The Most Typical Stages of Alcohol Withdrawal Explained

Luckily, alcoholism is a highly treatable disease. Every year, thousands of people beat their addiction and move forward with happy, healthy lives.

That said, getting sober is a big undertaking. Part of the process is dealing with the unpleasant process of withdrawal.

If you or a loved one is attempting to get sober, you should be familiar with the stages of alcohol withdrawal. Which is why we’ve put together this guide to help you out.

What Causes Alcohol Withdrawal?

Before we look at the symptoms, it’s important that we examine the root of the issue. 

The reason your body suffers from withdrawal is due to the fact that alcohol has a profound effect on your brain’s chemistry. Alcohol suppresses specific neurotransmitters in your brain. This is what causes the feeling of euphoria associated with drunkenness.  

As someone continues to drink heavily over long periods of time, the amount of alcohol needed to achieve the same effect increases. In turn, this causes your brain to adjust to having massive amounts of alcohol surrounding it at all times. 

When you attempt to quit drinking, those neurotransmitters are no longer suppressed and instead become overstimulated. This is what causes many of the withdrawal symptoms one might experience during the medical detox process.

The longer a person has been drinking, the worse those symptoms get. This is because the brain has had longer to adjust to its suppressed state, making the absence of alcohol all the more impactful.

When Will They Start?

Believe it or not, alcohol withdrawal symptoms can start as quickly as two hours after having your last drink. This is another factor that will likely be altered by how frequently you drink and how long you’ve been doing so. An alcoholic of ten years will probably notice the symptoms much quicker than someone who hasn’t been dealing with the illness for as long.

The Alcohol Withdrawal Stages

Let’s look at a timeline of when you will likely experience both the most common and most extreme withdrawal symptoms.

6-12 Hours After Last Drink

These symptoms will begin 6-12 hours after the last drink.

• Agitation
• Anxiety
• Headaches
• Shaking
• Nausea/Vomiting

 

12-24 Hours After Last Drink

These symptoms will begin 12-24 hours after the last drink.

• Disorientation
• Hand Tremors
• Seizures

 

48+ Hours After Last Drink

These symptoms will begin 48+ hours after the last drink.

• Seizures
• Insomnia
• High Blood Pressure
• Auditory/Visual Hallucinations
• Fever/Sweating
• Delirium Tremens

 

The type and severity of symptoms a person will experience depend on several factors, including how long they’ve been drinking, how much they consume on average, if they abuse other substances, and if they have other complicating medical conditions. More common symptoms such as headaches, anxiety, and nausea will likely be experienced by everyone. On the other hand, seizures, hallucinations, and other more extreme symptoms might only be experienced by heavy, long-term drinkers.

Delirium Tremens

Of all the potential withdrawal symptoms someone can experience, delirium tremens is the most serious. In some cases, it can even be deadly. 

Fortunately, DT only affects about 5% of people going through alcohol detox. Typically, it afflicts people who have abused alcohol for 10 or more years, drink daily, and have a previous history with alcohol withdrawal.

Hallucinations, high fever, and seizures are all symptoms associated with DT. If you or a loved one is experiencing any of those, seek medical treatment immediately.

Acute Alcohol Withdrawal

This is the term used to describe sudden, severe alcohol withdrawal. It typically occurs within the first couple weeks of quitting.

Loss of consciousness, seizures, and delirium tremens can all occur during this period, so it’s best to undergo the process at a hospital or specialized rehab facility. In some rare instances, the process can be fatal, so it’s better to be safe than sorry.

Post-Acute Withdrawal Syndrome (PAWS)

For especially heavy drinkers, certain symptoms can persist even after the initial withdrawal period is over. Depending on the severity of your alcohol abuse, PAWS can last from a couple of weeks to an entire year. 

Many of these symptoms are milder, but their persistence can make post-rehab life difficult for some people. Here are a few of the common symptoms.

• Irritability/Emotional Outbursts
• Mood Swings
• Anxiety
• Low Energy
• Sleep Trouble
• Memory Issues
• Dizziness
• Accident Proneness
• Stunted Reflexes

 

When dealing with PAWS, it’s important to remember that the condition will eventually subside. Often, people relapse in an effort to alleviate the symptoms, but that only makes things worse in the long run. Be patient and understand that things won’t be this way forever.

How to Treat the Stages of Alcohol Withdrawal

In the same way that everyone will experience the stages of alcohol withdrawal a little differently, there’s no one size fits all way to treat the symptoms. What might work for one person isn’t effective for another. Ultimately, your approach to treatment will depend upon the severity of your condition, your lifestyle, and many other factors.

If you’re dealing with serious, potentially life-threatening withdrawal, an inpatient program is likely the best route for you. On the other hand, someone mostly in need of guidance and moral support might benefit from an outpatient program.

At the end of the day, the decision is a deeply personal one, but that doesn’t mean you can’t get some professional guidance. If you or a loved one is ready to get sober but need a little assistance, click here to get in touch with hard-working professionals who know how to help. 

Resources:

1. Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353-365. PMID: 25666543 www.ncbi.nlm.nih.gov/pubmed/25666543
2. Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. [Updated 2020 Dec 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
3. Bayard M, McIntyre J, Hill KR, Woodside J Jr. Alcohol withdrawal syndrome. Am Fam Physician. 2004 Mar 15;69(6):1443-50. PMID: 15053409