Stages of Alcohol Detox: Signs, Timeline & Treatment Options

October 10, 2022

Table of Contents

Alcohol withdrawal refers to symptoms appearing when long-time drinkers quit cold turkey. Your brain cells are accustomed to alcohol's constant presence. When you quit, they emit electrical signals and cause symptoms ranging from excitability to seizures.

If you've struggled with alcohol misuse for a long time, and you've ever felt physically ill or mentally unstable when you tried to quit drinking, talk to your doctor before trying to quit abruptly. You might need treatment to help avoid alcohol's serious withdrawal side effects. 

Dangers of Alcohol Withdrawal 

Alcohol withdrawal symptoms range greatly between individuals. Some individuals may experience very few symptoms if they quit abruptly, while other may experience more severe symptoms including tremors, anxiety, confusion, visual hallucinations, seizures, and eventually even hypotension (low blood pressure), fast heart rate and other “autonomic dysregulation” of the cardiopulmonary system that can even lead to cardiac arrest and death.  The syndrome of these more severe symptoms is called delirium tremens. Up to 5% of people who have delirium tremens die from these symptoms. [1] Thus alcohol withdrawal, in rare cases, can be life threatening.

If you’ve been drinking regularly and heavily for a long time, never quit drinking without talking to a doctor first. With treatment, you can avoid serious side effects and achieve abstinence safely.

Stages of Alcohol Withdrawal

People who quit drinking move through a predictable series of steps. Understanding what they look like could help you determine if you need to call a doctor for help. Usually the whole process of withdrawing fully from alcohol takes anywhere from one to five days. Usually after five days, the acute symptoms of alcohol withdrawal abate. However, the individual may still experience cravings and desire to return to drinking after this time. 

Stage 1: Early Withdrawal 

Usually the first one to two days. You begin to experience the following:[2]

  • Anxiety
  • Confusion
  • Depression 
  • Fatigue
  • Irritability 
  • Mood swings 

Stage 2: Intensifying Symptoms 

Usually within the first few days, often lasting up to five days, you may experience more severe symptoms including hallucinations, confusion, altered mental status, or even seizures. These signs are more concerning and constitute more severe withdrawal. If you experience any of these signs, you should call your doctor or present to emergency care. 

Stage 3: Delirium tremens 

While rare, alcohol withdrawal symptoms can progress to a syndrome called delirium tremens, where you experience seizures, changes in blood pressure and heart rate, and these symptoms can even be fatal. If you experience any of these symptoms you should be brought to emergency care for close supervision and medication management. This serious issue is most common in people with a years-long history of excessive drinking.[3]

Alcohol Withdrawal Treatment Options

Treatment for alcohol withdrawal syndrome varies depending on symptom severity.[5] Some people need monitoring and supportive care only, while others may need medications and management in the hospital or even the intensive care unit. Some therapies you might receive if you are hospitalized include: 

Fluid Therapy

Many people entering alcohol withdrawal are dehydrated and have electrolyte imbalances.[4] Some people may need to be admitted to the hospital for electrolyte repletion and intravenous fluids. 

Medications

Benzodiazepine medications can ease electrical activity in the brain and keep symptoms from progressing to seizures.[4] Doctors use the lowest dose that keeps patients calm and prevents any seizures. These medications can be given as needed or even on a scheduled basis while a patient is in the hospital. [6] 

Healing From Alcohol Use Disorder Is Possible 

Once you move through the acute detox process, maintaining abstinence is the next step. Alcohol use disorder is a very treatable disease, either with behavioral therapy, medications, or both.

Thousands of people enter treatment every day, and you can be one of them. Talk to your doctor about how to go through withdrawal safely and how to maintain your abstinence thereafter.

Alcohol Detox FAQs

How long does it take to go through alcohol withdrawal?

Most people go through the full withdrawal process between one to five days. After this, most of the symptoms of acute alcohol withdrawal tend to abate. This may take longer for people with severe use disorders. 

How long does it take for brain chemistry to return to normal?

It depends on the severity and duration of alcohol use. Some researchers say it can take years for people with chronic alcohol misuse to fully recover.[3] Unfortunately, some damage, particularly brain and liver damage, can be irreversible.

Medically Reviewed By 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 Withdrawal. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441882/. November 2021. Accessed August 2022. 
  2. Alcohol Withdrawal. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/000764.htm. January 2021. Accessed August 2022. 
  3. Complications of Alcohol Withdrawal. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf. 1998. Accessed August 2022.
  4. 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 August 2022. 
  5. Caring for Hospitalized Patients with Alcohol Withdrawal Syndrome. Nursing Critical Care. https://journals.lww.com/nursingcriticalcare/fulltext/2019/09000/caring_for_hospitalized_patients_with_alcohol.3.aspx. September 2019. Accessed August 2022. 
  6. Alcohol Withdrawal Syndrome. American Family Physician. https://www.aafp.org/pubs/afp/issues/2004/0315/p1443.html. March 2004. Accessed August 2022.

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