Alcohol Withdrawal Timeline – Detoxing From Alcohol
Medically reviewed byDr. Gerardo Sison
April 1, 2019
The timeframe, severity, and symptoms of alcohol withdrawal can vary depending on the amount and frequency of alcohol consumption. Health and medical conditions can also influence how serious withdrawal becomes and how quickly it develops.
The exact timeline of alcohol withdrawal varies per person, but generally, symptoms begin in a matter of hours after a person’s last drink. In most cases, acute withdrawal symptoms are at their most severe one to three days after they begin, with symptoms decreasing from this point. However, certain individuals may experience symptoms for weeks.
The timeline for alcohol withdrawal is as follows:
- Mild symptoms of withdrawal typically begin six to eight hours after the last drink. Most people struggle with these symptoms for one to two days, however, certain people may experience them for three days or longer. Symptoms include anxiety, headache, shaking, stomach upset, and sweating.
Moderate to severe withdrawal:
- A person may have hallucinations within one day after they quit drinking. These visual, sound, and tactile (touch) disturbances may last six to seven days.
- Seizures can begin six to 48 hours after the last drink. Seizures typically decline around day three.
- Delirium tremens, or DTs, the most serious form of withdrawal, usually begin two to four days after a person stops drinking. In certain cases, it may be seven to 10 days after the last drink before they start. Delirium tremens can last two weeks.
Certain people struggle with withdrawal symptoms weeks after acute withdrawal fades. Protracted alcohol withdrawal syndrome (PAWS), or post-acute withdrawal syndrome, is a set of symptoms that can occur four to six weeks after abstinence. These symptoms can include anxiety, cravings, depression, sleep problems, and an inability to feel pleasure.
For the best chance of recovery success, and for the greatest measure of safety, a person seeking to quit drinking alcohol should consider a medically supervised detoxification program versus detoxing at home, without supervision.
The length of a detox program varies, based on the severity of a person’s addiction and any accompanying health problems. For some people, it may only be a matter of days before their body begins to normalize, and for others, this process may last up to two weeks.
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Understanding Alcohol Withdrawal
Withdrawal symptoms can be mild, moderate, or severe. Typically, individuals who consume excessive amounts of alcohol on a chronic basis encounter withdrawal symptoms more heavily. The greater the severity of symptoms, the greater the discomfort, danger, and likelihood that a person will need medical assistance.
When a person is dependent on alcohol their body can become very sick without it. Not every person who is addicted to alcohol will have withdrawal symptoms, however, a large number of people with alcoholism are in danger of withdrawal should they quit drinking.
If a person has had withdrawal before, they are more likely to develop it in the future. Further, certain individuals who binge drink may encounter certain symptoms of withdrawal.
People who drink heavily may also go into withdrawal when they significantly reduce the amount of alcohol they consume. Mild withdrawal can occur even when a person still has a detectable blood alcohol level.
Signs And Symptoms Of Alcohol Withdrawal
In certain cases alcohol withdrawal is merely uncomfortable, however, many people become very sick as their body works to flush the drug’s toxins from its system.
The physical symptoms of alcohol withdrawal include:
- clammy skin
- enlarged (dilated) pupils
- fast heart rate
- little to no appetite
- nausea and vomiting
- pale skin
- trembling hands
The psychological symptoms of alcohol withdrawal include:
- mood swings
- trouble focusing
Beyond these symptoms, certain people may develop severe withdrawal. Severe withdrawal includes delirium tremens, a potentially life-threatening condition.
Severe Alcohol Withdrawal: Withdrawal Seizures And Delirium Tremens
The most dangerous complications of alcohol withdrawal are withdrawal seizures and delirium tremens. Heavy drinkers are at a greater risk of experiencing severe withdrawal.
Without the medical oversight provided by a medical detox and trained professionals, these severe withdrawal states could put a person’s life in jeopardy. Identifying the symptoms of severe withdrawal could save a life.
In addition to the aforementioned symptoms of withdrawal, during delirium tremens a person may exhibit the following symptoms:
- agitation or excitement
- becoming sensitive to light, sound, and/or touch
- body tremors
- cognitive changes
- extreme confusion
- rapidly occurring mood swings
- surges of energy
- sleeping deeply for a day or more
Once symptoms begin, they can accelerate rapidly. Severe seizures can also occur, either alone or with these symptoms. Should a seizure happen, they are typically generalized tonic-clonic seizures (previously called grand mal seizures). These seizures can cause unconsciousness and rapid, violent muscle contractions.
Seizures and delirium tremens require immediate medical help. Without prompt medical intervention, a person could die. Choosing a medically supervised detoxification program could save the life of a person at risk for severe withdrawal, however, if a person appears to be experiencing DTs, contact emergency medical support right away.
The Importance Of A Medical Detox Program
In addition to offering greater protection against relapse, a medically supervised detox helps prepare a person for rehabilitation, the next stage of treatment.
While quitting drinking may be one of the hardest parts of recovery, the time that follows can be especially trying. Withdrawal symptoms can become unbearable, and without trained medical help, many people resort to drinking as a means to reduce these symptoms.
While mild to moderate withdrawal symptoms can be treated in an outpatient detoxification program, inpatient detoxification may be a better option for individuals who wish to transition to a residential rehabilitation program after detoxing.
Further, people facing certain health, medical, or life circumstances may need care that is best offered in an inpatient detoxification program.
In addition to pregnant women, these can include people who:
- have drank heavily in the recent past
- do not have a strong support network
- have detoxed several times in the past
- have a history of severe withdrawal
- have previously had withdrawal seizures or delirium tremens
- have a co-occurring disorder (when a person has a mental health disorder in addition to their substance use disorder)
In most cases, people facing severe withdrawal are best treated by 24/7 monitoring and intensive medical care. For this reason, hospitalization or inpatient detoxification programs are generally recommended for people who are suspected to be high-risk for severe withdrawal.
During an inpatient medical detox a person is supported physically, mentally, and emotionally. In addition to offering comfort and words of encouragement, trained clinicians will administer a variety of treatments to help a person progress more comfortably and safely through withdrawal. Quite commonly these treatments include medications and other medical supports, such as IV fluid hydration and the use of B vitamins, especially thiamine.
Treating Withdrawal With Benzodiazepine Medications
Benzodiazepines, a class of medications with sedative and calming properties, are frequently used to treat alcohol withdrawal, should medications be needed. Due to these effects, benzodiazepines can decrease anxiety and the symptoms of seizures. They can also help a person sleep and act as muscle relaxants. The combination of these effects can be useful in treating a person undergoing withdrawal.
If medications are necessary, the exact medication regime will be determined by the supervising medical team. A person’s health and medical history should be thoroughly examined in order to make this determination. The severity of withdrawal symptoms influences this as well.
When benzodiazepines are used, they may be administered one of two ways. Medications may be used as needed (a symptom-triggered regimen) or at set periods of time (a fixed-schedule regimen). The dosage will vary depending on which method medical staff determines is best for a patient’s specific needs.
The following benzodiazepine drugs are used to treat withdrawal in both of these ways:
- chlordiazepoxide (Librium)
- diazepam (Valium)
- lorazepam (Ativan)
Librium and Valium are both long-acting medications, whereas Ativan is a short-acting benzodiazepine.
In certain cases, treatment providers do use a short-acting benzodiazepine, however, long-acting forms are typically the preferred line of treatment for alcohol withdrawal. One example is people who have a hard time metabolizing certain medications, such as the elderly or persons with liver failure. These individuals may be better treated with short-acting medications.
Benzodiazepine medications can be dangerous and even fatal when mixed with alcohol. This is another reason why inpatient treatment may be the wisest option. During outpatient treatment, there are significant periods of time where a person isn’t supervised. Because of this, a person may mix these substances, leading to a lethal reaction. Inpatient treatment offers support, guidance, and accountability that can help protect a person from this threat.
Other Medications Used To Treat Alcohol Withdrawal
In addition to benzodiazepines, various other medications may be used to treat withdrawal symptoms. These include anticonvulsants, antipsychotics, barbiturates, and beta blockers. While once a common treatment for alcohol withdrawal, excluding phenobarbital, barbiturates aren’t widely used. This is because they are highly addictive and can cause a deadly reaction when used with alcohol.
It’s been suggested that naltrexone and acamprosate may be useful during the latter part of withdrawal treatment, however, they are not sufficient for alcohol detoxification. It’s believed that acamprosate decreases certain symptoms of post-acute withdrawal syndrome.
While benzodiazepines and other medications may be used in outpatient detoxification programs, during this treatment a person doesn’t have around-the-clock medical oversight and emotional support as they would in an inpatient detox program. For some people, this could mean the difference between successful detoxification and a return to alcohol abuse.
Once a person has detoxed from alcohol and begun to physically heal, an inpatient drug rehab program typically provides the most intensive opportunity for rehabilitation. These programs commonly use medication-assisted treatments for alcohol use disorders. This combination of medications, or pharmacotherapies, and behavioral therapies helps a person to continue healing physically while also addressing the psychological elements of addiction.
Contact Rehabcenter.net for more information on alcohol withdrawal and detox programs.Article Sources
American Family Physician - Alcohol Withdrawal Syndrome
Kings College London - Nature and Clinical Significance of the Protracted Withdrawal Syndrome in Alcohol Dependence
MedlinePlus - Alcohol Withdrawal, Delirium tremens
Substance Abuse and Mental Health Services Administration - A Treatment Improvement Protocol TIP 45
US National Library of Medicine - Clinical management of alcohol withdrawal: A systematic review
World Health Organization - Management of alcohol withdrawal