Alcohol Withdrawal - Signs, Symptoms, and Treatments

Without treatment help, alcohol detox can be potentially deadly. Read on to learn more about alcohol withdrawal.

Table of Contents

What is Alcohol Withdrawal Syndrome (AWS)?

Someone with an alcohol use disorder experiences an overwhelming physical and psychological need to drink. Once an alcohol addiction has developed, the physical cravings for alcohol are often so intense they can be debilitating. At this stage, if you try to reduce or stop drinking, you will experience alcohol withdrawal symptoms, which can be dangerous if you try to do it without help and support from an alcohol withdrawal treatment program.

Alcohol withdrawal syndrome or AWS encapsulates the various symptoms that someone with an alcohol use disorder experiences when they stop or significantly reduce the amount that they drink. When you have AWS, you will experience various physical and psychological symptoms. Depending on the individual, these acute alcohol withdrawal symptoms will vary from mild to severe.1

Alcohol Withdrawal Signs

Understanding AWS

Severe AWS symptoms can include potentially life-threatening medical emergencies like seizures and breathing problems. AWS symptoms generally begin within six hours after your last drink. The onset of AWS symptoms depends significantly on how often and how much you drink. The time required for your body to process the alcohol out of your system and the alcohol withdrawal timeline are based considerably on how much alcohol is there to start.2

Alcoholism Overview

Symptoms of Alcohol Withdrawal

The symptoms of AWS will vary from person to person, but there are several common alcohol withdrawal symptoms most people may experience. Typical early signs of alcohol withdrawal include physical symptoms of alcohol withdrawal and various emotional and behavioral symptoms.3

Examples of physical signs of alcohol withdrawal may include nausea and vomiting, headaches, excessive sweating, irregular heart rate, elevated body temperature, and chills from alcohol withdrawal. Other common withdrawal symptoms from alcohol typically include unpleasant or vivid dreams, depression, anxiety, difficulties sleeping, mood swings, and problems with memory or thinking.

When Do You Experience Symptoms?

Mild withdrawal symptoms often occur during the early alcohol withdrawal stages or for those with a mild alcohol addiction. When you begin to withdraw from alcohol, you may experience mild withdrawal symptoms, or, depending on the severity of your addiction, alcohol detox symptoms may be intense and severe from the beginning.

Severe alcohol withdrawal symptoms may include severe disorientation and confusion, extreme agitation, visual or auditory hallucinations, seizures, fever, and high blood pressure.

AWS Symptoms Overview

How Long Does Alcohol Stay in the Body?

Various tests are used to detect alcohol in your body, and each test has different capabilities. These will be detailed below.4


Your blood alcohol concentration, or BAC, is the percentage of pure alcohol that remains in your bloodstream after drinking. A blood test to detect blood alcohol concentration can detect levels of alcohol in your blood for up to twelve hours after you have had your last drink.


Urine tests can detect alcohol for longer than blood or breathalyzer tests. In general, urine tests can detect alcohol between twelve and forty-eight hours after your last drink, and some advanced urine tests continue to detect alcohol up to five days after your last drink.


Breath tests, or as they are more commonly known, breathalyzer tests, are machines used to measure blood alcohol content by testing your breath. Breathalyzer tests can detect alcohol levels in your system for approximately one day.


Another blood alcohol detection test is the saliva test. This method for detecting blood alcohol concentration can accurately detect alcohol in your blood for up to two days after your last drink.


Hair tests cannot determine blood alcohol content because there is no blood in your hair follicles. Hair tests can determine if you have been drinking within the last ninety days but not the concentration of alcohol in your body at the time of the test.

When Does Alcohol Withdrawal Start?

Many factors influence the exact duration of alcohol withdrawal. For some, detoxing from alcohol may require a few days, whereas it can take weeks or months in other cases. In general, each category or class of substance has an approximate timeframe for the onset and duration of symptoms.

The first signs of alcohol withdrawal will occur within hours after your last drink. Generally, detoxing from alcohol symptoms will peak within two to three days, although some symptoms may remain for a week or more.

Timeline of Alcohol Withdrawal Symptoms

Alcohol Withdrawal Symptoms

Long-term alcohol use and abuse can result in significant physical and physical health difficulties. Everyone who chooses to seek alcohol withdrawal syndrome treatment will likely experience withdrawal differently. The intensity and severity of the symptoms will depend on various factors, including the severity of your addiction, how often you drink, and your history with addiction treatment and relapse.

The Stages of Withdrawal

In most cases, the withdrawal timeline occurs in three stages. These will be discussed further below.

First Stage

The first stage, mild alcohol withdrawal, begins within six hours after your last drink and lasts approximately twelve hours. During this stage, people often experience anxiety, headaches, stomach problems, appetite changes, difficulties sleeping, and alcohol withdrawal nausea

Second Stage

Beginning approximately twelve hours after your last drink, withdrawal can escalate to stage two or moderate withdrawal. Stage two of the detoxing from alcohol timeline lasts about thirty-six hours, and ends approximately two days after your last drink. During stage two of alcohol withdrawal, your withdrawal symptoms will become more severe and difficult to manage without addiction treatment support. In addition to previously mentioned detox symptoms, other symptoms that may develop include seizures and hallucinations.5

Third Stage

The final, and third, stage of withdrawal is the most dangerous stage. Some withdrawal symptoms during this stage can be life-threatening if immediate medical intervention is unavailable. This stage begins approximately two days after your last drink and ends (usually) one to two days later. Typical withdrawal symptoms from alcohol include elevated heart rate, increased blood pressure, sweating, confusion, auditory hallucinations, delirium tremens (DTs), and even death.

Stage Three Severity

The shaking and seizures experienced by someone undergoing detox are often known as delirium tremens or DTs. Delirium tremens often occur in individuals who experience extreme alcohol withdrawal symptoms. DTs are relatively common during this stage, and some statistics suggest they occur in about one out of every twenty cases of alcohol withdrawal.6

DTs usually begin within two to three days after an individual stops drinking. If someone chooses to undergo detox without medical supervision and begins to exhibit signs of DTs, it is essential to get medical help immediately. Beyond shaking or seizing, symptoms of delirium tremens include fatigue, severe confusion, fever, and hallucinations.

What Causes Alcohol Withdrawal Syndrome?

Excessive drinking leads to alcohol dependency. When you develop alcohol dependence and attempt to reduce or stop drinking entirely, your body cannot cope or adapt easily to being without alcohol. One of the side effects of quitting drinking is alcohol withdrawal syndrome. If you suddenly stop drinking and dramatically reduce any and all alcohol intake, which is often called “quitting cold turkey,” it can lead to AWS.7

Anyone with an addiction to alcohol or who drinks heavily regularly and cannot gradually cut down or withdraw from alcohol is at an increased risk of developing AWS. Although alcohol withdrawal syndrome is more common in adults, adolescents and teens who actively engage in excessive drinking or binge drinking are also at risk. You are also at an increased risk for developing AWS if you have previously experienced withdrawal symptoms from alcohol or needed help from a medical detox program to address problematic drinking or alcohol addiction.

Factors That Affect the Severity of Alcohol Withdrawal

Alcohol Withdrawal Signs

When you begin to detox from alcohol, it is essential to remember that several factors affect the severity and duration of alcohol withdrawal symptoms. The most common of these include how much you drink each time you consume alcohol, how long you have been abusing alcohol, and how frequently you drink. Suppose you consume large amounts of alcohol multiple times each week. In that case, it puts you at a greater risk of severe alcohol withdrawal symptoms than someone who occasionally drinks one or two alcoholic beverages on a night out with friends.

Another factor that plays a role in the severity of alcohol withdrawal symptoms is the quality of alcohol you drink. Alcoholic beverages with higher alcohol volume per serving significantly impact your mind and body function and the speed at which alcohol dependency develops.

Other Factors That Impact AWS

Other factors unique to the individual such as age, history of substance abuse treatment, history of addictions to other substances (for example, prescription or illicit drugs), a family history of alcohol addiction, and any pre-existing mental or physical health conditions also contribute to an increased risk for developing alcohol dependence and for experiencing severe alcohol withdrawal symptoms when you begin alcohol detox.

How is Alcohol Withdrawal Diagnosed?

Alcohol withdrawal is diagnosed by a primary care provider or an addiction term provider at an alcohol addiction treatment program. They will ask about any symptoms and conduct a physical exam. They will look for potential indications of alcohol withdrawal symptoms such as dehydration, alcohol withdrawal fever, irregular heart rate, hand tremors, and other signs of common withdrawal symptoms.

They may also perform a toxicology screen. A toxicology screen is a specific test designed to indicate how much alcohol has remained in the body since the last drink. Another test option is the Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar), which is a series of questions addiction treatment providers and primary care providers can use to measure AWS. Some health care professionals may use this test to diagnose alcohol withdrawal syndrome as it can be used to determine the severity of your symptoms.8

How Does It Work?

The assessment measures ten specific symptoms, including anxiety, agitation, difficulties with thought, headache, auditory disturbances, nausea and vomiting, tactile disturbances, visual disturbances, tremors, and sudden uncontrollable sweating. However, it is crucial to mention that the withdrawal assessment listed above may be more unreliable than toxicology or blood alcohol tests because it is subjective, meaning it relies on the statements of the individual currently suffering from alcohol withdrawal symptoms to assess withdrawal severity.

Whether your alcohol withdrawal symptoms are mild or severe, it is essential to seek help at a program specializing in alcohol withdrawal syndrome treatments when you are ready to begin detox. Although uncommon, severe alcohol withdrawal symptoms can lead to death during detox. Unfortunately, this occurs most commonly when someone with an alcohol use disorder attempts to detox outside of medical supervision.

How To Safely Treat Alcohol Withdrawal

All rehab programs are not created equally. There are different kinds of programs and different lengths of stay. Also, some programs will offer amenities that others may not. Some of the most common types of programs are listed below.

Inpatient Rehab Programs

One of the two most common options for detox in subsequent rehab programs is inpatient rehab. In an inpatient program or residential rehab, you will live at the treatment center throughout the process. At these rehab centers, care is available around the clock to help you manage both your detox process and begin your subsequent treatment process.

Many rehab programs offer both detox and residential rehab services. These programs typically range from thirty to ninety days in length. How long you will need to stay depends on your addiction’s severity and the duration of time you have been using. Inpatient treatment programs are best for those with a chronic, severe substance use disorder or those who have previously tried outpatient treatment options and have since relapsed.

Outpatient Rehab Programs

Outpatient programs involve treatment during the day but being free to go home at night. Most outpatient treatment programs include individual or group therapy that takes place as little as one or as many as five times per week. Outpatient programs do not require participants to stay in a center; therefore, they can continue working and living at home throughout their treatment.

Outpatient treatment may benefit those with a mild addiction or for whom this is their first time in rehab. It is also essential to consider elements such as mental and physical health, the stability of your home environment, and the length of your history of problem drinking. If you have a co-occurring mental health disorder or your home environment is unstable and potentially a source of substance abuse triggers, an outpatient setting may not be best for you.

Medication-Assisted Therapy

Medication-assisted therapy, or MAT, uses specific medications, simultaneously with individual or group counseling, to offer a holistic or whole-person approach to addiction treatment. Medications administered by trained addiction treatment professionals helped to reduce the intensity and severity of debilitating withdrawal symptoms, which allows you to focus on progressing through the stages of detox rather than the discomfort of withdrawal.

Support Groups

Millions of people recovering from alcoholism find continued participation in a twelve-step program, such as Alcoholics Anonymous, as highly beneficial to helping maintain sobriety. These support groups consist of people of all ages who share their addiction-related experiences and provide a source of accountability for each other.

Members are encouraged to follow twelve steps for recovery that have remained the same for decades. The steps teach them how to cope with addiction and find peace in sobriety.

Support Group Opportunities Overview

Get Treatment for Alcohol Withdrawal at Soledad House

Although detoxing from mild alcohol addiction at home is possible, it is impossible to predict if you will experience severe or significant withdrawal symptoms when you begin detoxing from alcohol. While heavy or long-term drinking often leads to severe withdrawal, there is no rule regarding how detox affects each person seeking sobriety from alcohol addiction. For this reason and many others, it is essential to seek help at an alcohol rehab to put struggles with alcohol in the past.

How Can Treatment Centers Help?

Skilled medical professionals at a professional alcohol rehab will provide medical and emotional support as you progress through the stage of withdrawal. They will monitor your physical and mental health to ensure medical intervention is available should you experience severe or dangerous withdrawal symptoms. You can focus on healing when the more intense and unpleasant withdrawal symptoms are under control.

Once detox is complete, you will transition into an alcohol rehabilitation program consisting of therapy and ongoing mental health support. As part of therapy, you will learn more about addiction and how to overcome other factors that may lead you to begin drinking again after completing rehab. The steps to recovery are different for each person seeking lasting sobriety.

Begin Recovery Today

At a professional alcohol rehab like Soledad House, you can take those steps in a safe and supported environment where skilled professionals can help you through each stage of the recovery process. To learn more about detox and alcohol addiction recovery, contact a member of our admissions team today and ask how to get treatment for alcohol withdrawal at Soledad House.