Someone with alcohol use disorder experiencing alcohol withdrawal symptoms.

When Does Alcohol Withdrawal Start? Here’s What to Expect

/in

Alcohol withdrawal can be an intimidating process, especially for those who have been drinking heavily for an extended period. Understanding when alcohol withdrawal starts, what symptoms to expect, and how to manage them safely is crucial for anyone considering alcohol addiction recovery or any loved ones worried about their well-being.

What Causes Withdrawal?

Alcohol withdrawal happens when a person who has been consuming alcohol regularly suddenly reduces or stops alcohol use. This occurs because alcohol affects the central nervous system (CNS) by slowing down brain activity. Over time, the body adapts by working harder to keep brain function active despite the sedative effects of alcohol.

When alcohol is suddenly removed, the CNS overcompensates, leading to withdrawal symptoms such as anxiety, body tremors, and even severe complications like seizures and delirium tremens (DTs).

When Does Withdrawal Start?

Symptoms of alcohol withdrawal typically begin 6 to 24 hours after a person’s last drink. The exact timing depends on several factors, including:

  • The amount of alcohol intake
  • How long the person has been drinking
  • Overall wellness and metabolism
  • Presence of other health conditions

Alcohol Withdrawal Timeline

While withdrawal experiences vary from person to person, the withdrawal stages generally follow a predictable time frame based on how the body reacts to the absence of alcohol. These stages progress from mild to severe symptoms, potentially requiring medical attention.

Understanding these withdrawal stages can help individuals struggling with alcohol use disorder and their loved ones prepare for detox and help determine when severe alcohol withdrawal becomes a medical emergency.

6 to 12 Hours After the Last Drink

  • Mild symptoms begin to appear.
  • Common early signs include:
    • Anxiety
    • Irritability
    • Insomnia
    • Nausea
    • Sweating
    • Headache
  • Some individuals experience hand tremors or shakiness, which can indicate that withdrawal is progressing.

12 to 24 Hours After the Last Drink

  • Symptoms intensify as the body continues adjusting to the absence of alcohol.
  • Additional withdrawal symptoms may include:
    • Increased heart rate
    • High blood pressure
    • Confusion
    • Mood swings
  • Some people may begin to experience mild hallucinations, such as seeing or hearing things that aren’t there.

24 to 48 Hours After the Last Drink

  • This time frame is often when alcohol withdrawal symptoms peak in intensity.
  • Symptoms can include:
    • Severe anxiety
    • Profuse sweating
    • Increased body temperature
    • Vomiting
    • Loss of appetite
  • In some cases, withdrawal plateaus after this period, with symptoms gradually fading over the next few days.
  • However, for individuals with severe alcohol dependence, the risk of seizures increases around this time.

48 to 72 Hours After the Last Drink (High-Risk Period)

  • This stage can bring the most dangerous symptoms, particularly for those with a history of heavy alcohol use.
  • Possible complications include:
    • Seizures – Can occur within the first two days, often without warning.
    • Delirium Tremens (DTs) – A severe and life-threatening condition that causes:
      • Extreme confusion
      • Hallucinations
      • High fever
      • Rapid heart rate
      • Severe agitation
    • DTs typically develop within 48-72 hours and require immediate medical intervention.

3 to 7 Days After the Last Drink

  • By the end of the first week, most physical withdrawal symptoms begin to subside.
  • Psychological symptoms such as anxiety, depression, and cravings may persist longer.
  • For some individuals, post-acute withdrawal syndrome (PAWS)—a lingering phase of withdrawal—can last for weeks or months.

Prepare for Severe Alcohol Withdrawal

No one experiences alcohol withdrawal the same way, and while some may only face mild discomfort, others can develop severe and even life-threatening symptoms. Several factors influence how intense and severe withdrawal symptoms may become.

  • How long a person has been drinking alcohol – Long-term heavy drinkers are more likely to experience severe withdrawal.
  • Amount of alcohol consumed – Higher alcohol intake increases the risk of dangerous symptoms.
  • History of withdrawal symptoms – People who have experienced withdrawal before are at greater risk for complications.
  • Medical conditions – Pre-existing health issues, such as heart disease or liver damage, can make withdrawal more severe.
  • Co-occurring mental health conditions – Anxiety or depression can worsen withdrawal symptoms.

When to Seek Medical Help for Alcohol Withdrawal

While not everyone will experience an alcohol withdrawal seizure or other serious health problems during detoxification, it’s important to understand the risks.

Mild alcohol withdrawal can sometimes be managed at home, but moderate to severe withdrawal requires supervision from a medical professional. Seek immediate help from a healthcare provider specializing in addiction treatment if any of the following occur:

  • Seizures
  • Hallucinations (seeing or hearing things that aren’t real)
  • Severe confusion or disorientation
  • High fever or excessive sweating
  • Rapid heart rate and high blood pressure
  • Uncontrollable shaking or tremors

These symptoms may indicate delirium tremens (DTs), which can be fatal without treatment. If you or a loved one is experiencing severe withdrawal symptoms, seek medical attention immediately.

Treatment Options for Alcohol Withdrawal

If you are concerned about withdrawal, it’s important to consider safe detox options. Here are some approaches to managing alcohol withdrawal:

Inpatient Medical Detox

Inpatient addiction treatment is the safest option for individuals with a history of heavy drinking, as it provides 24/7 access to medical attention in a controlled environment. This level of care ensures that patients who experience alcohol withdrawal are closely monitored, reducing the risk of severe symptoms or complications. To ease discomfort and prevent dangerous symptoms, medications such as benzodiazepines (e.g., diazepam or lorazepam) may be administered, helping to stabilize the nervous system and promote a safer detoxification process.

Outpatient Detox

Outpatient addiction treatment is a suitable option for individuals experiencing mild to moderate withdrawal symptoms, allowing them to undergo detox while continuing to live at home. This approach provides medical support without requiring a long-term stay, making it a more flexible option for those with less severe alcohol dependence. Patients regularly check in with a doctor or addiction specialist to monitor their progress, manage symptoms, and ensure a safe withdrawal process.

Supportive Care at Home

Some people may be able to detox at home, but only if they have very mild symptoms. Staying hydrated by drinking lots of water and electrolytes is especially important. Over-the-counter medications may be used to alleviate common withdrawal discomforts, such as headaches and nausea. However, it is essential to have a trusted person nearby who can provide support and seek medical attention if symptoms worsen.

What Happens After Detox?

Successfully going through alcohol withdrawal syndrome is a significant milestone, but it is not the end of the recovery journey. While detox helps remove alcohol from the body, it does not address the underlying causes of addiction or equip the individuals with the tools needed to maintain long-term sobriety. To reduce the risk of relapse and build a healthier future, ongoing support and structured treatment are essential.

Outpatient Treatment Programs

Outpatient addiction treatment helps those recovering from alcohol use disorder continue on their road to sobriety after alcohol detox. Regular appointments can help them stay accountable for their recovery and keep going through the stages of change with the support they need.

Inpatient Treatment Programs

Inpatient treatment can help those recover from alcohol use disorder. Some people need to be removed from their environment and potential triggers or alcohol cravings in order to fully recover. Inpatient programs allow people to recover in a structured, supportive setting, even if they no longer experience withdrawal symptoms.

Support Groups

Support groups play a crucial role in alcohol addiction recovery by providing a sense of community, accountability, and encouragement from others who have similar experiences. Organizations like Alcoholics Anonymous (AA) offer a structured, 12-step program that helps individuals maintain sobriety through peer support and personal growth.

Mental Health Care

Mental health counseling and therapy are a vital part of the alcohol addiction recovery process, as they help individuals address the underlying emotional and psychological factors that contribute to substance use. Through therapy techniques like cognitive behavioral therapy (CBT) and trauma-informed counseling, individuals can develop healthier coping mechanisms, manage stress, and work through past experiences that may have influenced their alcohol usage.

Co-Occurring Disorders

Many individuals struggling with alcohol addiction also experience co-occurring mental health disorders, such as anxiety, depression, or post-traumatic stress disorder (PTSD), which can contribute to substance use as a way to self-medicate. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 21.5 million Americans have a co-occurring disorder. Treating both addiction and these underlying mental health conditions simultaneously is crucial for a successful recovery, as untreated mental illness can increase the risk of relapse.

Integrated healthcare programs that combine therapy, medication management, and behavioral health support help individuals achieve long-term sobriety by addressing the root cause of addiction.

Knowing When Alcohol Withdrawal Starts Can Save Lives

Understanding when alcohol withdrawal starts and what to expect can help individuals make informed decisions about quitting safely. Symptoms typically begin within 6-24 hours and can range from mild discomfort to life-threatening complications.

If you or someone you love is struggling with alcohol withdrawal, don’t hesitate to seek medical attention. A safe, supervised alcohol detox can prevent serious health risks and set the stage for long-term recovery.

Need help? If you or a loved one is experiencing alcohol withdrawal symptoms or is considering a detox, Meridian HealthCare is here whenever you need it. Our residential detox facility, The Donofrio Center, treats those seeking to recover from alcohol and/or substance use disorder — open for admissions 24/7.