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Your Guide to Alcohol Detoxification.

Written By Jeff Mahre BA MFA MLIS - January 12th, 2017

Alcohol may be one of the most socially acceptable drugs. However, addiction to alcohol and the detoxification process can be debilitating. Alcohol withdrawals can be extremely uncomfortable and, unlike most other drug withdrawals, can be ultimately deadly. This is especially the case when alcohol is taken for a long period of time or is mixed with other substances. It is recommended that any individual who decides to quit sustained alcohol use should choose to do so in a safe medical facility with licensed medical staff. Contact someone who can help you today.


alcohol abuse facts

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Alcohol addiction can be devastating to a person’s life and is the third leading cause of preventable death in the United States. This is according to the National Institute on Alcohol Abuse and Alcoholism1, that states that alcohol is accountable for a third of all driving fatalities. Sadly, it is abused by more than 15 million Americans each year. Further statistics from the institute also show that;

  • Alcohol abuse cost the United States nearly $250 billion in 2010.
  • In 2015, almost 40,000 people died of alcohol-related liver disease.

So why do people keep using it?

 Addiction is difficult to understand, regardless of what the user is addicted to. Families and friends may find it difficult to sympathize with a drug or alcohol-user when their destructive behavior continues. However, addiction is regarded in the literature to be secondary to chemical imbalances in the brain. As Harvard Health Publishing (2011) so accurately describes, “addiction hijacks the brain”, just as any other chronic illness causes organ damage. Any addictive substance, including alcohol, releases large amounts of dopamine in the brain which in turn alters how an individual perceives pleasure. An addict thus develops a compulsive need to seek out pleasure because of a relative deficiency of dopamine and/or available dopamine receptors in the brain. Willpower, in this instance, simply does not cut it. This often means that external medical assistance is needed.

Furthermore, alcohol withdrawal symptoms are intense and people may continue with their alcohol consumption in order to avoid them. The alcohol detoxification process, in chronic alcohol users especially, is downright miserable.

It is important to understand the symptoms of alcohol withdrawal so that you know when to seek immediate medical help. In serious cases of alcohol withdrawal, inpatient treatment may be warranted.

If you or a loved one struggle with alcohol dependence, please seek immediate medical help for both treatment and recovery.

symptoms of alcohol withdrawal

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There are different symptoms and stages of alcohol withdrawal, depending on the following patient characteristics4:

  • The duration of alcohol use (long-term vs. short-term user)
  • The amount of alcohol use (how “heavy” the drinking history is)
  • How abruptly alcohol was discontinued

The stages of alcohol withdrawal, which increase in severity1, and consist of the following;

  1. Minor withdrawal symptoms (“hangover” symptoms)
    • Occurs 6-12 hours after cessation of alcohol.
  2. Alcoholic hallucinosis – visual, auditory and tactile hallucinations
    • Occurs 12-24 hours after cessation of alcohol.
  3. Alcohol withdrawal seizures
    • Occurs 24-48 hours after cessation of alcohol.
  4. Delirium tremens – delirium, psychosis, seizures and coma
    • Occurs 48-72 hours after cessation of alcohol.

It’s important to note that someone who uses alcohol does not necessarily progress through these stages from 1 to 4. The longer you drink, the heavier you drink, and the more abruptly you discontinue drinking simply places you at a higher risk of experiencing a higher stage; particularly stages 3 and 4. This, therefore, places you at a higher risk of a serious withdrawal symptom and even death.

What Causes the Symptoms?

Alcohol has a depressive effect on the central nervous system, meaning that it slows it down. This causes impaired coordination, slurred speech, and a staggering gait. In higher doses, it even causes coma and death.4

With long-term alcohol use, the body adjusts to the intake of alcohol and the same amount of alcohol no longer produces the desired effect. This is called tolerance. Thereafter, there is a subsequent imbalance in brain chemistry, causing abnormal and excessive firing of neurons in the brain when alcohol is withheld.4 This abnormal firing of neurons can cause severe aforementioned symptoms such as hallucinations or seizures. Without the depressive effects of alcohol, this “excited” state can be unbearable to withstand.

Signs and Symptoms

The symptoms of alcohol withdrawal can range from mild to severe, as we have mentioned previously.

Mild withdrawal symptoms, or a “hangover,” often include1:

  • Tremors or “the shakes”
  • Headache
  • Nausea
  • Vomiting
  • Anxiety

With sustained/long-term alcohol use, withdrawal then includes:

  • Sweating
  • Tachycardia or palpitations
  • Insomnia
  • Anxiety
  • Craving
  • Confusion

More severe withdrawal symptoms can be downright terrifying, and these include stages 2, 3 and 4; hallucinations, seizures and delirium tremens (or “DTs”) respectively.

Delirium tremens is a potentially fatal complication of alcohol withdrawal. It occurs within 48 to 72 hours after the last drink. It is a rapid onset of confusion, altered consciousness, vivid hallucinations and possibly withdrawal seizures. DTs can occur in up to 10% of alcoholics that go through the withdrawal process. Delirium tremens has a mortality rate of nearly 35% when not treated, making alcohol one of the most dangerous substances to detoxify from. It is absolutely essential that delirium tremens is managed in an inpatient, hospital setting (Trevisan, Boutros, Petrakis & Krystal, 1998).

alcohol withdrawal timeline

Abuse facts  |  Withdrawal symptoms  |  Detox |  Back to top

Although the severity of the symptoms varies for each individual, the withdrawal timeline generally lasts about a week. This timeline applies to heavy drinkers because, in those who have long-term alcohol use, the withdrawal symptoms may be more severe and last much longer.4

Alcohol use can also cause long-term effects even after full detoxification, including dementia, amnesia and cognitive slowing. These effects are generally irreversible and progress if left untreated.4

The following timeline has been proposed (Trevisan, Boutros, Petrakis & Krystal, 1998):

Stage 1: 8-12 Hours

About eight hours after the last drink, users typically begin to experience the mild withdrawal symptoms (“hangover symptoms”) previously mentioned.

Stage 2: 12-24 Hours

For heavier alcohol users, symptoms typically peak at this time. The symptoms have already been discussed but include; sweating, tachycardia or palpitations, insomnia, anxiety, craving and confusion. Hallucinations may or may not occur in certain heavy users.

Stage 3: 1-2 days

Seizures may occur in heavy users, and may or may not include auditory or visual hallucinations, severe confusion, fever and agitation.

Stage 4: >2 days

Depending on the user, the physical symptoms of withdrawal may begin to dissipate. However, 48-72 hours is the prime time for delirium tremens to develop. Risk of a seizure is highest in the first 48 hours but this risk persists for more than 2 weeks.

symptoms of alcohol detox

Abuse facts  |  Withdrawal symptoms  |  Withdrawal timeline  |  Back to top

Alcohol withdrawal syndrome can be incredibly uncomfortable and extremely dangerous. It is best to go through the detoxification process under the guidance and care of healthcare professionals.

If you are ready to break free of your alcohol-use disorder and begin the path toward recovery, we can help. Search through our directory for the right treatment facility for you or send us a message for personalized recommendations.



  1. Bayard, M., McIntyre, J., Hill, K.R., Woodside, J. (2004). Alcohol withdrawal syndrome. Am Fam Physician, 69:1443–1450.  4
  2. Harvard Health Publishing. (2011). How addiction hijacks the brain. Retrieved February 24, 2019, from
  3. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics. Retrieved February 24, 2019, from
  4. Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol Health Res World, 22(1):5-12.
  5. Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: Pathophysiological insights. Alcohol Health and Research World, 22(1), 61–66.

Medically Reviewed: September 25, 2019

Dr Ashley

Medical Reviewer

Chief Editor


All of the information on this page has been reviewed and verified by a certified addiction professional.

Dr Ashley Murray obtained her MBBCh Cum Laude in 2016. She currently practices in the public domain in South Africa. She has an interest in medical writing and has a keen interest in evidence-based medicine.

All of the information on this page has been reviewed and verified by a certified addiction professional.