Alcohol withdrawal is one of the few drug withdrawal syndromes that can be life-threatening. It’s essential to understand the symptoms, and to know when they cross from uncomfortable to dangerous, whether you’re stopping drinking or supporting someone who is.
Early Symptoms (6–24 Hours)
The first symptoms of alcohol withdrawal typically begin six to twelve hours after the last drink, even while a person’s blood alcohol level is still elevated:
- Anxiety and agitation
- Tremors (shaking hands)
- Headache
- Nausea and vomiting
- Sweating and heart palpitations
- Insomnia
Experiencing these symptoms after stopping drinking?
Please seek medical attention. Early alcohol withdrawal is manageable with proper care, but it can escalate quickly. A call is the fastest way to get guidance.
Moderate Symptoms (24–48 Hours)
As withdrawal progresses, more serious symptoms may develop:
- Auditory, visual, or tactile hallucinations (alcohol hallucinosis), possible while still conscious and oriented
- Elevated blood pressure and heart rate
- Confusion and disorientation
- Fever
- Seizures (most common 24–48 hours after last drink)
Alcohol withdrawal seizures can happen without warning in people who have drunk heavily, even those who have never had a seizure before. This is the main medical emergency during alcohol withdrawal.
Severe Symptoms: Delirium Tremens (48–96 Hours)
Delirium tremens (DTs) is the most severe form of alcohol withdrawal. It usually develops 48 to 96 hours after the last drink and affects about 3 to 5% of people going through withdrawal. Without treatment, DTs carry a mortality rate of 15 to 40%. With proper medical care, that drops to under 5%.
Symptoms of DTs include: severe confusion and disorientation, extreme agitation, hallucinations, fever, profuse sweating, and seizures. This is a medical emergency.
Someone showing signs of severe alcohol withdrawal?
Call 911 if someone is having a seizure or showing signs of delirium tremens. If the situation is not yet at that point, call our line to understand what level of medical support is needed.
Risk Factors for Severe Withdrawal
- History of previous alcohol withdrawal seizures or DTs
- Long duration of heavy drinking
- High daily alcohol consumption
- Older age
- Co-occurring medical conditions
What Medical Treatment Involves
Medical treatment for alcohol withdrawal uses benzodiazepines, most commonly Librium or Ativan, to prevent seizures and ease symptoms. Doctors may add other medications for specific complications. Thiamine, or vitamin B1, is given to prevent Wernicke’s encephalopathy, a serious neurological complication of alcohol withdrawal.