Alcohol Withdrawal Timeline: Symptoms and What to Expect

Cutting back or cutting out alcohol is an amazing choice you can make for your health and lifestyle. As a therapist that helps people stop drinking, I often hear from clients that they want to make a change, but are intimidated by the potential of experiencing withdrawal symptoms. Withdrawal is a real possibility when cutting back or cutting out alcohol, but it can be safely managed and mitigated with the right tools. 

While everyone’s experience is different, learning more about the typical withdrawal timeline can help you set expectations and make a plan to get through challenges. Let’s take a closer look at alcohol withdrawal below.  

What is Alcohol Withdrawal 

Alcohol withdrawal can occur when a person who has used alcohol for a significant period of time stops drinking or significantly decreases their use. Alcohol withdrawal can have a broad range of symptoms, some of which can be dangerous or even life-threatening if not treated. That’s why it’s vital to consult a physician before you stop drinking in order to create a plan to stop drinking or taper down safely.  

So what causes withdrawal symptoms, exactly? Alcohol is a depressant, meaning it suppresses the central nervous system. Over an extended period of time, our bodies adapt and adjust to the depressive qualities of alcohol. Our brain chemistry changes to find a balance with alcohol, which can make us dependent on alcohol in order to function ‘normally’. This is often described as ‘alcohol dependence.’ When we then stop drinking alcohol, our central nervous system can become over excited and dysregulated, leading to various withdrawal symptoms.¹ 

Alcohol Withdrawal Symptoms 

There are two types of alcohol withdrawal, acute withdrawal and post-acute withdrawal, also known as ‘PAWS’. Acute withdrawal occurs in the first hours and days after you stop drinking, whereas PAWS can last for weeks or even months. Below are the common symptoms for both types of withdrawal. 

Please keep in mind that symptoms may vary in severity, and you may not experience the full list below. It’s vital you speak with your treatment team before you stop drinking so that potentially dangerous symptoms can be avoided. If symptoms start to develop, seek medical assistance immediately. 

Possible acute withdrawal symptoms include:

Possible Post-Acute Withdrawal symptoms include:

  • Headache 
  • Agitation/irritability 
  • Anxiety 
  • Nausea
  • Depression 
  • Fatigue
  • Difficulty sleeping
  • Alcohol cravings 
  • Memory issues

"Take it one day at a time, sometimes one minute at a time. Sobriety is a process, not an event. -Adrianne L. Clinton, MA, LPC, CAADC, monument therapist"

The Four Stages of Alcohol Withdrawal and What to Expect 

The medical community often refers to the “four stages of withdrawal” as a roadmap for what someone might expect right when they stop drinking. Remember that it’s important to connect with a medical professional before you stop drinking to ensure that you can go through each stage safely. 

Stage One

6 – 12 hours This is the stage in which symptoms may start to develop. You may experience shakiness, anxiety, depression, difficulty concentrating, brain fog, heart palpitations, problems sleeping, mood swings, nausea, vomiting, hypertension, increased heart rate, and/or increased body temperature. 

Stage Two

12 – 48 hours Symptoms typically intensify at this stage. You may experience headaches, achiness, continued trouble sleeping, anxiety, sweating, strong urges to drink,  lightheadedness, fever, irritability, obsessive thinking about drinking, heartburn, and confusion.

Stage Three

48 – 72 hours This stage is typically when initial symptoms become the most intense. This is also the window in which the more dangerous symptoms could develop, such as seizures and delirium tremens, which can last up to five days. It’s important to create a plan ahead of time with a medical professional so that these symptoms can be avoided. 

Stage Four

3 – 7 days In this time frame, symptoms may have reached their peak and could be gradually improving. You may start to feel relief, but still experience anxiety, trouble sleeping, racing thoughts, mental fatigue and alcohol cravings. It’s normal for these symptoms to persist after one week sober

If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911. 

Alcohol Withdrawal Timeline: How Long Does It Last?

Now that we’ve covered the first four stages of withdrawal, let’s take a look at the weeks and months that follow. While everyone’s alcohol recovery timeline is different, below is an example of how long withdrawal symptoms may last. You may experience all, some, or none of these symptoms. Plus, over time you will begin to experience the many benefits of sobriety

One week: During the first week of not drinking alcohol, you may experience various acute withdrawal symptoms including headaches, nausea, sweating, and mood swings. The most intense symptoms typically start subsiding around day 3 or 4. You may also notice that you’re experiencing intense alcohol cravings and increased anxiety. 

One month: After thirty days without alcohol, withdrawal symptoms typically subside substantially. You may start to see improvements in sleep, your mental clarity can improve, and you will start to feel less anxious. You may have less bloating and your skin will start to have an alcohol-free glow. That said, it’s still normal to experience post-acute withdrawal symptoms such as anxiety, trouble sleeping, and brain fog. These symptoms will subside – it’s just a matter of time. 

Two to three months: Two to three months after you quit drinking, you will begin to see many positive changes. You may experience weight loss after quitting alcohol, your blood pressure will decrease, you will have more energy, and your liver function may go back to normal. Your risk for cancer will also decrease. 

Twelve months and beyond: One year of sobriety is a huge accomplishment. Some studies suggest that alcohol withdrawal symptoms could last after one year, with sleep problems occurring up to three years. However, most people feel back to ‘normal’ after one year, and continue to reap the health and wellness benefits of an alcohol-free lifestyle.

"Alcohol withdrawal timeline: 0-24 hours, common symptoms include headaches, anxiety, nausea or vomiting, and increased body temperature. 24-48 hours: there is a risk of seizures, shakes, hallucinations, and delirium tremens. One week: common symptoms include fatigue, difficulty sleeping, mood swings, sweating, and brain fog. One to two months: post-acute withdrawal symptoms such as anxiety or irritability may continue. One year: an amazing accomplishment! Most, if not all, symptoms dissipate, and health outcomes improve significantly."

What Factors Impact Withdrawal Severity 

There are many different factors that can affect the severity of alcohol withdrawal. For example, the frequency, duration, and the amount of alcohol consumed when drinking can all play a role in the severity of withdrawal symptoms. Your age, and whether you have had a history of seizures and/or delirium tremens, as well as your past withdrawal history are all also factors in withdrawal severity. 

The best way to prepare and minimize withdrawal symptoms is to meet with a physician. They will ask you about your drinking history, health concerns, and other factors to determine how to make sure you can cut back safely and with the least discomfort possible. At Monument, you can meet with a physician entirely online in a judgment-free environment, and also discuss medication to stop drinking. (Note: the medication prescribed at Monument does not treat or prevent alcohol withdrawal.)

Treatment for Alcohol Withdrawal 

There is safe and affordable (or free!) treatment for alcohol withdrawal. If a physician determines that you’re at risk for severe withdrawal, it’s important that you get the appropriate care so that you can be monitored and evaluated during your withdrawal. Treatment may take place at a hospital or at an inpatient detox center. There are also some medication options prescribed by doctors that may help with symptoms. 

For those who don’t require inpatient treatment, it can still make a big difference to seek support. This can look like finding alcohol support groups and looking for sober communities, either online or in your area. Connecting with others who have been through the withdrawal process can provide encouragement and remind you that things will get better with time. 

Another treatment tool for alcohol recovery is alcohol therapy. Working with a therapist can help you work through the emotional aspects of longer-term withdrawal, like anxiety and depression. It can also help you develop alternative coping mechanisms and tools to manage alcohol cravings. At Monument, you can connect with a therapist specialized in helping people cut back on drinking, such as myself.   

You should feel empowered to use any and all tools you have access to. The more support you have, the greater your chances of success. Withdrawal is one of the most uncomfortable parts of the sobriety journey, but it is temporary. Our bodies have the incredible capacity to heal, and with time sobriety can open the door to a happier and healthier life.

"enroll in your personalized care plan"

Sources:

  1. National Library of Medicine. Alcohol Withdrawal, https://www.ncbi.nlm.nih.gov/books/NBK441882/.” Accessed Oct 7th, 2022.
  2. Healthline. “Here’s What Happens When You Quit Drinking Alcohol For One Month, https://www.healthline.com/health-news/what-happens-to-your-body-when-you-quit-alcohol-for-30-days.” Accessed Oct 7th, 2022.
Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

About the Author

Tiffany HopkinsTiffany graduated from the University of Cincinnati with her BA in psychology. She then went on to work at a community mental health agency where she gained experience in helping the severely mentally disabled population. While there, she earned her master's degree in social work and became independently licensed in Ohio with supervisory designation. She then left the agency to become a stay-at-home mom to her two amazing boys. While raising her boys she obtained a certificate in integrated behavioral health and primary care from the University of Michigan. She went back to work in a counseling position at a primary care physicians office and eventually opened up her own telehealth private practice where she specializes in anxiety, depression and substance abuse. She has since earned her ACE Certified Health Coach certification so that she can further assist her clients as a whole, mind and body. In her spare time, she enjoys watching her boys play sports, camping and traveling.