Medical Reviewer

The Stages of Alcohol Withdrawal

Last Medical Review On: July 18, 2024
Updated On: June 15, 2024
6 min read
Written by:

Amanda Stevens, B.S.

Medical Review by:

Dr. Po-Chang Hsu, M.D., M.S.

Alcohol withdrawal refers to the physiological and psychological symptoms that can occur when a person who regularly consumes alcohol either stops or significantly reduces their intake.[1] Typically, alcohol withdrawal unfolds in several distinct stages, each with its own set of symptoms and challenges to navigate.

Alcohol Withdrawal
Jump to Section

    What is Alcohol Withdrawal Like?

    The experience of alcohol withdrawal can be highly distressing and may require medical assistance to manage symptoms safely and effectively. The process can vary from person to person, influenced by various factors, including the extent of the alcohol dependence, your overall health, and any prior withdrawal experiences.[2] Usually, people undergoing alcohol withdrawal may experience a range of symptoms that often emerge within hours to a few days after stopping drinking and can significantly disrupt daily functioning and well-being.

    In more severe cases of alcohol withdrawal, individuals may encounter hallucinations, seizures, and delirium tremens (DTs), a potentially life-threatening condition characterized by extreme confusion, rapid heartbeat, fever, and even seizures.[3] DTs usually occur within 48 to 72 hours after your last drink and require immediate medical attention.

    Alcohol Withdrawal Symptoms

    Alcohol withdrawal can vary widely in severity and duration and may include:[4]

    • Anxiety: Feelings of nervousness, restlessness, or unease are common during alcohol withdrawal.
    • Tremors: Shaking or trembling, particularly in the hands, can occur as the body adjusts to the absence of alcohol.
    • Sweating: Profuse sweating, especially during the night, is a common symptom of alcohol withdrawal.
    • Nausea and vomiting: Digestive upset, including nausea and vomiting, can occur as the body reacts to the absence of alcohol.
    • Insomnia: Difficulty falling asleep or staying asleep is common during alcohol withdrawal.
    • Agitation: Feelings of irritability, agitation, or heightened emotional responses are frequent symptoms.
    • Headaches: Alcohol withdrawal can often trigger headaches or migraines.
    • Increased heart rate: Some individuals may experience a rapid heartbeat or palpitations during withdrawal.
    • High blood pressure: Blood pressure may temporarily increase during alcohol withdrawal.
    • Confusion or disorientation: Difficulty concentrating, confusion, or disorientation can occur, especially in more severe cases of withdrawal.
    • Hallucinations: Visual, auditory, or tactile hallucinations may occur, particularly in severe cases of withdrawal.
    • Seizures: In some instances, individuals may experience seizures during alcohol withdrawal, particularly if they have a history of heavy alcohol use.
    • Delirium tremens (DTs): This severe symptom of alcohol withdrawal can involve hallucinations, severe confusion, fever, rapid heartbeat, and seizures, requiring immediate medical attention.

    It’s important for those experiencing alcohol withdrawal symptoms to seek medical help, as severe withdrawal symptoms can be dangerous or even life-threatening if not properly managed. Medical professionals can provide appropriate care and support, including medications and behavioral therapies, to help individuals safely navigate through the withdrawal process and begin their journey toward recovery.

    Alcohol Withdrawal Timeline

    A general timeline of alcohol withdrawal often follows these stages:[5]

    • 6-12 hours: The early stages of alcohol withdrawal often begin within 6 to 12 hours after the last drink. During this time, individuals may experience mild symptoms such as anxiety, tremors, sweating, nausea, and insomnia listed above.
    • 24-48 hours: Symptoms typically escalate during the first one to two days of withdrawal. This period may involve worsening anxiety, increased tremors, more pronounced sweating, digestive upset, and heightened agitation. Some individuals may also experience hallucinations or seizures, particularly if they have a history of heavy alcohol use.
    • 2-3 days: The peak of alcohol withdrawal symptoms often occurs around 48 to 72 hours after the last drink. Symptoms may intensify during this time, with severe anxiety, tremors, sweating, nausea, vomiting, insomnia, agitation, confusion, hallucinations, and seizures occurring in some cases.
    • 3-5 days: After the withdrawal symptoms peak, they gradually subside. However, some individuals may continue to experience lingering symptoms such as anxiety, insomnia, and mood disturbances for several days or even weeks.
    • Beyond 5 days: While acute withdrawal symptoms generally resolve within the first week, some individuals may experience a protracted withdrawal syndrome characterized by persistent symptoms such as anxiety, depression, insomnia, and cravings for alcohol. This phase can last weeks or months and may require ongoing medical and psychological support.

    Post Acute Withdrawal Syndrome for Alcohol

    Post-acute withdrawal syndrome (PAWS) refers to a set of lingering symptoms that can persist for weeks or months after the acute phase of alcohol withdrawal has subsided.[6] While acute withdrawal symptoms typically peak within the first week after the cessation of alcohol use, PAWS can manifest as a continuation or recurrence of certain symptoms, albeit to a milder degree. PAWS is believed to result from neurochemical imbalances and changes in the brain’s functioning due to chronic alcohol abuse.

    PAWS can vary in duration and intensity from person to person, and its impact on daily functioning and quality of life can also vary accordingly. Effective management of post-acute withdrawal syndrome often involves a combination of medical treatment, therapy, lifestyle changes, and ongoing support from healthcare professionals and support networks. Engaging in healthy habits such as regular exercise, proper nutrition, stress management techniques, and participating in support groups or counseling can help individuals cope with the challenges of PAWS and maintain their recovery from alcohol dependence.

    Types of Drug Withdrawal Treatment

    If you or someone you care about is struggling with alcohol addiction—or another substance use disorder—seeking treatment can make all the difference. Alpas is committed to providing comprehensive care at every stage of the healing process, offering a range of services tailored to address your needs, including medication-assisted treatment on a case-by-case basis.

    Levels of care include:

    • Medical Detox: Medical detoxification, often referred to as medically managed withdrawal, is a critical component of alcohol withdrawal treatment, particularly for individuals with moderate to severe alcohol dependence. This level of care involves a supervised process of safely eliminating alcohol from the body while managing withdrawal symptoms and addressing any potential complications that may arise.
    • Medically-Managed Care: Medically-managed care, often referred to as inpatient care, is a crucial aspect of alcohol withdrawal treatment, particularly for individuals with moderate to severe alcohol dependence. This level of care involves comprehensive medical oversight and intervention to ensure the safety and well-being of the individual throughout the withdrawal process.
    • Inpatient Treatment: Inpatient treatment, also known as residential treatment, is a comprehensive level of care for individuals struggling with alcohol dependence, particularly those with severe addiction or co-occurring mental health disorders. Inpatient treatment involves residing in a specialized facility where individuals receive round-the-clock medical and therapeutic support in a structured environment.

    How Alcohol Withdrawal Treatment Works

    Alcohol withdrawal treatment typically involves a multi-faceted approach aimed at managing withdrawal symptoms, addressing underlying issues contributing to alcohol dependence, as well as laying the groundwork for supporting long-term recovery. The process often begins with an assessment by healthcare professionals to determine the appropriate level of care needed based on the individual’s medical history, the severity of their alcohol dependence, and any potential withdrawal symptoms.

    After the initial assessment, individuals who require medical supervision to manage withdrawal symptoms safely may undergo medical detox, which may involve the use of medications to alleviate symptoms and ensure a safe transition from alcohol dependence. Following detox, individuals may progress to higher levels of care, such as residential or inpatient treatment programs that offer intensive therapy, counseling, and support to address the psychological, social, and behavioral aspects of alcohol dependence.

    As individuals gain stability and progress in their recovery, they may transition to lower levels of care, such as outpatient treatment or support groups, where they can continue to receive ongoing support and maintain sobriety in their everyday lives. This step-by-step approach allows individuals to receive the appropriate level of care at each stage of their recovery journey, ultimately promoting long-term success in overcoming alcohol dependence.

    Medications Used for Alcohol Withdrawal

    Several medications are commonly used to manage alcohol withdrawal symptoms and support you during the detoxification process. These medications help alleviate discomfort and promote a safer and more manageable withdrawal experience:[7]

    • Benzodiazepines: Benzodiazepines are the primary medications used to manage alcohol withdrawal symptoms, particularly anxiety and seizures. Examples include diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium).
    • Anticonvulsants: Anticonvulsant medications such as gabapentin (Neurontin) and carbamazepine (Tegretol) may be used to prevent seizures during alcohol withdrawal. These medications help stabilize neuronal activity and reduce the risk of seizure activity, particularly in individuals with a history of alcohol-related seizures.
    • Alpha-2 Adrenergic Agonists: Medications such as clonidine (Catapres) and dexmedetomidine (Precedex) may be used to alleviate symptoms such as high blood pressure, rapid heartbeat, and agitation during alcohol withdrawal.
    • Beta Blockers: Beta-blockers such as propranolol (Inderal) may be prescribed to manage symptoms of autonomic hyperactivity during alcohol withdrawal, including tremors, palpitations, and sweating.
    • Sedative-Hypnotics: Sedative-hypnotic medications such as zolpidem (Ambien) or trazodone (Desyrel) may be used to promote sleep and alleviate insomnia during the withdrawal process.

    Ready to get help for you or a loved one? Contact us

    What’s the Best Way to Find Alcohol Withdrawal Treatment?

    Finding alcohol withdrawal treatment represents an important step toward recovery for those struggling with alcohol. Contact healthcare professionals, such as your primary care physician or an addiction specialist, who can assess your needs and guide your treatment options. Family and friends can also support and guide your recovery journey.

    Research online to find programs offering evidence-based treatments and comprehensive care. Evaluate treatment approaches that incorporate medical interventions, behavioral therapies, and holistic approaches to address all aspects of alcohol dependence. There are several places you can look to for treatment referrals, including:

    Above all, trust your instincts and choose a treatment program where you feel comfortable, supported, and confident in the quality of care.

    Cost of Drug Withdrawal Treatment

    The cost of drug withdrawal treatment can vary based on factors like the type of facility and level of care needed. Inpatient programs tend to be more expensive due to 24/7 supervision. The duration of treatment also affects costs; longer programs may have higher upfront fees but offer more comprehensive support.

    Insurance coverage is also significant; many plans offer detox, rehabilitation, and therapy coverage. Financial assistance programs or sliding scale fees may be available for those in need. Ultimately, it’s essential to consider the quality of care and potential long-term benefits when evaluating costs. Explore insurance coverage, financial assistance, and alternative funding sources to make treatment more accessible.

    Share this post on your social networks:

    Ready to get help for you or a loved one? Contact us

    Editorial Guidelines At Alpas Wellness

    To ensure accuracy and quality, every contributor to the Alpas Wellness resource library undergoes a thorough evaluation of their experience, credentials, and achievements prior to publication.

    Find Alcohol Withdrawal Treatment Near Me

    Frequently Asked Questions about Alcohol Withdrawal Treatment


    How do healthcare professionals determine the appropriate level of care for alcohol withdrawal treatment?


    Healthcare professionals determine the appropriate level of care for alcohol withdrawal treatment based on factors such as the severity of alcohol dependence, the presence of co-occurring medical or psychiatric conditions, the risk of complications during withdrawal, and the individual’s social support network. A comprehensive assessment evaluates these factors and tailors treatment recommendations to the individual’s specific needs and circumstances.


    Is inpatient treatment necessary for alcohol withdrawal, or can it be managed on an outpatient basis?


    The necessity of inpatient treatment for alcohol withdrawal depends on factors such as the severity of withdrawal symptoms, the presence of co-occurring medical or psychiatric conditions, and the individual’s support system. While some individuals with mild withdrawal symptoms may be managed on an outpatient basis, those with moderate to severe symptoms or significant medical complications may require the intensive monitoring and support provided by inpatient treatment.


    What happens after completing alcohol withdrawal treatment?


    After completing alcohol withdrawal treatment, individuals may transition to ongoing support services to help maintain sobriety and prevent relapse. This may include participation in outpatient therapy, attendance at support group meetings such as Alcoholics Anonymous (AA), engagement in aftercare programs offered by the treatment facility, and ongoing medication management if necessary. The goal is to provide continued support and resources to help individuals navigate the challenges of early recovery and establish a solid foundation for long-term sobriety.


    [1] Alcohol withdrawal: MedlinePlus Medical Encyclopedia. (2018). on April 9, 2024

    [2] Newman, R. K., Stobart, M. A., & Gomez, A. E. (2023, July 21). Alcohol Withdrawal.; StatPearls Publishing. on April 9, 2024

    [3] Rahman, A., & Paul, M. (2018, November 18). Delirium Tremens (DT).; StatPearls Publishing. on April 9, 2024

    [4] Alcohol Withdrawal. (n.d.). Cleveland Clinic. on April 9, 2024

    [5] Alcohol Withdrawal. (n.d.). Cleveland Clinic. on April 9, 2024

    [6] Bahji, A., Crockford, D., & El-Guebaly, N. (2022). Neurobiology and Symptomatology of Post-Acute Alcohol Withdrawal: A Mixed-Studies Systematic Review. Journal of Studies on Alcohol and Drugs, 83(4), 461–469. on April 9, 2024

    [7] Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. JOURNAL of CLINICAL and DIAGNOSTIC RESEARCH, 9(9). on April 9, 2024

    Begin Your Recovery Journey Today