4 Stages of Alcohol Withdrawal

If you or a loved one who’s displaying signs of alcoholism has recently decided to take the courageous step to address your relationship with alcohol abuse, you may have some angst built up around the alcohol withdrawal symptoms experienced when one stops drinking.

This is perfectly understandable, particularly if you’re a functioning alcoholic or have developed a dependence on alcohol—a complication that affects approximately one in eight American adults.¹ And while withdrawing from alcohol can certainly be stressful and uncomfortable (and perhaps even seem impossible), it’s important to bear in mind that alcohol withdrawal can be managed—and that detoxification may pave the way for life-changing benefits.

Read on as we walk you through the stages of alcohol withdrawal so that you know what to expect—and when to consider medical supervision.

What is Alcohol Withdrawal?

“Alcohol withdrawal” may sound straightforward, but it’s an intricate process that can range from mild to severe and in worst-case scenarios, life-threatening.²Therefore, knowing how to detox from alcohol safely with the proper guidance is imperative.

There are exasperating alcohol withdrawal symptoms you might experience in a typical hangover, such as a lingering headache and nausea. Then there are more intense and critical symptoms, usually present in those with alcohol use disorder (AUD)—50% of whom will experience severe alcohol withdrawal symptoms.

Alcohol withdrawal syndrome (AWS) is connected to these severe symptoms. AWS is a medical condition that may occur after the cessation or reduction of substantial alcohol consumption.³ 

Dangers of Alcohol Withdrawal

Alcohol withdrawal isn’t just bothersome and distressing; it can also progress swiftly and perilously. 

Indeed, untreated delirium tremens—the fourth and most hazardous stage of alcohol withdrawal—has a mortality rate of 37%.⁴ Recognizing how withdrawal evolves and what its different stages are can be a life-saving measure. 

If you suspect that your alcohol withdrawal symptoms will exacerbate, it’s imperative that you perform a detox under the guidance of medical professionals through a holistic rehab clinic.

Symptoms of Alcohol Withdrawal

You might meet the diagnostic criteria for AWS if you display two or more of these symptoms:

• Insomnia
• Hand tremors
• Excessive sweating
• Elevated pulse (100 beats or more per minute)
• Anxiety
• Psychomotor agitation
• Nausea or vomiting
• Hallucinations—tactile, auditory, or visual
• Seizures

While experiencing one alcohol withdrawal symptom is already unpleasant, much less two or more, it’s also a sign that your brain and body are working hard to recalibrate. Moreover, with the right support and addiction treatment  by your side, you can overcome this challenge and place yourself on the route toward recovery.

What Are the 4 Stages of Alcohol Withdrawal?

Symptoms typically unfold in distinct stages. Naturally, everyone will withdraw from alcohol addiction at different rates, but most will follow a similar alcohol withdrawal timeline.

Generally, the stages of alcohol withdrawal come are as follows:

Stage One: 6-12 Hours Post-Alcohol

The first alcohol withdrawal stage normally begins between 6 to 12 hours after you cease drinking. The symptoms most commonly associated with this phase include:⁵

• Psychological changes – Anxiety, depression, irritability, mood swings, and other psychological changes may be felt soon after alcohol cessation. This is due to the changes excessive, or prolonged alcohol use has on brain chemistry and your central nervous system (CNS). Simply put, your stores of key neurotransmitters—chemical messengers like GABA that are connected to feelings of well-being and elation—have been depleted through alcohol use. During withdrawal, your brain may struggle to rebalance itself, and this may be exacerbated by the sleep disturbances that are also prevalent during this alcohol withdrawal stage.

• Cognitive issues – As your body gets rid of the alcohol in your system, you may experience cognitive problems, namely trouble concentrating and brain fog.

• Heart palpitations and hypertension – Alcohol acts as a diuretic, and high amounts of it are notorious for causing dehydration. When you’re dehydrated, your body must work double-time to pump blood, which may increase your heart rate and result in palpitations.⁶ High blood pressure may also be seen at this stage.

• Gastrointestinal complications – Ever felt nauseous after a night of drinking—or even while you’re drinking? You’re not alone: nausea and vomiting are ubiquitous during alcohol withdrawal. On the acute end of the spectrum, you may also experience dry heaves and diarrhea.

• Shaking and sweating – Frequently referred to as “alcohol shakes,” shaking is also common in the first several hours after alcohol consumption ends and can range from subtle to extreme. Profuse sweating may be present in more severe withdrawal symptoms too. And while it may seem that you’re sweating out alcohol, only a small amount of alcohol is expelled through sweating, breath, and urine. The rest is omitted through metabolic processes primarily performed by your liver.⁷

• Pins and needles – A sensation of pins and needles in your extremities, such as your legs and feet, may also be felt.

Stage Two: 12-24 Hours Post-Alcohol

Stage Two of AWS sets in approximately 12-24 hours after your last drink. While some of the symptoms that materialized in Stage One may subside, others may intensify. Mild, moderate, and acute alcohol withdrawal symptoms during this phase include the symptoms outlined above, as well as:⁸

• Headaches
• Fatigue
• Fever
• Racing heart rate
• Confusion 
• Tremors
• Fast breathing
• Dysperceptions, such as hearing voices and seeing things that are not there
• Paranoia and agitation

One of the most difficult parts to overcome in this stage of alcohol withdrawal is the urgent desire to drink. Even if the thought of drinking again makes you feel ill, you will feel an alcohol craving so overwhelming that it may compel you to drink again. 

Indeed, findings indicate that environmental stimuli—such as seeing a familiar bar or discovering that there’s no alcohol in your refrigerator—may prompt a relapse.⁹ It’s less about wanting to feel the positive side of intoxication and more about feeling less awful; it also underscores the necessity of medically-supervised alcohol detox for some individuals and circumstances. 

Moderate and severe manifestations of these cravings, as well as the symptoms listed above, should be monitored and managed by a team of healthcare professionals in an alcohol detox center.

Stage Three: 24-48 Hours Post-Alcohol

It would seem that the longer you go without alcohol, the more your symptoms will dissipate, if not vanish altogether.

This may be true for some. However, a small portion of patients, or 10% experiencing withdrawal, will progress into the third stage of AWS. 

This stage is chiefly defined by generalized tonic-clonic seizures, or what’s been historically known as grand mal seizures.¹⁰ These seizures can be accompanied by decreased awareness or a complete lack of consciousness and require immediate medical attention.

Stage Four: 48-72+ Hours Post-Alcohol (Delirium Tremens)

Chronic or excessive use of alcohol can wreak havoc on your entire system. While your symptoms of withdrawal may be gradual and mild at first, they can evolve into the fourth and most dangerous stage: alcohol withdrawal delirium. This phase is marked by:

• Delirium tremens – You may have heard people call alcohol shakes delirium tremens, or DTs, as they’re commonly known, but they’re two different issues. Delirium tremens is recognized as the gravest manifestation of alcohol withdrawal syndrome and may occur in individuals who haven’t sought medical assistance prior to or during stabilization. The DTs usually present within 72 hours after your last drink; however, they can arrive up to 10 days after alcohol consumption has ended. The symptoms of DTs include falling in and out of consciousness, abrupt changes in cognition, profound anxiety, agitation, delirium, hallucinations, and vital sign abnormalities, among others.¹¹

• Medical complications or coma – Delirium tremens are also commonly linked to coma, injuries, and medical complications such as aspiration pneumonia or a heart attack, which are fatal in 1 to 5% of cases. 

Will Everyone Experience These Stages of Alcohol Withdrawal Syndrome?

No. The severity of alcohol withdrawal is contingent upon several factors, including:

• Duration of alcohol use
• Amount of alcohol consumed
• Drinking frequency

That said, if you’ve experienced alcohol withdrawal syndrome in the past, you may experience more acute withdrawal in a phenomenon known as “alcohol kindling.”¹² In fact, experts indicate that medically supervised detox is particularly important for individuals who have a history of AWS even if their initial withdrawal symptoms are mild.

How Long Does it Take Your Body and Mind to Recover from Alcohol?

Overcoming the physical, psychological, and mental hurdles of alcohol withdrawal syndrome is the first and most crucial step toward reclaiming your health and wellness. 

So how long does it take to detox from alcohol? Exact durations vary, but you may continue to experience some of the symptoms of alcohol withdrawal for weeks and even months. If so, this may be diagnosed as “post acute withdrawal syndrome” (PAWS), a clinical condition characterized by the persistence of symptoms such as:¹³

• Alcohol craving
• Irritability
• Anxiety
• Insomnia 
• Mood swings

Fortunately, ongoing support, coupled with pharmacological therapy, may help quell the symptoms of PAWS and decrease the risk of a relapse.

Find Compassionate Support for the Stages of Alcohol Withdrawal with Elevated Rehab

The symptoms of alcohol withdrawal may seem daunting—so much so they may perpetuate alcohol use disorder or prevent an individual from seeking help. And yet, it’s a critical, meaningful shift toward recovery.

Elevate Rehab can help you get there. As a holistic drug rehab in California, we don’t just address the symptoms of alcohol use disorder and alcohol withdrawal. Rather, we take a whole-person approach to help you discover physical, mental, and spiritual well-being. 

With locations in two of the most healing enclaves of California, Santa Barbara and Lake Tahoe, we offer a tailored mix of conventional and alternative treatments to help you discover who you are under an addiction that may have robbed you of what you value most in life.

We’re here for you when you’re ready to take charge of your present and future.

Sources: 

1. JAMA Psychiatry. Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2647079
2. Alcohol Health & Research World. Complications of alcohol withdrawal.  https://pubs.niaaa.nih.gov/publications/arh22-1/61-66.pdf
3. American Academy of Family Physicians. Alcohol withdrawal syndrome. https://www.aafp.org/pubs/afp/issues/2004/0315/p1443.html
4. National Library of Medicine. Delirium tremens. https://www.ncbi.nlm.nih.gov/books/NBK482134/
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9. Scripps Research. Scripps research study reveals how alcohol cravings get stronger after drinking during withdrawal.  https://www.scripps.edu/news-and-events/press-room/2022/20220502-weiss-alcohol-cravings-withdraw.html
10. National Library of Medicine. Generalized tonic-clonic seizure. https://www.ncbi.nlm.nih.gov/books/NBK554496/
11. National Library of Medicine. Alcohol withdrawal. https://www.ncbi.nlm.nih.gov/books/NBK441882/
12. National Library of Medicine. Kindling in alcohol withdrawal. https://pubmed.ncbi.nlm.nih.gov/15706729/
13. Journal of Psychopharmacology. The recognition and management of protracted alcohol withdrawal may improve and modulate the pharmacological treatment of alcohol use disorder. https://pubmed.ncbi.nlm.nih.gov/32648800/