Alcohol Withdrawal: Symptoms, Timeline, and Treatment

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AWS (alcohol withdrawal syndrome) is the clinical term for the presentation of symptoms that occurs when those who are dependent on alcohol suddenly stop or significantly reduce their intake after a period of sustained consumption.

Alcohol withdrawal is associated with a variety of physical and emotional symptoms, from fatigue and mild anxiety to vomiting and nausea. Severe symptoms of AWS include hallucinations and life-threatening seizures.

What is Alcohol Withdrawal?

Alcohol withdrawal is one of the most prominent markers of alcohol dependency. The symptoms of alcohol withdrawal are a physical and psychological response from a system accustomed to the continuous presence of alcohol.

The sustained consumption of alcohol causes tolerance to build. As the effects of alcohol diminish, many people drink more alcohol to achieve the initial effects, accelerating the formation of physical dependence. If you abruptly stop drinking alcohol, your body takes time to adjust to its absence, triggering symptoms like anxiety, nausea, and insomnia as it attempts to restore homeostasis (balance).

The effects associated with this process are not only unpleasant and uncomfortable, but they can also be life-threatening. It is almost always advisable to initiate the alcohol withdrawal process with medical supervision to mitigate complications and streamline the detox process.

How Long Does Alcohol Withdrawal Last?

Alcohol withdrawal symptoms differ depending on the severity of AWS. Symptoms present over distinct stages:

  1. Mild alcohol withdrawal
  2. Moderate alcohol withdrawal
  3. Severe alcohol withdrawal (delirium tremens)

Mild alcohol withdrawal

Mild alcohol withdrawal symptoms include:

  • Insomnia
  • Headaches
  • Tremors
  • Depression
  • Anxiety
  • Appetite loss
  • Vomiting
  • Gastrointestinal issues
  • Abdominal pain

Moderate alcohol withdrawal 

Moderate alcohol withdrawal is associated with the above symptoms alongside these moderate withdrawal symptoms:

  • Shallow breathing
  • Rapid heartbeat
  • High body temperature
  • Excessive sweating
  • Raised blood pressure levels

In addition to these physical symptoms, moderate AWS may trigger a sense of confusion, as well as irritability, and mood changes.

Severe alcohol withdrawal (delirium tremens)

It is estimated that 5% of those who detox from alcohol experience severe withdrawal (delirium tremens or DTs). This can be fatal if untreated.

Many factors influence the scope, severity, and duration of withdrawal symptoms, including:

  • Duration of alcohol abuse
  • Amount you have been drinking
  • Medical history
  • Family history of alcoholism
  • Co-occurring mental health conditions
  • Stress levels


Alcohol Withdrawal Timeline

Not everyone will experience all stages of alcohol withdrawal, and all cases of alcohol detox are unique. That said, alcohol withdrawal follows a predictable pattern over a 7 to 10-day period. This is a typical timeline:

  • 24 hours after last alcoholic beverage: The first alcohol withdrawal symptoms may present 8 hours after the last alcoholic beverage.
  • 24 to 72 hours after last alcoholic beverage: Withdrawal symptoms usually peak after three days. Additionally, the severe symptoms of AWS may present at this stage of withdrawal.
  • End of week 1 of alcohol withdrawal: Withdrawal symptoms reduce in intensity toward the end of the first week of withdrawal.
  • Second week of alcohol withdrawal: Most physical symptoms should subside after a week or so. Some psychological symptoms may linger for several weeks, so engage in ongoing treatment after alcohol withdrawal to maximize the likelihood of a sustained recovery without relapse.

Signs of Alcohol Withdrawal

During an initial assessment at an alcohol rehab center or licensed medical detox center, a doctor will review your medical history, assess your symptoms, and conduct a physical examination. Here are some signs of alcohol withdrawal that your doctor will look for:

  • Hand tremors
  • Fever
  • Dehydration
  • Irregular heart rate

Additionally, the doctor may conduct a toxicology screen to test how your BAC (blood alcohol concentration) levels of alcohol.

Alcohol Withdrawal Symptoms

Alcohol withdrawal symptoms manifest as follows:

6 to 12 hours after last alcoholic beverage

  • Headaches
  • Anxiety
  • Agitation
  • Shaking
  • Nausea
  • Vomiting

12 to 24 hours after last alcoholic beverage

  • Hand tremors
  • Disorientation
  • Seizures

48 hours after last alcoholic beverage

  • Insomnia
  • Fever
  • Sweating
  • High blood pressure
  • Hallucinations
  • Seizures
  • Delirium tremens


After you stop drinking alcohol, withdrawal symptoms will manifest quickly. Headaches and mild anxiety are among the first symptoms that present. At the same time, you can also expect to experience nausea, vomiting, and powerful cravings for alcohol.

Headaches and other early withdrawal symptoms peak by the third day of detox, subsiding in intensity and dissipating after a week or so.

Alcohol withdrawal typically lasts 7 to 14 days. Those who experience protracted withdrawal, prolonged withdrawal, or PAWS (post-acute withdrawal syndrome) may experience headaches and anxiety that take months to fully subside.

Night Sweats

Alcohol stimulates the CNS (central nervous system), the circulatory system, and other organs. Consuming alcohol can trigger an increase in heart rate, prompting blood vessels in the skin to widen, leading the body to produce more sweat than normal. This process is clinically termed vasodilation.

Those who have been drinking alcohol heavily or regularly or more susceptible to experiencing night sweats during withdrawal. Night sweats usually occur from two hours to ten days after the last alcoholic beverage.

Can You Die from Alcohol Withdrawal?

There are two symptoms of alcohol withdrawal that can be life-threatening:

  • Seizures: Those who have been abusing alcohol heavily are more liable to experience seizures during the withdrawal process. This can lead to aspiration, choking, or physical injuries due to uncontrollable convulsions.
  • Delirium tremens: Delirium tremens (DTs) is a serious condition that triggers dangerous symptoms of withdrawal such as disorientation, confusion, hyperactivity, seizure, stroke, and heart attack. Studies show that delirium tremens has a 37% mortality rate when untreated.

Engaging with a supervised medical detox program will mitigate the life-threatening complications associated with withdrawal.

Alcohol Withdrawal Medication

The safest and most comfortable approach to alcohol withdrawal is a medically-supervised detox in an inpatient rehab or licensed medical detox center. A treatment team may administer medications to streamline the intensity of the withdrawal process.

Benzodiazepines or benzos are often indicated to treat alcohol withdrawal symptoms. Like alcohol, benzos are CNS depressants that trigger sleepiness and drowsiness.

Benzos can alleviate the following symptoms:

  • Insomnia
  • Headaches
  • Nausea
  • Vomiting
  • Restlessness
  • Irritability
  • Anxiety
  • Panic
  • Tremors
  • Seizures

The following benzodiazepines have FDA approval for treating acute alcohol withdrawal:

  • Valium
  • Librium
  • Tranxene
  • Serax

Seizure medications may be prescribed for severe alcohol withdrawal. These anticonvulsants are indicated for alcohol detox:

  • Depakene
  • Trileptal
  • Neurontin
  • Tegretol

Additionally, there are three FDA-approved medications for treating alcohol use disorder:

  1. Acamprosate
  2. Disulfiram
  3. Naltrexone

Of these medications, acamprosate may help with alcohol withdrawal by regulating chemicals in the brain disrupted by chronic alcohol abuse. Naltrexone and disulfiram may help you to maintain abstinence in your ongoing recovery.


A 2020 study suggests that gabapentin may relieve the symptoms of alcohol withdrawal, especially in those who have a history of more symptoms presenting after a few days of abstinence.

Gabapentin is marketed as Neurontin, Horizant, and Gralise in the United States and is approved for use as an antispasmodic medication and muscle relaxer. The medication has also been used off-label to treat other conditions, including alcohol withdrawal syndrome.

The study author concludes that “gabapentin may work by itself as a relapse prevention medication” for those prone to severe alcohol withdrawal.

Alcohol Withdrawal Syndrome Treatment at Ohio Community Health

If you are physically dependent on alcohol, abruptly quitting at home could be fatal. Instead, engage with a supervised medical detox to mitigate complications and reduce the intensity of withdrawal symptoms. We can connect you with licensed medical detox centers throughout Cincinnati to help you address the issue of alcohol dependence at Ohio Community Health.

You will then be ready to choose from the following treatment programs at our alcohol addiction treatment and rehab center in Cincinnati:

  • PHP (partial hospitalization program)
  • IOP (intensive outpatient program)
  • Dual diagnosis treatment program (for addictions with co-occurring mental health conditions)

All of Ohio Recovery Centers’ treatment programs involve individualized and evidence-based treatment that includes MAT (medication-assisted treatment), psychotherapy (CBT or DBT), individual counseling, and group therapy.

When you’re ready to detox from alcohol as safely and comfortably as possible, call (877) 679-2132 for immediate assistance.

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Joseph Gilmore

Joseph Gilmore has been working in the addiction industry for half a decade and has been writing about addiction and substance abuse treatment during that time. He has experience working for facilities all across the country. Connect with Joe on LinkedIn.
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Christopher Glover CDCA

My name is Christopher Glover, and I am from Cincinnati, Ohio. I am currently in school and working to grow in competence to better support our community. As a recovering individual I know the struggles that you or a loved one can go through and that there is help for anything you may be struggling with.

The hardest part is asking for help and we are here as a team to best support you and your decision to start your journey towards a better future. Connect with Chris on LinkedIn

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Amanda Kuchenberg PRS CDCA

I recently joined Ohio Community Health Recovery Centers as a Clinical Case Manager. I am originally from Wisconsin but settled in the Cincinnati area in my early 20s.  My career started in the fashion industry but quickly changed as I searched to find my drive and passion through helping others who struggle with addiction. 

As someone who is also in recovery, I wanted to provide hope, share lived experience, and support others on their journey.  I currently have my Peer Recovery Support Supervision Certification along with my CDCA and plan to continue my education with University of Cincinnati so I can continue to aid in the battle against substance addiction. Connect with Amanda on LinkedIn.

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Patrick McCamley LCDC III

 Patrick McCamley (Clinical Therapist) is a Cincinnati native who has worked in substance use disorder/co-occurring mental health disorder treatment since 2019. Patrick received his bachelors degree in psychology from University of Cincinnati in 2021 and received his LCDC III (Licensed Chemical Dependency Counselor) license from the Ohio Chemical Dependency Professionals Board in 2022. Patrick has worked in Clinical Operations, Clinical Case Management, and Clinical Therapy throughout his career.

Patrick has tremendous empathy and compassion for the recovery community, being in recovery himself since 2018. Patrick is uniquely qualified to be helpful because of the specific combination of his academic background and his own experience in recovery.

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Bill Zimmerman CDCA

Bill Zimmerman is a Greater Cincinnati Area native who has worked in substance use disorder/co-occurring mental health disorder treatment since 2018. Bill received his (Chemical Dependency Counselor Assistant) license from the Ohio Chemical Dependency Professionals Board in 2020.

Bill has worked in Clinical Operations in both support and supervision, and Program facilitating and 12 step recovery support during his career. Bill has a passion for the recovery community, having been in recovery himself since 1982. Connect with Bill on LinkedIn

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Taylor Lilley CDCA, PRS

Growing up in Louisiana with addiction running rampant on both sides of my family. A life away from drugs and alcohol seemed impossible for someone like me. I remember what it was like sitting across from someone thinking there is no way they could ever understand what I was going through.

Sharing my experience offers a credibility and a certain type of trust with clients that only someone who has walked down this road can illustrate. To immerse myself further into the field of addiction, I am currently studying at Cincinnati State for Human and Social Services.  I hope I never forget where I came from, if I can do it, so can you!

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Thomas Hunter LSW

Hello my name is Thomas Hunter. I was born and raised in Cincinnati, Ohio. I am a licensed social worker.In my scope of practice I have worked in the areas of mental health and recovery for thirty years. The clients I have worked with in my career have ranged in age from seven to seventy.

I strive each day to serve my purpose of helping those in need and I believe I do so by utilizing all of my experiences to accomplish my goal of supporting those who desire to establish their sobriety and maintain it in their recovery. Connect with Thomas on LinkedIn.

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Mary D.Porter,LICDC

 My name is Mary D. Porter. I received my Masters of Social Work in 2008 from The University of Cincinnati. I received My Licensed Independent Chemical Dependency Counselor Licensure in 2001. I retired from The Department of Veteran Affairs Medical Center on April 14, 2014. Currently, I am the Associate Clinical Director for The Ohio Community Health Recovery Centers in Cincinnati.. Due to the fourth wave of the Opioid Epidemic in 2019,  I decided to enter back into the workforce to assist the addicted population.

The overdoses were astounding and I wanted to help.  I consider myself  to be an advocate for the addicted population. My compassion, resilience, empathy, wisdom, knowledge, experience and  love I have for this forgotten population goes beyond words. I consider what I do for the addicted population as a calling versus a “career,” because I too was once an “addict and alcoholic.” Today I am 45.5 years alcohol and substance free.

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Ben Lemmon LCDC III

Hello, my name is Ben Lemmon, and I’m the Vice President and Clinical Director at Ohio Community Health Recovery Centers. I’ve been working in the addiction and mental health field since 2013 and decided to enter the field after overcoming my own challenges with addiction.

When I first meet a client, I always explain to them that the reason we are meeting is because they are not capable of obtaining or maintaining sobriety, and my goal is to create a person that can maintain sobriety. I believe a person’s personality is made up of their thoughts, feelings and actions and my job is to help clients identify the thoughts, feelings and actions that have them disconnected from recovery and provide them with the tools to live a healthy and happy life. Connect with Ben on LinkedIn