How long does alcohol withdrawal last? Causes, Timeline, Symptoms, Dangers & Treatment Options
If you decide to stop drinking daily and heavily, you will likely experience withdrawal symptoms. The time it takes to detox depends on a few factors, including how much you drink, how long you’ve been drinking, and whether you’ve gone through detox before.
How long does alcohol withdrawal last? Most people stop having alcohol withdrawal symptoms four to five days after their last drink. Read on to learn more about what time frame to expect when detoxing from alcohol.
How long does alcohol withdrawal last? Causes of Withdrawal
Alcohol withdrawal is thought to arise as a function of various changes in brain activity caused by prolonged and excessive alcohol use. Though the neurochemical details of alcohol withdrawal syndrome are somewhat complicated, its associated symptoms reflect compensation for previous disruptions in both excitatory and inhibitory neurotransmitter activity—the balance between the two having been upended, to begin with as a result of prolonged alcohol use.
The effects alcohol has on the body are complex, but two particular neurochemicals contribute to both short-term effects of drinking as well as the development of alcohol withdrawal syndrome when someone stops drinking: the brain’s main inhibitory chemical, gamma-aminobutyric acid (GABA), and the brain’s main excitatory chemical, glutamate.
When a person drinks alcohol it changes the functioning of GABA receptors as well as certain glutamate receptors, resulting in a slowdown of brain functioning that a person typically experiences as decreased anxiety and sedation. The brain reacts by decreasing the amount of GABA being released and increasing glutamate signaling to compensate for how alcohol alters these levels. This adaptation functions as long as you continue to drink alcohol—this is known as ‘tolerance.’
If you stop or significantly reduce alcohol intake, it disrupts your brain activity, causing a hyper-aroused state which leads to a range of withdrawal symptoms that can appear within hours after your last drink. The withdrawal symptoms a person experiences, as well as their severity, may vary greatly from one person to the next, and it has been estimated that more than 80% of those with an alcohol use disorder may experience withdrawal symptoms.
How long does alcohol withdrawal last? Timeline
According to a 2013 literature review in the Industrial Psychiatry JournalTrusted Source, the following are general guidelines about when you can expect to experience alcohol withdrawal symptoms:
Minor alcohol withdrawal symptoms usually begin about six hours after your last drink. A person who has a long history of heavy drinking could have a seizure six hours after stopping drinking.
12 to 24 hours
A small percentage of people going through alcohol withdrawal have hallucinations at this point. They may hear or see things that aren’t there. While this symptom can be scary, doctors don’t consider it a serious complication.
24 to 48 hours
Minor withdrawal symptoms usually continue during this time. These symptoms may include headache, tremors, and stomach upset. If a person goes through only minor withdrawal, their symptoms usually peak at 18 to 24 hours and start to decrease after four to five days.
48 hours to 72 hours
Some people experience a severe form of alcohol withdrawal that doctors call delirium tremens (DTs) or alcohol withdrawal delirium. A person with this condition can have a very high heart rate, seizures, or a high body temperature.
This is the time when alcohol withdrawal symptoms are usually at their worst. In rare cases, moderate withdrawal symptoms can last for a month. These include rapid heart rate and illusions (seeing things that aren’t there).
How long does alcohol withdrawal last? Simptoms
Alcohol depresses the central nervous system. This causes feelings of relaxation and euphoria. Because the body usually works to maintain balance, it will signal the brain to make more neurotransmitter receptors that excite or stimulate the central nervous system.
When you stop drinking, you take away alcohol not only from the receptors you originally had but also from the additional receptors your body made. As a result, your nervous system is overactive. This causes symptoms such as:
- Rapid heart rate
In severe instances, you may experience DTs. Symptoms doctors associate with DTs include:
- High body temperature
These are the most severe symptoms of alcohol withdrawal.
How long does alcohol withdrawal last? Dangers of Withdrawal
Moderate-to-severe alcohol withdrawal can be extremely dangerous and sometimes life-threatening. The most severe form of alcohol withdrawal, delirium tremens, has a mortality rate of 1-4%.
Experiencing severe alcohol withdrawal symptoms is somewhat rare, however, it can be difficult to predict those who will experience them and those who will only experience mild withdrawal symptoms. Despite this, studies have identified some predictors of severe alcohol withdrawal (e.g., withdrawal seizures or DTs). These include:
- Heavy daily alcohol use
- Being of older age
- History of DTs or alcohol withdrawal seizures
- Comorbid illnesses
- Electrolyte disturbances
- Brain lesions
- Abnormal liver function
How long does alcohol withdrawal last? Other Factors
According to a 2015 article in the New England Journal of Medicine, an estimated 50 percent of people with an alcohol use disorder go through withdrawal symptoms when they stop drinking. Doctors estimate 3 to 5 percent of people will have severe symptoms.
Multiple factors can affect how long it may take you to withdraw from alcohol. A doctor will consider all these factors when estimating how long-lasting and how severe your symptoms may be.
Risk factors for DTs include:
- Abnormal liver function
- History of DTs
- History of seizures with alcohol withdrawals
- Low platelet counts
- Low potassium levels
- Low sodium levels
- Older age at time of withdrawal
- Preexisting dehydration
- Presence of brain lesions
- Use of other drugs
If you have any of these risk factors, you must withdraw from alcohol at a medical facility that’s equipped to prevent and treat alcohol-related complications.
Some rehabilitation facilities offer a rapid detox process. This involves giving a person sedative medication so they are not awake and aware of their symptoms. However, this approach is not well suited for those with other health problems, such as heart or liver problems.
How long does alcohol withdrawal last? Treatment Options
To assess a person’s withdrawal symptoms and recommend treatments, doctors often use a scale called the Clinical Institute for Withdrawal Assessment for Alcohol. The higher the number, the worse a person’s symptoms are and the more treatments they likely need.
You may not need any medications for alcohol withdrawal. You can still pursue therapy and support groups as you go through withdrawal. You may need medications if you have moderate to severe withdrawal symptoms. Examples of these include:
- Benzodiazepines. Doctors prescribe these medicines to reduce the likelihood of seizures during alcohol withdrawals. Examples include diazepam (Valium), alprazolam (Xanax), and lorazepam (Ativan). Doctors often choose these drugs to treat alcohol withdrawals.
- Neuroleptic medications. These medications can help depress nervous system activity and may be helpful in preventing seizures and agitation associated with alcohol withdrawal.
- Nutritional support. Doctors may administer nutrients such as folic acid, thiamine, and magnesium to reduce withdrawal symptoms and to correct nutrient deficiencies caused by alcohol use.
Doctors may prescribe other medications to treat withdrawal-related symptoms. One example is a beta-blocker (such as propranolol) to reduce high blood pressure. Once the immediate withdrawal symptoms have passed, a doctor may prescribe medicines to reduce the likelihood that a person will start drinking again. Examples include:
- Disulfiram (Antabuse). This medication can reduce alcohol cravings and makes a person feel very ill if they drink while taking it.
- Naltrexone (ReVia). Naltrexone can reduce alcohol cravings and help a person maintain their abstinence from alcohol by blocking opioid (feel-good) receptors in their body.
- Topiramate (Topamax). This medicine may help reduce alcohol consumption and extend the periods of abstinence from alcohol abuse.
A doctor may discuss these and other medicines with you. You can choose to use these along with therapy and support groups to help you maintain your sobriety.
In general, the course of alcohol withdrawal is highly variable and somewhat unpredictable. Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms. Those experiencing mild alcohol withdrawal symptoms or who are concerned about experiencing withdrawal symptoms will benefit from the advice of a physician or clinician trained to assess and treat patients in alcohol withdrawal.
Those experiencing moderate to severe symptoms of alcohol withdrawal, or those who are at risk of experiencing moderate to severe symptoms (i.e., if you’ve had severe alcohol withdrawal symptoms in the past) typically require inpatient monitoring and treatment of withdrawal symptoms at an acute care hospital or detox-equipped facility. Outpatient treatment may be available for mild-to-moderate symptoms of alcohol withdrawal, however, should symptoms become severe, inpatient care may be required.