Alcohol withdrawal is the set of symptoms that can start when someone who drinks heavily stops or cuts back. Early signs like shaking, sweating and anxiety often begin within 6 to 12 hours of the last drink. For some people, withdrawal becomes dangerous in the first few days, with seizures or delirium tremens (DTs).
If this is an emergency: Call 911 right away if someone in alcohol withdrawal has a seizure, becomes very confused, sees or hears things that aren’t there, or has a high fever or a racing heart. For a mental health or suicide crisis, call or text 988.
Call (561) 340-7269 to talk with our admissions team.
What Is Alcohol Withdrawal?
Alcohol slows down your brain. When you drink heavily for weeks or months, your brain adjusts to stay in balance. It turns down its calming chemical signals (GABA) and turns up its excitatory ones, mainly glutamate (NIAAA).
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When the alcohol suddenly stops, those changes don’t reverse right away. Your nervous system stays revved up, which causes shaking, sweating, a racing heart and anxiety. In severe cases, this overactivity can trigger seizures or delirium.
Doctors call this alcohol withdrawal syndrome. It’s a sign of physical dependence, which often comes with alcohol use disorder (AUD). Withdrawal can happen even if you still go to work every day and don’t think of yourself as having a drinking problem.
Who Is Most at Risk?
Withdrawal is most likely if you drink heavily every day or almost every day. Your risk of severe withdrawal is higher if you:
- Have had withdrawal seizures or DTs before
- Have gone through withdrawal several times, since each episode can make the next one worse (an effect called kindling)
- Drink in the morning to stop shaking or nausea
- Are older, or have liver disease, an infection or other health problems
- Also depend on other sedatives, such as benzodiazepines or sleeping pills
Alcohol Withdrawal Symptoms
Symptoms range from mild to life-threatening. Most people have mild to moderate symptoms, but no one can predict for sure how withdrawal will go for a given person.
| Severity | Common symptoms |
|---|---|
| Mild | Shaky hands (tremor), anxiety, irritability, headache, sweating, nausea, trouble sleeping, vivid dreams, strong cravings |
| Moderate | Stronger shaking, vomiting or diarrhea, fast heartbeat, higher blood pressure, fast breathing, low-grade fever, restlessness |
| Severe | Hallucinations, withdrawal seizures, sudden severe confusion (delirium tremens), high fever, drenching sweats |
Some symptoms, like shaking and anxiety, can start while there’s still alcohol in your blood. That’s why someone can be in withdrawal before their blood alcohol level reaches zero.
Alcohol Withdrawal Timeline
Withdrawal follows a fairly typical pattern, but timing varies from person to person. The table below shows when symptoms usually appear after the last drink (American Family Physician).
| Time since last drink | What may happen |
|---|---|
| 6-12 hours | Early symptoms: shaky hands, anxiety, sweating, headache, nausea, upset stomach, trouble sleeping and strong cravings. |
| 12-48 hours | Symptoms may grow stronger. Some people have hallucinations (alcoholic hallucinosis) while otherwise alert. Withdrawal seizures are most likely by 48 hours and can happen as early as 6 hours after the last drink. |
| 48-72 hours | Delirium tremens can begin, usually between 48 and 96 hours. For many people with milder withdrawal, symptoms peak in this window and then start to ease. |
| Beyond 72 hours | Mild to moderate symptoms usually fade over the next several days, often within about a week. DTs, if they happen, can last several days. Sleep problems, low mood, anxiety and cravings can linger for weeks or months. |
For most people, the worst physical symptoms pass within about a week. Feeling only mildly sick on day one does not mean the danger is over, because seizures and DTs can start later.
What Affects How Long Withdrawal Lasts
- How much you drink and for how long
- How many times you’ve gone through withdrawal before
- Your age and overall health, including your liver
- Other substances you use
- Whether you have medical care during withdrawal
Lingering Symptoms After Withdrawal
Some people have trouble sleeping, low energy, anxiety, low mood or cravings for weeks or months after the physical symptoms fade (NIAAA). This is sometimes called protracted withdrawal or post-acute withdrawal syndrome (PAWS). These symptoms usually ease with time, and support in ongoing treatment can help you cope without drinking.
When Alcohol Withdrawal Is Dangerous
Most withdrawal is miserable but not deadly. For some people, though, it can turn life-threatening quickly. Learn these warning signs, and call 911 first if you see them.
Withdrawal Seizures
Alcohol withdrawal seizures usually happen within 6 to 48 hours of the last drink (American Family Physician). They often look like a sudden collapse, with the body stiffening and then jerking. They can happen to people who have never had a seizure before (source).
If someone has a seizure, call 911. Move hard or sharp objects away, turn the person on their side if you can, and don’t put anything in their mouth. Learn more about alcohol withdrawal seizures.
Delirium Tremens (DTs)
DTs are the most severe form of alcohol withdrawal (source). They usually begin 48 to 96 hours after the last drink and can last several days. Signs include:
- Sudden, severe confusion, such as not knowing where they are
- Seeing, hearing or feeling things that aren’t there
- High fever and heavy sweating
- Racing heart and high blood pressure
- Severe agitation or shaking
DTs can be fatal without treatment and need hospital care (StatPearls). Read more about delirium tremens symptoms and treatment.
Other Signs That Need Emergency Care
Call 911 or go to the nearest emergency room if someone in withdrawal has:
- Chest pain or trouble breathing
- Vomiting that won’t stop, or can’t keep fluids down
- Confusion, trouble walking straight or unusual eye movements, which can be signs of a vitamin B1 problem called Wernicke encephalopathy
- Thoughts of suicide (you can also call or text 988)
Why Medical Detox Matters
Because severe withdrawal is hard to predict, doctors advise against stopping heavy drinking without medical advice. Medical detox gives you a safe place to get through withdrawal while trained staff check your symptoms and vital signs often. If problems start, they can act quickly.
During detox, doctors may use FDA-approved medications, such as benzodiazepines, to ease symptoms and lower the risk of seizures and DTs. Care teams also commonly give fluids, nutrition support and thiamine (vitamin B1) to protect the brain. The exact plan depends on each person’s health and history.
Detox handles the physical side of quitting. It doesn’t treat the reasons behind drinking, so it’s meant to be the first step before ongoing treatment.
To learn what the process involves, see our guide to alcohol detox and what to expect or read about our medical detox program. If you’re thinking about quitting on your own, read about the risks of alcohol withdrawal at home and talk to a doctor first.
Getting Help for Alcohol Withdrawal in Palm Beach County
The Recovery Village Palm Beach at Baptist Health offers medical detox for alcohol at our Lake Worth campus, 4905 Lantana Rd. After detox, care can continue in intensive inpatient, residential, partial hospitalization (PHP) or intensive outpatient (IOP) programs, with aftercare planning before you leave. Your care team sets the length of stay based on your needs.
Many people who drink heavily also live with depression, anxiety or trauma. Our dual diagnosis care treats both at the same time, using therapies such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), individual and group therapy, and 12-step based programming.
We’re accredited by The Joint Commission, licensed by the Florida Department of Children and Families, and we treat adults 18 and older. Our campus is about 20 to 25 minutes from downtown West Palm Beach. Learn more about alcohol rehab in Palm Beach County.
Call (561) 340-7269 to talk with our admissions team.
Alcohol Withdrawal FAQs
How long does alcohol withdrawal last?
For most people, physical symptoms start within 6 to 12 hours of the last drink, peak around 24 to 72 hours, and ease within about a week (American Family Physician). DTs, if they happen, can last several days.
Sleep problems, anxiety and cravings can linger for weeks or months. Heavier, longer drinking and past withdrawals can make it last longer.
When does alcohol withdrawal start?
Symptoms often begin 6 to 12 hours after the last drink, and sometimes sooner. Some people notice shaking, sweating or anxiety while there’s still alcohol in their blood.
Seizures are most likely in the first 48 hours, and DTs usually start between 48 and 96 hours. Because timing varies, get medical advice before you stop drinking.
Can alcohol withdrawal kill you?
Yes, in some cases. Withdrawal seizures and delirium tremens can be fatal without treatment (StatPearls).
That’s why doctors advise medical supervision for people who drink heavily and want to stop, since medical care lowers these risks. If someone has a seizure or becomes severely confused during withdrawal, call 911 right away.
What are the first signs of alcohol withdrawal?
Early signs include shaky hands, sweating, anxiety, irritability, headache, nausea and trouble sleeping. Many people also have strong cravings and a fast heartbeat.
At first, these symptoms can feel like a bad hangover. If they get worse, or if confusion or hallucinations appear, get medical help right away.
Is it safe to quit drinking cold turkey?
If you drink heavily every day, stopping suddenly without medical advice can be dangerous. You could have seizures or DTs, even if you’ve never had them before.
Talk to a doctor before you quit. A doctor can check your risk and help you decide whether you need medical detox.
What is the most dangerous day of alcohol withdrawal?
For most people, the highest-risk window is about 24 to 72 hours after the last drink, when seizures happen and DTs can begin. DTs can still start as late as day 4. Feeling okay early on does not mean the risk has passed, so stay under medical care or close watch for the first several days.
