction. If you stop drinking suddenly, the see-saw slams down."
When a person stops drinking, GABA receptors suddenly become empty and glutamate rushes in, causing distress and overstimulation in the body.
"When we drink on a daily basis over weeks and months, our body adjusts to account for the alcohol. When we stop suddenly, the body reacts to compensate and that can be deadly," says Kevin Gilliland, PsyD, the Executive Director at Innovation 360, an addiction treatment center.
Symptoms of alcohol withdrawal
There is a wide range of physical and mental alcohol withdrawal symptoms, ranging from minor hangovers and increased anxiety to severe seizures.
Moderate symptoms of alcohol withdrawal include:
Restlessness
Sweating
Nausea
Temperature dysregulation (feeling hot when it's cold or vice-versa)
Elevated pulse
Irritability
Nightmares
Tremors
More severe symptoms of alcohol withdrawal include:
Hallucinations
Seizures
Another severe symptom of alcohol withdrawal is called delirium tremens, a life-threatening condition that causes dangerous changes in breathing, circulation, temperature control, and blood pressure.
Signs of delirium tremens include:
Confusion
Disorientation
Loss of consciousness
Nervous or angry behavior
Irrational beliefs
Sleep disturbances
Hallucinations
Timeline of alcohol withdrawal symptoms
Alcohol withdrawal symptoms begin quickly after a person quits drinking - minor symptoms within six hours and more severe symptoms after 25 hours.
6 hours: Withdrawal symptoms like tremors, sweating, headache, anxiety, and abnormal heart rate can begin within six hours of your last drink. Heavy drinkers can also experience seizures at this time.
12 to 24 hours: Hallucinations, or seeing, hearing, or feeling things that aren't real, usually begin within 12 to 24 hours after your last drink and can last as long as two days. Tremors typically peak around this time.
24 to 48 hours: In heavy drinkers, seizures can occur between six to 48 hours after the last drink consumed. "The seizure window that I worry about is typically between 24 and 72 hours," DeSanto says. After 36 hours, a person who is experiencing minor symptoms is unlikely to develop severe withdrawal symptoms like seizures and hallucinations.
48 to 72 hours: Delirium tremens typically begins two to three days after the last drink consumed, peaking four to five days into sobriety.
Five days: Withdrawal symptoms often improve within five days, but can last for weeks in severe cases.
How to treat alcohol withdrawal safely
Gilliland says heavy drinkers should visit their doctor before quitting alcohol to learn about how to detox safely. Additionally, if you are experiencing severe symptoms like confusion, hallucinations, or seizures, you should seek immediate medical attention.
Doctors can prescribe medications like benzodiazepines to mitigate severe withdrawal symptoms and make the experience more comfortable, but there is no way to speed up the process.
Both doctors warn that quitting cold turkey can be dangerous for heavy drinkers and greatly increase the risk of seizure and death.
"If you think you might be drinking too much, and if you start experiencing any of those severe symptoms, the best course of action is to not stop cold turkey because you may experience a seizure, and that's the worst outcome," DeSanto says.
Insider's takeaway
Alcohol withdrawal can be a scary, uncomfortable, and even life-threatening experience, but working alongside a doctor who can prescribe medications and monitor symptoms can make the process significantly safer and more comfortable.
"They don't have to do it on their own. They are not alone, a lot of people have done this before them, so take comfort in that," DeSanto says.
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