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Alcohol Withdrawal Symptoms, Timeline & When to Get Help

July 6, 2022

Table of Contents

Some individuals with alcohol use disorder (AUD) will experience withdrawal when they attempt to quit drinking “cold turkey”.

Mild symptoms will fade in a few days, but some withdrawal problems are life-threatening. This is why you need medical assistance to withdraw from alcohol safely.

People with alcohol withdrawal syndrome tend to have an alcohol use disorder. Most people who get withdrawal symptoms get treatment from a primary care physician, not a treatment center or in a hospital.[1] Anybody who gets significant withdrawal when they stop drinking alcohol probably has an unhealthy relationship with alcohol. In fact, withdrawal symptoms are one of the diagnostic criteria for AUD. 

Alcohol Withdrawal Syndrome Symptoms Explained

There are many degrees of severity of alcohol withdrawal, ranging from very mild to even life threatening symptoms. The degree of withdrawal that you experience depends largely on your personal genetics, how much you drink and for how long, and your height, weight, etc. Here are some examples of the symptoms you might experience with alcohol withdrawal:

1. Mild AWS

Your symptoms may include the following:[2]

  • Anxiety
  • Headaches 
  • Insomnia
  • Nausea 
  • Shaking

2. Moderate AWS

Your symptoms may seem mild at first. But you may also develop the following:

  • Hallucinations 
  • Seizures

About 50% of people who have a seizure during withdrawal will progress to severe AWS symptoms including blood pressure changes, fast heart rate, and even potentially loss of respiratory drive, coma or death .[2]

3. Severe AWS

Delirium tremens (or DTs) take hold in up to 5% of people undergoing alcohol withdrawal.[3] Delirium tremens is a term which refers to the autonomic change sin a person’s vital signs - fast heart rate, dropping blood pressure, fevers, or fast breathing rate. It is a sign of impending coma and even death. While it is a rare side effect, it can be life-threatening. Your symptoms include the following:[4]

  • Confusion or delirium 
  • Racing heartbeat
  • Fast breathing
  • Dropping blood pressure

If left untreated, DTs can lead to cardiovascular collapse and death. 

Alcohol Withdrawal Timeline

The time to develop alcohol withdrawal symptoms varies between individuals but a typical timeline looks something like this:

6 hours Mild issues, such as shaking and anxiety, begin If symptoms do not progress, they will resolve within 24 to 48 hours.[5] 12–48 hours Hallucinations If symptoms do not progress, they will resolve in 24 to 48 hours.[5] 48 hours - 5 days Full-body seizures, hallucinations, cardiovascular problems Without treatment, death can occur. With treatment, problems can last for a week or longer.[2]

Generally, patients are said to be “out of the window” for dangerous symptoms of alcohol withdrawal after about 4-5 days, meaning they will not develop life threatening symptoms if they haven’t already. 

How Serious Is AWS?

Most withdrawal symptoms are not life-threatening.[6] But serious issues like seizures and cardiovascular collapse can cause death in a small percentage of people.

Anywhere from 1% to 5% of people with delirium tremens die from the condition.[2]

If you're a heavy drinker with a long history of alcohol use disorder, talk with a treatment team before you try to get sober “cold turkey”. You shouldn’t attempt to stop drinking suddenly on your own. Doing so could be dangerous.

Medications can help ease your withdrawal symptoms and, particularly for patients who experience seizures from withdrawal, can help to prevent seizures and the progression to more serious complications.

If you don't think you'll develop alcohol withdrawal syndrome but you start to feel shaky or confused in the hours or days following your last drink, consider this a medical emergency. Get help immediately, and tell your team about your alcohol history. Don’t be afraid to reach out for help if you need it.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Alcohol Facts and Statistics. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics. March 2022. Accessed June 2022.
  2. Alcohol Withdrawal. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441882/. November 2021. Accessed June 2022.
  3. Delirium Tremens. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK482134/. August 2021. Accessed June 2022.
  4. Delirium Tremens (DTs). Medscape. https://emedicine.medscape.com/article/166032-overview. August 2021. Accessed June 2022.
  5. Management of Moderate and Severe Alcohol Withdrawal Syndromes. UpToDate. https://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes. November 2021. Accessed June 2022. 
  6. Mythbusters: Death by Withdrawal. NZ Drug Foundation. https://www.drugfoundation.org.nz/matters-of-substance/archive/november-2011/mythbusters-death-by-withdrawal/. November 2011. Accessed June 2022.

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