Alcohol Withdrawal Timeline

What To Expect During the Alcohol Withdrawal Timeline

If you are thinking about addiction treatment, your first question is probably, “How long is this going to last?” It’s normal to be scared of the unknown.

While the alcohol withdrawal timeline is different for everyone, the physical part usually lasts 5 to 7 days. Knowing what’s coming can help you prepare and get through detox safely and successfully.

Timeline Key Takeaways

• When it starts: Symptoms usually kick in 6–12 hours after your last drink.
• When it peaks: The worst symptoms happen between 24 and 72 hours (the “Danger Zone”).
• When it ends: Physical symptoms usually fade within 5–7 days.
• What happens afterward: Emotional ups and downs (PAWS) can last for months after detox.

Alcohol Withdrawal Duration Overview

How long the withdrawal lasts depends on how heavy the alcohol addiction is.

Medical professionals generally break the timeline down into three phases (or stages):

1. Acute Withdrawal (Days 1–5)
2. Sub-Acute Withdrawal (Weeks 1–2)
3. Post-Acute Withdrawal (Months 1–6+)

Stage 1: Onset (6 to 12 Hours)

The first stage often starts while there is still some alcohol in your system. When the brain stops getting its usual sedative, it bounces back into a hyperactive state. During this first window, you can expect mild but uncomfortable physical symptoms.

Common symptoms right now include:

• “The Shakes”: Your hands might start trembling.
• Physical Instability: You might sweat a lot and feel your heart beating faster than normal.
• Anxiety: A distinct feeling of nervousness, agitation, or a sense that “something is wrong.”
• Stomach Issues: Nausea, vomiting, and a lack of appetite as your body clears toxins.

Stage 2: Intensification (12 to 24 Hours)

As you move into the first full day, symptoms get stronger. This is often when people start seeing or hearing things that aren’t there (hallucinations). Unlike the severe confusion that happens later, you usually know these things aren’t real, but it’s still scary.

Look for these specific signs:

• Hallucinations: Seeing spots, hearing sounds, or feeling itching sensations.
• Formication: A creepy-crawly feeling, like bugs are on your skin.
• Insomnia: Being totally exhausted but unable to fall asleep.
• Mental Fog: Trouble focusing or losing track of time.

Stage 3: The Peak & “Danger Zone” (24 to 72 Hours)

This is the most dangerous time in the alcohol withdrawal timeline. For people who have been drinking heavily for a long time, the risk of life-threatening complications is highest during days 2 and 3.

Severe Symptoms May Include:

• Seizures: Generalized seizures (Grand Mal) can happen without warning, even if you’ve never had one before.
• Delirium Tremens (DTs): A medical emergency affecting 3-5% of patients. It causes severe confusion, fever, and hallucinations.
• Heart Strain: Dangerously high blood pressure and a racing heart.

Stage 4: Stabilization (Day 4 to Day 7)

By day 4 or 5, most people’s worst physical symptoms usually start to fade. The risk of seizure drops way down, and you start thinking clearly again. While the shaking and sweating lessen, they are often replaced by being really tired and having “brain fog.”

This is the best time to move from medical detox to a rehab program to tackle the root causes of addiction, now that the immediate physical danger has passed.

Long-Term Timeline: Post-Acute Withdrawal (PAWS)

Many people think they are “cured” after detox, only to be blindsided by Post-Acute Withdrawal Syndrome (PAWS) weeks later. Knowing that this is just part of the timeline helps you not give up. Lasting from 6 months to 2 years, this phase includes:

• Up-and-down energy levels and deep fatigue.
• Feeling emotionally numb or having sudden mood swings.
• Trouble sleeping and having vivid dreams.
• Trouble thinking clearly or solving problems.

Factors That Impact the Timeline

Why does one person detox in 3 days while another takes a week? Several things matter. Years of heavy drinking change your brain chemistry more than short-term bingeing, leading to a longer recovery. Underlying mental health issues like anxiety can also make the emotional side last longer.

Crucially, the “Kindling Effect” plays a major role: if you have gone through detox and relapsed multiple times, your brain becomes more sensitive. Each time you go through withdrawal, it gets faster, harder, and more dangerous.

If a Loved One Refuses Medical Help: A Safety Guide

It is incredibly stressful when a loved one decides to stop drinking “cold turkey” but refuses to go to a detox center. While you cannot force them to get help, you can take steps to reduce the immediate danger at home.

Please note that this information is for emergency situations only, so that you are armed with what to do in a helpless caregiving situation. Our team does NOT advise alcohol detox at home, ever.

1. Do Not Leave Them Alone (Days 1–3)

The first 72 hours are the most volatile. Ensure someone is with them around the clock. If they have a seizure while alone, they could fall, hit their head, or choke violently.

2. Hydration and Nutrition

Dehydration worsens withdrawal. Offer water and electrolyte drinks (like Gatorade or Pedialyte) frequently. If possible, provide a Vitamin B1 (Thiamine) supplement, as alcohol depletes this vitamin, leading to potential brain damage.

3. Create a Low-Stimulus Environment

An overstimulated brain is more likely to seize. Keep the lights low, turn off loud TVs, and keep the environment calm. Avoid arguments or heavy emotional conversations during the acute detox phase.

4. Know the “Red Line”

You must agree on when to call 911, regardless of their protests.

Call emergency services immediately if you see:

• Confusion about where they are or who you are.
• Vivid hallucinations (talking to people who aren’t there).
• Uncontrollable shaking or convulsions.
• Loss of consciousness.

Medical Management of the Timeline

Going cold turkey with alcohol withdrawals is dangerous. Medical detox uses protocols to smooth out the peaks and keep you safe.

• Medications: Doctors use meds like Ativan or Librium to mimic alcohol’s effects, stopping your brain from crashing too hard. These are slowly tapered off over 5–7 days.
• Nutritional Support: Patients get high doses of Vitamin B1 (Thiamine) to prevent long-term brain damage (Wet Brain).
• Monitoring: Frequent checks catch blood pressure spikes before they cause a stroke or heart attack.

When to Seek Help

You don’t have to go through this challenging process alone. Medical detox makes the process much more comfortable and safe.

If you are ready to start your timeline to recovery, visit our Treatment Directory to find a detox near you or call the SAMHSA National Helpline at 1-800-662-HELP (4357).

Written by

Jessica Miller

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Co-Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.