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Stopping drinking after a long stretch of heavy use can set off withdrawal that ranges from uncomfortable to life-threatening. This guide covers the symptoms from mild to severe, the usual timeline, who faces the greatest risk, how medical teams treat withdrawal, and the warning signs that mean calling 911.
Key Points About Alcohol Withdrawal
- Withdrawal can become life-threatening, with seizures and delirium tremens posing the greatest danger.
- Anyone who drinks heavily every day should talk with a doctor or detox program before stopping suddenly.
- Symptoms often begin 6 to 24 hours after the last drink and reach their peak within 1 to 3 days.
- Delirium tremens, a medical emergency, typically starts 2 to 4 days after someone stops drinking.
- Clinicians rate severity with a 10-item scale called CIWA-Ar and treat withdrawal with benzodiazepines first.
- A seizure, severe confusion, hallucinations, a fever or an irregular heartbeat means call 911 immediately.
In This Article
- Is Alcohol Withdrawal Dangerous?
- Alcohol Withdrawal Symptoms by Severity
- Alcohol Withdrawal Timeline
- Who Is at Risk for Severe Alcohol Withdrawal?
- How Alcohol Withdrawal Is Treated
- When to Call 911
- Frequently Asked Questions About Alcohol Withdrawal
Is Alcohol Withdrawal Dangerous?
Yes, it can be. Alcohol withdrawal is a serious condition that can quickly become life-threatening, according to MedlinePlus, especially for someone who stops suddenly after a long period of heavy drinking. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) calls that kind of sudden stop a painful or even potentially life-threatening process of withdrawal and urges anyone planning to quit to get medical help first.
If heavy drinking is part of your daily routine, do not quit abruptly on your own. A doctor or a detox program should hear from you first. Dial 911 if a seizure, severe confusion, hallucinations, a high fever or an irregular heartbeat occurs.
The most severe consequences of alcohol withdrawal include seizure, delirium, and death, according to the American Society of Addiction Medicine. The most dangerous of these is delirium tremens (DTs), a severe form of withdrawal marked by confusion, shaking and a racing heart, and MedlinePlus calls delirium tremens a medical emergency. StatPearls reports that deaths from DTs have been as high as 20% historically and are now around 1% with treatment.
Most people never reach that point. According to NIAAA, as many as half of those with alcohol use disorder (AUD) feel some withdrawal symptoms after quitting, and just a small share require medical care and monitoring, or detox, to keep potentially dangerous symptoms under control. The problem is that no one can say in advance who will need that care, which is why clinicians assess the risk first.
If you are thinking about quitting, the alcohol hub explains withdrawal within the wider picture of alcohol addiction: signs, withdrawal and treatment, and a medical detox program can help you plan a safe start.
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Alcohol Withdrawal Symptoms by Severity
Alcohol withdrawal symptoms range from mild, like shakiness, anxiety, sweating and trouble sleeping, to severe, like hallucinations, seizures and delirium tremens (DTs). StatPearls notes that alcohol withdrawal syndrome can range in severity from mild to fatal, and because symptoms may escalate fast, no one can tell early on how severe a given person’s withdrawal will become.
Mild to Moderate Symptoms
The early symptoms are uncomfortable rather than dangerous. MedlinePlus lists anxiety or nervousness, depression, fatigue, irritability, jumpiness or shakiness, mood swings, nightmares and not thinking clearly. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), describing the diagnostic criteria in the DSM-5-TR, adds tremors, sweating, elevated pulse and blood pressure, insomnia and nausea or vomiting, and its consumer list names “trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart,” and “a seizure.”
Mild to moderate withdrawal usually involves some mix of:
- Shakiness or tremors
- Anxiety or nervousness
- Sweating
- Trouble sleeping
- Nausea or vomiting
- Restlessness
- A racing heart
- Fatigue
- Irritability
- Mood swings
Severe Symptoms
Severe withdrawal brings three main dangers. The first is hallucinations, called alcohol hallucinosis: StatPearls describes these as visual or auditory hallucinations that usually fade within 2 to 3 days after the last drink. The second is seizures (usually whole-body seizures), and alcohol withdrawal seizures are always an emergency. The third is delirium tremens, covered below.
Clinicians score a 10-item checklist called CIWA-Ar to gauge how severe withdrawal is and choose the treatment and setting.
Delirium Tremens
Delirium tremens is the most severe form of alcohol withdrawal and a medical emergency. MedlinePlus lists its signs as sudden, severe confusion (delirium), fever, seizures and seeing or feeling things that are not there, and StatPearls describes visual hallucinations, profound confusion, tachycardia (a racing heart) and hypertension (high blood pressure), along with high body temperature, agitation and heavy sweating. According to MedlinePlus, it occurs most often in people who have a history of alcohol withdrawal and commonly affects people who have used alcohol for more than 10 years. Only approximately 3% to 5% of people with alcohol withdrawal syndrome progress to alcohol withdrawal delirium, StatPearls reports, but anyone showing its signs needs emergency care, so call 911. It usually starts later than the milder symptoms, and the timeline below shows when it tends to set in.
Alcohol Withdrawal Timeline
Withdrawal symptoms usually begin within 6 to 24 hours after the last drink, are at their strongest about 1 to 3 days in, and typically settle within about 2 to 10 days, according to the World Health Organization (WHO). MedlinePlus notes they tend to peak by 24 to 72 hours and may go on for weeks. Seizures tend to occur during the first 2 days, while delirium tremens typically starts 2 to 4 days after someone’s last drink.
The timing differs from one person to the next, shaped by how much and how long they drank and by their health.
| Phase | Typical timing | What may happen |
|---|---|---|
| Early withdrawal | Typically within 6 to 24 hours after the last drink; may begin as early as a few hours in, or days later (MedlinePlus; WHO 2009) | Anxiety, shakiness, sweating, nausea, headache, irritability, poor sleep and a fast heartbeat (MedlinePlus; NIAAA) |
| Seizure risk | Most often 8 to 48 hours following the last drink; may occur within just a few hours (StatPearls) | Seizures, usually whole-body. Call 911. Hallucinations may also appear and typically clear up within about 48 hours (StatPearls) |
| Peak | Around 24 to 72 hours following the last drink (MedlinePlus; StatPearls) | Symptoms are at their strongest. A clinician may adjust treatment based on CIWA-Ar scores, a standard scale that rates how severe withdrawal is |
| Delirium tremens risk | Most often 2 to 4 days (48 to 96 hours) after the last drink, though it can begin up to 7 to 10 days out (MedlinePlus) | Sudden severe confusion, fever, seizures, hallucinations, fast heartbeat. A medical emergency (MedlinePlus). Call 911 |
| Easing | Acute symptoms usually ease within about 2 to 10 days; some “may go on for weeks” (WHO 2009; MedlinePlus) | Fatigue, mood swings and poor sleep may persist |
Some symptoms can linger well past the acute phase. MedlinePlus reports that after delirium tremens, issues like mood swings, fatigue and trouble sleeping may persist for a year or more.
Withdrawal may begin while alcohol is still in a person’s blood, so no longer feeling drunk is not the starting point. StatPearls reports that alcohol withdrawal seizures typically occur between 8 and 48 hours after the last drink and can begin within just a few hours. MedlinePlus warns that DT symptoms most often occur within 48 to 96 hours after the last drink, may occur 7 to 10 days after, and that the condition is a medical emergency.
Alcohol follows its own pattern, and withdrawal timelines for other substances look different, so the timing above applies to alcohol alone.
Who Is at Risk for Severe Alcohol Withdrawal?
Severe withdrawal is more likely in some people than in others. The risk goes up for someone who has had withdrawal seizures or delirium tremens in the past, who has been through withdrawal many times, who is over 65, who has another serious illness, or who is also physically dependent on benzodiazepines or barbiturates. Drinking heavily for a long time raises the risk as well.
The American Society of Addiction Medicine (ASAM) lists these risk factors for complicated withdrawal:
- delirium or seizures during a past withdrawal
- many past withdrawal episodes
- another serious medical condition, especially a traumatic brain injury
- being over 65
- a long period of heavy drinking
- seizures during the current withdrawal
- signs of an overactive nervous system, such as a racing heart and high blood pressure
- physical dependence on benzodiazepines or barbiturates
History matters beyond any single factor. StatPearls notes that a person who has had a complicated withdrawal once is more likely to have a complicated one again, which is why someone with that history should not try to cut down or stop drinking without medical help. In a hospital, clinicians can also use a short screening tool called the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) to estimate how severe withdrawal may become, according to ASAM.
How Alcohol Withdrawal Is Treated
Alcohol withdrawal is treated by medical professionals, and their first job is to gauge how dangerous it is likely to be. Treatment then focuses on the symptoms, most often with benzodiazepines, the medication the American Society of Addiction Medicine (ASAM) names as first-line in its 2020 guideline. Treatment may take place in an outpatient program where someone stays with the person or, when the risk is higher, in a hospital or an inpatient medical detox unit. Detox is only the first step. Treatment for alcohol use disorder (AUD) comes after it.
Assessment
Before treatment begins, clinicians review the person’s drinking history, any past withdrawal episodes, other health problems and current symptoms. Both the ASAM guideline and StatPearls describe rating severity with CIWA-Ar, a clinical scale that scores withdrawal symptoms. It is a tool for medical teams, not a self-test.
Setting
Where treatment happens depends on that risk. In outpatient care the person lives at home and checks in with the medical team; MedlinePlus says someone will need to stay with them and keep an eye on them, and the ASAM guideline has ambulatory patients checking in daily for up to five days. The same guideline has primary care clinicians sending severe withdrawal directly to the nearest Emergency Department, and MedlinePlus notes that people with moderate-to-severe symptoms may need to be treated at a hospital, where sedatives are used to ease symptoms. For people at risk of potentially life-threatening symptoms, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) describes intensive inpatient detox. Choosing between inpatient or outpatient care is a judgment the medical team makes from the assessment.
Medications
Benzodiazepines, a class of sedatives, are the main treatment: the ASAM guideline names them first-line for moderate withdrawal, NIAAA calls them “considered the gold standard,” and StatPearls notes that treatment with benzodiazepines reduces the risk of symptoms progressing. For mild withdrawal, StatPearls says gabapentin may be an option under a clinician’s care. According to StatPearls and the ASAM guideline, phenobarbital is given in some inpatient settings and in situations where benzodiazepines cannot be used.
People in withdrawal also receive thiamine (vitamin B1). ASAM recommends it as protection against Wernicke encephalopathy, a serious brain disorder brought on by thiamine deficiency, given by mouth for ambulatory patients and by injection for patients with poor nutrition, malabsorption or severe complications. StatPearls similarly calls for thiamine and folate supplementation, warning that untreated, severe thiamine deficiency can result in Wernicke encephalopathy. One thing withdrawal is never treated with is alcohol: the ASAM guideline states that oral or intravenous alcohol should not be used to prevent or treat it.
After Withdrawal
Detox clears the alcohol, but on its own it is not treatment for AUD. According to NIAAA, three medications are currently approved by the U.S. Food and Drug Administration: naltrexone, in oral and long-acting injectable forms, acamprosate, and disulfiram, and all of these medications are nonaddictive. These medications used in treatment are typically combined with counseling and support groups, and care for co-occurring mental health conditions is often part of ongoing alcohol addiction treatment. The directory can help you find detox and treatment programs near you.
When to Call 911
Call 911 or get to an emergency room at once if any of these signs show up while you or someone with you is in alcohol withdrawal. MedlinePlus says to go to the emergency room or call 911 when seizures, fever, severe confusion, hallucinations or irregular heartbeats occur, because they can point to delirium tremens (DTs), a medical emergency.
- A seizure, or shaking that will not stop
- Severe confusion, like not knowing where they are
- Hearing, seeing or feeling things that are not there
- A fever, or a heartbeat that races or feels irregular
- For a substance use or mental health crisis, call or text 988
The 988 Suicide & Crisis Lifeline is available 24/7/365 by call, text or chat; conversations there are free and confidential, and it lists alcohol or drug use concerns as a reason to reach out.
If you are the one helping, stay with the person and do not leave them alone, and never give them alcohol or other drugs to try to calm them.
Frequently Asked Questions About Alcohol Withdrawal
Withdrawal often starts 6 to 24 hours after the last drink, peaks around 24 to 72 hours and generally settles within about 2 to 10 days, according to MedlinePlus and the World Health Organization (WHO), though the timeline shows some can last weeks. Delirium tremens (DTs), a sudden and severe form of withdrawal, most often begins within 48 to 96 hours of the last drink, MedlinePlus reports.
Yes, it can. MedlinePlus describes alcohol withdrawal as “a serious condition that may quickly become life-threatening,” and the American Society of Addiction Medicine (ASAM) names seizures and delirium tremens as the main dangers of withdrawal in its 2020 guideline. StatPearls reports that about 1% of people with DTs die when the condition is treated, versus up to 20% historically.
The first signs tend to be shakiness, sweating, anxiety, nausea, trouble sleeping and a racing heart, and they can show up within hours of the last drink, according to MedlinePlus and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). They often intensify across the next 1 to 3 days, so reach out to a doctor early rather than waiting to see how bad it gets.
Not by yourself, no. After heavy drinking over a long period, quitting suddenly can be dangerous, and the NIAAA advises getting medical help, such as through a detox program, to plan a safe recovery. Clinicians then decide between outpatient and inpatient care, and MedlinePlus notes that even outpatient withdrawal calls for someone to stay with you.
According to the ASAM 2020 guideline and StatPearls, CIWA-Ar, the Clinical Institute Withdrawal Assessment for Alcohol, revised, is a 10-item scale clinicians use to measure how severe a person’s withdrawal from alcohol has become and to shape decisions about treatment and where that care happens. A trained clinician scores it from observation and questions; it is not a self-test.
Withdrawal care is only the first step. NIAAA reports that three medications are FDA-approved and nonaddictive for alcohol use disorder (AUD): naltrexone, acamprosate and disulfiram, each used alongside counseling or support as part of ongoing alcohol addiction treatment. A doctor decides whether one of them fits.
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