Alcohol withdrawal is one of the few withdrawals that can kill. MedlinePlus puts it plainly: alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition [2]. It also says most people who go through it make a full recovery, but that death is possible, especially if delirium tremens occurs [2].
That is why this page leads with the risk rather than the schedule. Below: what the symptoms are, when they start, when they peak, when seizures happen, what delirium tremens is, what changes the picture, why supervision matters, and what detox does and does not do. Our wider guide to withdrawal symptoms covers other drugs.
Is Alcohol Withdrawal Dangerous?
Yes, and MedlinePlus says so in the plainest terms it uses anywhere: alcohol withdrawal is a serious condition that may quickly become life-threatening [2]. It tells readers to contact a provider right away, or go to the emergency room, if they think they may be in alcohol withdrawal [2].
SAMHSA’s detox protocol says the same from the clinical side. Seizures and true delirium tremens represent the most extreme forms of severe alcohol withdrawal [1].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
None of that means everyone who stops drinking is in danger. It means nobody can tell in advance which group they are in, and that is the reason to ask a clinician first rather than find out alone.
Alcohol Withdrawal Symptoms
MedlinePlus lists the common ones as anxiety or nervousness, depression, fatigue, irritability, jumpiness or shakiness, mood swings, nightmares and not thinking clearly [2]. It adds sweating and clammy skin, enlarged pupils, headache, insomnia, loss of appetite, nausea and vomiting, pallor, rapid heart rate and tremor [2].
SAMHSA’s list runs the same way, and sorts it by severity. Mild alcohol withdrawal generally consists of anxiety, irritability, difficulty sleeping and decreased appetite [1].
Severe alcohol withdrawal is different in kind, not just degree. SAMHSA describes obvious trembling of the hands and arms, sweating, a raised pulse and blood pressure, nausea sometimes with vomiting, and a hypersensitivity to noise and light in which sounds seem louder and light seems brighter [1]. Brief periods of hearing and seeing things that are not there may also occur, and a fever above 101 degrees Fahrenheit may be seen, though a clinician has to rule out infection first [1].
When Symptoms Start
The pinned figure on this site is SAMHSA’s, and it is a range rather than a single hour. The signs and symptoms of acute alcohol withdrawal generally start 6 to 24 hours after the patient takes his last drink [1].
One detail is worth holding on to. SAMHSA notes that alcohol withdrawal may begin while the patient still has significant blood alcohol concentrations [1]. A person can be withdrawing and still test positive. Waiting to “sober up” before getting help is not a plan.
The Peak, and How the Course Varies
MedlinePlus gives the peak: symptoms tend to peak by 24 to 72 hours, but may go on for weeks [2].
SAMHSA gives the honest caveat about everything around that peak. The course of these symptoms is extremely variable [1]. One person may progress partly through the symptoms and then improve slowly. Another may have mild to moderate symptoms that stop almost abruptly. Another may present with a seizure or with hallucinations [1]. Some people with alcohol dependence, whatever their pattern of drinking or the amount they drink, appear to develop only minor symptoms or none at all [1]. “Appear” is SAMHSA’s own word, and it is doing work: it is not a rule you can plan around.
So a timeline is a shape, not a promise. If you are planning around one, plan around the worst case and be glad if it does not arrive. Our page on how long rehab takes covers the longer question of treatment.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Seizures and Delirium Tremens
Seizures come early. SAMHSA reports that the majority of alcohol withdrawal seizures occur within the first 48 hours after cessation or reduction of alcohol, with peak incidence around 24 hours [1]. Those two words matter: cutting down sits inside the risk window, not outside it.
Most alcohol withdrawal seizures are singular, and where more than one occurs they tend to fall within several hours of each other [1]. SAMHSA adds that someone who has an alcohol withdrawal seizure is at greater risk of progressing to delirium tremens [1].
Delirium tremens is the severe form. MedlinePlus says it can cause agitation and irritability, sudden severe confusion, fever, seeing or feeling things that are not there, and seizures [2]. It is also the reason MedlinePlus says death is possible [2].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Supervised alcohol detox in Washington
The Recovery Village Ridgefield is our campus in Ridgefield, Washington. Its own page cards medical detox, inpatient treatment, partial hospitalization programming, intensive outpatient programming, dual diagnosis treatment and medically-assisted treatment, and it describes that last card as being for severe opioid or alcohol use disorders. Ask admissions which of those is open when you call, and say plainly how much and how recently the person has been drinking.
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The Recovery Village Ridgefield is part of our family of treatment centers. See the Recovery Village Ridgefield campus.
What Changes the Timeline
How regularly someone drinks. MedlinePlus says the more often you drink, the more likely you are to have withdrawal symptoms when you stop [2].
Other medical problems. MedlinePlus is direct: you may have more severe withdrawal symptoms if you have certain other medical problems [2].
Previous withdrawals. SAMHSA’s observation that a seizure raises the risk of progressing to delirium tremens [1] is why a history of complicated withdrawal changes the plan.
Whether it is a stop or a cut. The seizure window SAMHSA describes covers cessation or reduction [1].
Other substances. Sedatives and alcohol act on the same system, and stopping both at once is a different clinical problem. Tell the assessing clinician everything, including prescriptions.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Why a Supervised Setting Matters
Because the treatment is monitoring. MedlinePlus describes inpatient care for moderate to severe withdrawal as being watched closely for hallucinations and other signs of delirium tremens, with blood pressure, body temperature, heart rate and blood chemistry monitored, fluids or medicines given by IV, and sedatives given until withdrawal is complete [2].
Outpatient care exists too, and MedlinePlus sets out what it requires: it is for mild to moderate symptoms, someone has to stay with you and keep an eye on you, and you will likely need daily visits to your provider until you are stable [2]. Treatment there usually includes sedatives, blood tests, counseling for you and your family, and testing for other medical problems linked to alcohol use [2].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Read those two paragraphs together and the pattern is clear. Both settings involve someone watching. Our guides to medical detox, inpatient rehab and outpatient rehab set out what each involves, and our alcohol detox page covers the alcohol-specific version.
Which medicines, how much and for how long is a prescriber’s decision about a particular person. It is not something to plan from a web page, and this page does not publish one.
What Detox Does and Does Not Do
SAMHSA defines detoxification as a set of interventions aimed at managing acute intoxication and withdrawal [3]. It runs on three parts: evaluation, stabilization, and fostering the patient’s entry into treatment [3].
The third part is the one people skip. SAMHSA states that detoxification is not substance abuse treatment and rehabilitation, and that a detox program is not designed to resolve the long-standing psychological, social and behavioral problems tied to alcohol and drug use [3]. NIDA says what happens when it is skipped: detox alone, without treatment afterwards, generally leads to a return to drug use [4].
SAMHSA suggests a written treatment contract during detox — signed by choice once a person is stable enough, and not legally binding — in which the patient agrees to a continuing care plan with the contacts arranged before detox ends [3]. Ask for it in writing.
After Detox: What Lasts and What Helps
Some things outlast the acute phase. MedlinePlus says symptoms such as sleep changes, rapid changes in mood and fatigue may last for months [2].
Where a person lives next matters. MedlinePlus puts it directly: it is important to go to a living situation that supports you in avoiding unhealthy alcohol use, and some areas have housing options that provide a supportive environment for people trying to stay sober [2].
If a person drinks again, that is information rather than a verdict. NIDA’s position is that a return to use does not mean treatment has failed; it means speaking with a doctor about resuming treatment, changing it, or trying another one [4]. NIDA also notes that medications are available to help treat alcohol use disorder [4], and our page on medication-assisted treatment covers where they fit.
Cost, Insurance and Getting Started
Detox is the shortest and most staff-heavy part of a course of care. Our own cost page puts medical detox at $250 to $800 per day and basic residential treatment at $2,000 to $20,000; those are our published ranges, not federal figures. See how much rehab costs and does insurance cover rehab.
Whatever the money looks like, the order is the same. An assessment first, then a setting, then the plan for afterwards. If there is any chance of a severe withdrawal, that assessment is urgent rather than something to book for next week.
Frequently Asked Questions
How long does alcohol detox take? Symptoms generally start 6 to 24 hours after the last drink, and MedlinePlus says they tend to peak by 24 to 72 hours, though they may go on for weeks. SAMHSA adds that the course is extremely variable from person to person. Some symptoms, including sleep changes, mood swings and fatigue, may last for months.
What is the worst day? Usually inside the first three days, because that is when symptoms tend to peak and when the majority of alcohol withdrawal seizures occur, with peak incidence around 24 hours. But SAMHSA is clear the course is extremely variable: some people improve steadily, and others first present with a seizure or with hallucinations.
Can I do this at home? Not without asking a clinician first. MedlinePlus says alcohol withdrawal is a serious condition that may quickly become life-threatening, and to contact a provider right away or go to the emergency room if you think you may be in withdrawal. If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
What medications are used? That is a prescriber’s decision, and this page publishes no schedule. MedlinePlus describes inpatient treatment as including fluids or medicines given by IV and sedatives given until withdrawal is complete, and outpatient treatment as usually including sedatives to ease symptoms. NIDA adds that medications are available to help treat alcohol use disorder itself, which is a separate question from withdrawal.
What comes after detox? Treatment does. SAMHSA states that detoxification is not substance abuse treatment and rehabilitation, and that a detox program is not designed to resolve the long-standing problems involved. NIDA adds that detox alone, without treatment afterwards, generally leads to a return to drug use. Ask for a written continuing care plan before discharge.
Sources
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances — Alcohol. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
- U.S. National Library of Medicine. Alcohol Withdrawal. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000764.htm
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction — Treatment and Recovery. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
This page is for general information and is not medical advice. Only a licensed clinician who
knows your history can tell you what is right for you. If you or someone you know is in
immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
