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What Are Alcohol Withdrawal Symptoms?

Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking alcohol [1]. The more you drink regularly, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking. You may have more severe withdrawal symptoms if you have certain other medical problems.

 A severe form of alcohol withdrawal is called delirium tremens (DT). Delirium Tremens can be highly disorientating and scary – and it can even cause death. This is one of the more severe reactions indicated by hallucinations or alcohol-induced psychosis, confusion, agitation, tremors, and a high fever. The reported number of death for people who experience delirium tremens is anywhere from 1 to 5% [2].

Though alcohol withdrawal symptoms typically begin within eight hours after your last drink, you may not experience any until several days later. These symptoms tend to spike around 24 to 72 hours after your last drink, though milder ones may persist for much longer in some people.

Alcohol Withdrawal Symptoms
People with moderate-to-severe alcohol withdrawal symptoms may need inpatient treatment. You will be watched closely for hallucinations and other signs of delirium tremens.

Common alcohol withdrawal symptoms include:

  • Feeling anxious or nervous
  • Feeling irritable
  • Feeling depressed
  • Feeling wiped out and tired
  • Shakiness
  • Mood swings
  • Not being able to think clearly
  • Having nightmares
  • Dilated pupils
  • Sweating
  • Headache
  • Difficulty sleeping
  • Nausea and/or vomiting
  • Appetite loss
  • Faster heart rate
  • Pale skin
  • Tremor

Severe Symptoms of Alcohol Withdrawal

One of the most severe symptoms of alcohol withdrawal is called delirium tremens, or “the DTs.” About 3% to 5% of people who withdraw from heavy drinking experience delirium tremens. This condition can become fatal if it’s left untreated, so if you or a loved one show any symptoms of the DTs, seek emergency treatment because symptoms can get worse.

Symptoms of delirium tremens include:

  • Fever
  • Extreme agitation
  • Seizures
  • Extreme confusion
  • Hallucinations (feeling, seeing, or hearing things that aren’t there)
  • High blood pressure

Hospitals and alcohol detox centers have experienced staff familiar with these symptoms and have the tools to provide appropriate treatment.

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How Long Do Alcohol Withdrawal Symptoms Last? 

When do alcohol withdrawal symptoms start? Alcohol withdrawal symptoms start as early as two hours after drinking, peaking in severity approximately two to three days after the last drink. Alcohol withdrawal symptoms can last for up to a year after quitting, although this tends to be limited to temptation and relapse. The variety of symptoms changes, depending on the amount of time since someone last consumed an alcoholic drink. 

Alcohol Withdrawal Symptoms Timeline

6 to12 Hours After Quitting Alcohol

During the first six to twelve hours of the alcohol withdrawal timeline, symptoms begin setting in roughly at hour six. That is the reason why many alcoholics have to start drinking the moment they wake up. Since the symptoms are so severe, many wrongly assume that the 6-12 hours stage is the most dangerous, but that is the 24-48 hours phase in reality.

Alcohol withdrawal symptoms include, but are not limited to:


  • Alcohol is an addictive drug or substance. So naturally, when a person suffering from alcohol use disorder does not have it, they crave it. Unfortunately, cravings are terrible at this stage since the person knows that drinking would relieve all the unpleasant effects of alcohol withdrawal.


  • Throughout the initial stage of the alcohol withdrawal timeline, an individual’s mind and body are all out of whack. A person will feel sick, uncomfortable, hurt, and various other bothersome symptoms that can increase a person’s anxiety. For those who already experience high anxiety, these feelings will be doubled.

Extreme Sweating 

  • The body begins to overheat when alcohol is no longer in the system. Sweating is the body’s attempt to protect and cool down the organs. Sweating through your bedsheets is expected, so keeping a high fluid level is so important to the doctors who are monitoring the process.


  • It is usually caused by loss of body fluid and dehydration.

Alcohol Withdrawal Symptoms
The more you drink regularly, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking.


  • Alcohol does change the way a person sleeps; skipping the initial phases of sleep and dropping straight to REM helps someone fall asleep, but it doesn’t produce healthy sleep. In this stage of alcohol withdrawal, the mind may want to sleep but be incapable, either from restlessness or other symptoms.


  • Extreme drinking changes the intestine walls and the amount of stomach acid the body produces. As a result, nausea is quite common during this stage of alcohol withdrawal.


  • When the brain starts to function on overdrive without the alcohol’s depressant effects to counteract this hyperactivity, the brain has trouble working, causing malfunctions in nerve cell activity, leading to tremors and shakes.

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12 to 24 Hours After Stopping Drinking

In Stage 12-24 hours of the alcohol withdrawal, the person may see a continuation of the previous symptoms in addition to some new symptoms. This trend may continue with each following stage.


  • Dehydration really sets in at this stage of the alcohol withdrawal timeline due to trips to the bathroom and sweating. The advantage of an inpatient detox program is the capability to have medical professionals monitor the levels of care and make sure the person has enough fluids.


  • Low blood sugar combined with extra dopamine release often results to hallucinations. Although these can be very disorienting or upsetting, hallucinations are not life-threatening.


  • As the body experiences all these uncomfortable symptoms, the last thing on someone’s mind is food. A loss of appetite should not be surprising for someone dealing with nausea.

24 to 48 Hours Post Drinking

As mentioned above, this is the most dangerous and crucial part of the alcohol withdrawal timeline. At this phase, the alcoholic’s body is in full panic mode and can have some severe reactions to the absence of alcohol in the system.


  • At this point of the alcohol withdrawal timeline, mood swings are not unusual. The person is anxious uncomfortable, and their body and brain feel like they are going haywire. Any patience or discipline they might have had initially had already faded, if not completely diminished.

Low Blood Sugar Levels 

  • Alcohol use disorder usually leads to alcoholic liver cirrhosis and alcoholic hepatitis. When the liver does stop functioning, it fails to release glucose into the bloodstream. Hypoglycemia is a typical effect of alcohol withdrawal at this stage, This leads o exhaustion and weakness.

Grand Mal Seizures 

  • Approximately four out of a hundred individuals will experience grand mal seizures after quitting in a day or two. The effects of alcohol withdrawal, particularly seizures, arise from sleep, water, and nutrient deprivation. For some, these seizures can be a warning sign of much more alarming and dangerous effects of alcohol withdrawal known as Delirium Tremens.

Delirium Tremens

  • The possibly deadly effects of alcohol withdrawal, Delirium Tremens, is a sudden case of extreme confusion followed by sweats, shivering, seizures, overheating, hallucinations, and in some instances, death. During this period of alcohol withdrawal, the body is experiencing a biochemical decline where the brain is malfunctioning and firing off incorrect signals.

48 to 168 Hours Post Drink

At this stage of the alcohol withdrawal timeline, most physical symptoms have softened if not completely disappeared. Most of these are replaced by mental distress and feelings of anxiety, depression, confusion, restlessness, anger, and others. Now, in recovery, the client will learn to express and manage these feelings as well as coping ways to combat relapse.

PAWS (Post-Acute Withdrawal Syndrome) refers to the long-term side effect of alcohol abuse, potentially challenging and affecting a person’s life. Symptoms might continue years after withdrawal and initial detox. That is why it is highly recommended to continue treatment after the initial seven-day detox.

These symptoms include:

  • Hostility
  • Irritability
  • Anxiety & Depression
  • Mood swings
  • Low levels of energy
  • Fatigue
  • Insomnia
  • Inability to focus
  • Lack of sex drive
  • Chronic pain

These symptoms are mainly psychological and have been known to continue for months or years after alcohol cessation. They tend to ‘come and go’ in waves or episodes, and can be triggered by specific circumstances, memories, smells, or people.

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Alcohol Withdrawal Syndrome Treatments

Medically-assisted Detox

Detox from alcohol is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to alcohol use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox from alcohol and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of alcohol withdrawals.

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for alcohol use disorder and mental health disorder are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

The ultimate goal of MAT is full recovery, including the ability to live a self-directed life. This treatment approach has been attested to:

  • Improve patient survival
  • Increase retention in treatment
  • Lessen illegal opiate use and other criminal activity among people with substance use disorders
  • Increase patients’ ability to secure and maintain employment
  • Improve birth outcomes among women who have substance use disorders and are pregnant

Dual Diagnosis Treatment

Mental health disorders such as depression and anxiety, and alcoholism and often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the mental disorder and the substance abuse problem are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

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Behavioral Therapies

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) can improve addicts’ behavior. CBT targets negative and maladaptive thought patterns as it promotes positive emotions and beliefs, while DBT helps clients address conflicting impulses so they can make healthy choices. Both therapies treat substance abuse and mental health disorders. Therapy also empowers clients to identify, avoid and mitigate cues that trigger drug cravings.

Individual and Group Counseling

Addiction and mental health counseling occur in both individual and group settings. One-on-one treatment sessions may address unresolved trauma, unconscious conflicts, and specific struggles, while group sessions often involve training in life skills, stress management, conflict resolution, and social connections. Group counseling also gives clients the chance to share their thoughts and experiences to develop social support, which is essential for lasting recovery.

If you or a loved one are struggling with long-term substance abuse, showing alcohol withdrawal symptoms, and a co-occurring mental health condition such as depression, contact one of our helpful treatment specialists today. We Level Up NJ can provide information on dual diagnosis and detox programs that may fit your specific needs.

Alcohol Withdrawal Symptoms
Seeking help for alcohol addiction is a huge step toward sobriety. That’s why the decision on where to get treatment should not be taken lightly.

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[1] NIH –

[2] NCBI –