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The Alcohol Withdrawal Timeline Explained | Addiction & Recovery

 

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Recovery is a process. When a person decides to stop drinking, the unknown physical and psychological reaction to such a decision can be enough to make them have second thoughts. Unlike other types of recovery, there is no definite time where things “go back to normal”. Alcohol addiction is a treatable chronic disease that requires active measures to manage symptoms. These active measures begin as soon as the individual stops drinking. The following article will discuss an alcohol withdrawal timeline as well as the stages of withdrawal and the treatment received during those times. Like in all things regarding addiction, all individuals are unique, and all treatment must be tailored for them specifically.  

Alcohol Withdrawal Stages

Withdrawal is the body’s reaction to the effects of alcohol “wearing off”. The stages can be broken down in line with the severity of  symptoms:

  1. Stage 1 (Mild): The individual is experiencing mild symptoms of withdrawal. These symptoms can range from anxiety, headaches, difficulty sleeping, upset stomach and feelings of your heart racing. The individual may also experience mild shaking or tremors. These are common symptoms of what is labeled as a hangover.
  2. Stage 2 (Moderate): The individual may be experiencing the above symptoms as well as sweating, rapid heart rate and breathing, some cognitive impairment in the form of confusion, fever and an increase in blood pressure.
  3. Stage 3 (Delirium Tremens): The individual is experiencing all the above. The individual can experience cognitive issues including delusions and hallucinations, visual and auditory issues as well as disorientation and lack of attention.

The first two stages are not an uncommon experience even to individuals without a diagnosable alcohol use disorder. They can be unpleasant but resolve within a few days. However, the progression between the second and third stage can occur suddenly and can be experienced by individuals with chronic and severe use disorders and cases of binging alcohol.

Delirium Tremens is the most severe symptom of alcohol withdrawal and can result in cardiac failure. The chronic overuse of alcohol disrupts normal neurotransmitter function within the brain. The affected neurotransmitters tend to regulate bodily functions such as temperature control, mood regulation and parts of the brain that address stressors such as fight or flight. When the individual stops drinking, the lack of certain neurotransmitters that have been previously disrupted are not available. he individual then cannot manage the overexcitation of the brain, leading to system overwhelm which can include the symptoms listed above and can result in uncontrolled seizure activity.   

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Alcohol Withdrawal Timeline

For anyone who has experienced a hangover, the question is, how long does alcohol withdrawal last? The timeline regarding the withdrawal process  is heavily dependent on how much an individual drank, how long they have been drinking, the individual’s age, health and mental health history. The following approximates the timeline in which an individual can expect withdrawal symptoms:

Minor withdrawal symptoms can begin within six hours after the individual stops drinking. Minor withdrawal symptoms can occur from six to 72 hours to some extent. Albeit unpleasant, these symptoms are manageable.

Moderate withdrawal symptoms refer to more severe symptoms and they can occur soon after the individual stops drinking. These symptoms are more severe and are what usually spurs the individual to “take a drink”. This is a clear symptom of a use disorder since the person is actively avoiding the symptoms of withdrawal by using the substance. Moderate withdrawal symptoms can last up to one week.

Severe withdrawal symptoms can occur suddenly within 48 hours of the last drink. An individual can be experiencing moderate symptoms and begin having cognitive issues and seizures. Severe withdrawal symptoms can occur at any time after use, or in the case of binge drinking, during consumption. However, in cases of chronic alcohol use, the symptoms of severe withdrawal can linger for up to 14 days. For most individuals, physical withdrawal symptoms usually last up to one week, but the psychological withdrawal from alcohol can last a lifetime if they do not seek any form of therapeutic treatment.

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Alcohol Withdrawal Treatment

Outpatient Treatment: Mild and moderate alcohol withdrawal syndrome can be managed in outpatient treatment. Outpatient medical detox facilities will usually perform some psychological assessments to gauge the level of alcohol use, and from those results, they can create a treatment plan to manage symptoms medically. Medication prescription is based on symptom severity. This is a cost-effective method of withdrawing safely. However, as stated previously, the individual should follow up with psychological treatment.

Inpatient Treatment: Some residential programs offer a combination of detoxification and the beginnings of a psychological treatment plan. These programs can last from two weeks to 90 days. The average stay is usually 28 days.

Detox Centers: A detox center provides a medically managed withdrawal from all substances. The length of stays varies depending on the severity of the withdrawal.

Medications: Depending on the symptoms of withdrawal, the individual may require medication. Medication protocols have been created to manage the symptoms of mild to moderate alcohol withdrawal symptoms as well as Delirium Tremens. The most common types of withdrawal medication for alcohol are benzodiazepines.  Chlordiazepoxide and diazepam are the drugs of choice for mild to moderate withdrawals and are given in dosages that depend on the previous consumption of alcohol. However, if the individual has co-occurring medical issues in cases of severe withdrawals such as seizures, oxazepam and lorazepam are used. It is not uncommon to also provide individuals with anti-psychotic medications like risperidone in cases of severe withdrawals if they are experiencing hallucinations and delusions.

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Alcohol Recovery Timeline- After Withdrawals

The withdrawal process can be frightening. As the alcohol leaves the body, the damage to the body and mind may linger. Chronic use of alcohol can result in major organ issues such as cardiac myopathy, high blood pressure, liver issues such as hepatitis and cirrhosis, pancreatitis, cancers of the throat, mouth, liver, and esophagus, and a general weakening of the immune system leaving the individual vulnerable to bacterial infections. The psychological effects can last a lifetime if left untreated.

The good news is that outpatient substance abuse treatment is highly effective in treating alcohol use disorders. Also, the brain can “bounce back” once the individual stops drinking. Brain volume can return in many critical areas of the brain after 14 days of sobriety. Staying sober will also assist in dealing with any physical issues that may have been caused from their drinking. With the use of counseling, support groups and proper medications (if warranted due to co-occurring disorders), it is a long-held belief that recovery is a process and not a goal. In other words, a person can create a sustained sobriety, but the course of recovery is a lifelong practice.

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References:

https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

https://www.aafp.org/afp/2004/0315/p1443.html

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders

https://emedicine.medscape.com/article/166032-overview

https://www.aafp.org/afp/2013/1101/p589.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085800/

https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a2.htm?s_cid=mm6353a2_w

https://www.aafp.org/afp/2010/0815/p344.html

https://store.samhsa.gov/shin/content//SMA14-4126/SMA14-4126.pdf

https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360883/

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1530-0277.2012.01853.x

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