Alcohol is one of the most popular recreational drugs in the United States. An estimated 15.1 million adults live with alcohol use disorder. People who have developed a dependence on alcohol experience uncomfortable physical and psychological symptoms when they discontinue alcohol use and these symptoms characterize alcohol withdrawal syndrome. Extreme cases of alcohol withdrawal can be fatal. People with moderate to severe alcohol use disorders should only undergo detox and withdrawal under the supervision of medical professionals.
Among the effects of alcohol abuse is the development of alcohol tolerance, meaning that ever-increasing amounts of alcohol are required to achieve the desired effect. If chronic alcohol use continues, physical symptoms of withdrawal will occur when alcohol use is discontinued. Symptoms and signs of alcohol dependence include an inability to stop drinking without physical and psychological symptoms including trembling, nausea or vomiting and intense cravings that go away when alcohol consumption is resumed.
The alcohol withdrawal timeline is generally predictable and includes consistent signs and symptoms. Withdrawal symptom severity generally correlates with the degree of alcohol dependence.
What Causes Alcohol Withdrawal?
Chronic excessive alcohol use causes several chemical changes in the brain, most notably to the inhibitory neurotransmitter GABA and the excitatory neurotransmitter NMDA. These changes lead to increased levels of dopamine, which drives addiction. If the brain adapts to these changes, a sudden absence of alcohol will cause physical and psychological signs and symptoms that are complications of alcohol withdrawal.
How Long Does Alcohol Stay In Your System?
Unlike many other drugs of abuse, the half-life of alcohol depends on the amount consumed. The more you drink, the longer it will stay in your system. This reaction is because the liver metabolizes alcohol at a constant rate of about one standard drink per hour. If you have two drinks over the course of 30 minutes, the liver will spend the next hour and a half metabolizing them. If you continue to drink, additional alcohol will remain in your bloodstream until the liver can metabolize it.
Because of the constant metabolic rate of alcohol, there are no truly effective ways to sober up from alcohol. Alcohol is rapidly transferred out of the gastrointestinal system into the bloodstream, so even vomiting is unlikely to have substantial changes in the level of intoxication. Commonly cited remedies for drunkenness include drinking caffeine or taking a cold shower. While these may cause modest, transient changes in mental state and marginally increase alertness, they are not able to address the root cause of intoxication, which is the accumulation of alcohol in the bloodstream.
Alcohol Withdrawal Symptoms
Even moderate alcohol consumption can cause the brain to adapt to the constant presence of alcohol. Withdrawal occurs when alcohol is suddenly unavailable and the brain cannot maintain alcohol-induced changes in function.
Mild Alcohol Withdrawal Symptoms
Approximately six to eight hours after the last drink, someone with alcohol dependence will begin to experience mild withdrawal symptoms, including:
- Mild Withdrawal Symptoms
Irritability and anger
Vivid dreams and nightmares
Moderate Alcohol Withdrawal Symptoms
In addition to the symptoms of mild alcohol withdrawal, moderate withdrawal symptoms set in within 24 hours after the last drink and often include:
- Moderate Withdrawal Symptoms
Vomiting or diarrhea
Rapid heart rate
Psychomotor agitation (repetitive, purposeless motions)
Increased anxiety and emotional stress
Severe Alcohol Withdrawal Symptoms
Severe alcohol withdrawal symptoms include those listed for mild and moderate withdrawal but may also include dangerous symptoms including respiratory depression, seizures or delirium tremens (DTs). Severe alcohol withdrawal can be fatal. It is important that people with serious alcohol use disorders seek medical care before they undergo detox and withdrawal.
People who undergo medically assisted detox may be candidates to receive prescription alcohol withdrawal medication that can mitigate their symptom severity and significantly reduce the chance that alcohol withdrawal-induced seizures will occur.
Alcohol Withdrawal Timeline
Mild, moderate and severe alcohol withdrawal duration can vary to some degree between individuals, but for the most part, the symptoms are reliable and consistent. Symptom onset is generally within about six to eight hours after the last drink. Mild and moderate withdrawal symptoms peak around 72 hours after the last drink and acute withdrawal symptoms often resolve within about one week. Severe withdrawal has a prolonged timeline, however, and may include incredibly dangerous, even lethal symptoms.
Even after the resolution of acute withdrawal symptoms, some people may experience fluctuating withdrawal symptoms for weeks, months or even years after their last drink. This phenomenon is called post-acute withdrawal syndrome (PAWS), and it can be frustrating to manage. It is important that people in recovery understand that PAWS is normal and that the symptoms will subside as time goes on.
A Day-by-Day Alcohol Withdrawal Timeline
Although there is some individual variability, a general timeline of alcohol withdrawal involves:
- First 24 Hours
Early symptom onset occurs six to eight hours after the last drink, including cravings, irritability, trembling, nausea and vomiting. People with severe withdrawal may experience seizures during the first day of withdrawal.
- Day 2
Symptoms will become more uncomfortable. More severe symptoms like low-grade fever and pronounced trembling will set in. Severe withdrawal-associated seizure activity and DT-induced confusion or hallucinations set in.
- Day 3
Mild withdrawal symptoms may begin to subside, but moderate symptoms will persist. Severe/DT-associated symptoms continue to develop.
- Day 4
Mild symptoms may be nearly resolved, moderate symptoms persist but may start to subside. Severe symptoms will persist and may continue to develop. DT symptoms may become more pronounced.
- Day 5
Moderate symptoms may subside. Severe withdrawal symptoms will continue to be profoundly debilitating. DTs persist.
- Day 6
Mild symptoms will have mostly or completely resolved by day six. Moderate symptoms will be substantially reduced. Most of, but not all of, people experiencing DTs will begin to feel some relief.
- After One Week
Mild and moderate symptoms should be largely resolved by day seven. All but the most extreme cases of severe withdrawal should be starting to resolve by day seven.
Factors Impacting Alcohol Withdrawal
While the most significant factor affecting alcohol withdrawal is the degree of alcohol dependence, there are other factors that can contribute to withdrawal.
Factors that may lessen withdrawal severity include:
- Healthy diet
- Regular exercise
- Younger age (if dependence was established after adolescence)
Factors that may increase withdrawal severity include:
- Poor diet
- Lack of exercise
- Mental health disorders
- Alcohol dependence that began during adolescence
- Immune system dysfunction or other diseases
How To Cope With Alcohol Withdrawal
Alcohol withdrawal is an uncomfortable process even in the best of cases, and there are no shortcuts or reliable home remedies for alcohol withdrawal. People with mild dependence may be able to somewhat lessen the severity of their withdrawal symptoms during home detox using the following tips:
- Stay hydrated
- Maintain an appropriate electrolyte balance by sipping a sports drink
- Try to eat healthy foods. If you cannot eat, drink soup or broth.
- Enlist a trusted friend or family member to check on you regularly
- If possible, lightly exercising or taking a walk can help with symptoms including alcohol withdrawal insomnia
When Professional Detox Is Needed
Regular excessive alcohol consumption rapidly produces physical dependence that can be challenging to overcome. Detox and withdrawal can be dangerous, even for people with mild or moderate dependence. To ensure safe detox and withdrawal, an assessment with a rehab professional should be sought before the detox begins.
Alcohol withdrawal delirium is associated with confusion and hallucinations. People who are experiencing these symptoms may not be able to seek medical help. If you or someone you know has a serious alcohol use disorder, quitting cold turkey without professional oversight can be dangerous, even lethal. By some estimates, up to 37% of untreated delirium tremens can be fatal. When appropriate, medically assisted detox can provide pharmacotherapies that can attenuate the severity of withdrawal symptoms.
Where to Find Help in South Florida
There are a number of South Florida alcohol detox centers, but they are not all alike. When you are evaluating rehab facilities, look for experienced teams that provide multidisciplinary care and evidence-based treatment strategies to allow you to safely detox from alcohol. Rehab centers that can provide quality care during every stage of recovery, from the initial assessment to aftercare programs that support long-term recovery, provide the most reliable way to overcome an alcohol use disorder and maintain long-term sobriety.
Contact The Recovery Village Palm Beach at Baptist Health to speak with a representative about how professional treatment can address an alcohol use disorder and any co-occurring mental health disorders. You deserve a healthier future, call today.
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Rogawski, Michael A. “Update on the Neurobiology of Alcohol Withdrawal Seizures.” Epilepsy Currents, November 2005. Accessed September 12, 2019.
Schuckit, Marc A. “Recognition and Management of Withdrawal Delirium (Delirium Tremens).” The New England Journal of Medicine, November 2014. Accessed September 12, 2019.
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Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.