How Long Does Alcohol Withdrawal Last?

Dr. Ximena Sanchez-Samper

Ximena Sanchez-Samper, MD is a Board- Certified Addiction Psychiatrist who obtained her degree as a psychiatrist at the Mayo Clinic in Rochester, MN and completed her Addictions Fellowship through the combined Massachusetts General Hospital, McLean Hospital / Brigham and Women’s Hospital Addictions Fellowship program in 2004.

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Understanding Alcohol Withdrawal: Stages, Symptom, and Strategies for Recovery

When someone who regularly consumes large amounts of alcohol abruptly cuts down or stops drinking altogether, they may experience alcohol withdrawal symptoms. Even though withdrawal symptoms tend to affect adults the most, they can also occur in young children and teenagers who drink alcohol. 

The more you drink, the more severe your withdrawal symptoms will be when you stop. They can become even worse if you have a co-occurring health disorder. However, this doesn’t mean you can’t stop drinking. In fact, millions of people rely on alcohol treatment every year to help them overcome their alcohol use disorder (AUD). It might be easier to stop drinking if you have a good idea of what to anticipate and how long the withdrawal symptoms will last. 

Early Stage Withdrawal

Alcohol withdrawal consists of three primary stages, and not everyone will experience the same symptoms. Your general health and well-being, including your diet and physical activity as well as how long you’ve been drinking, have a great impact on the symptoms. The first and earliest stage of withdrawal starts around six to 12 hours after a person has had their last drink. These early-stage symptoms usually last several hours up to a couple of days.


When you stop drinking, your central nervous system gets agitated and excited. This happens as a result of changes in neurotransmitter activity as the body tries to adjust to functioning without alcohol. For many people, these changes manifest in the form of increased anxiety. 


Changes in neurotransmitter activity, especially those involving dopamine and gamma-aminobutyric acid, can alter sleep patterns. These chemicals have an effect on the reward area of the brain as well as the body’s capacity to wind down and go to sleep. For some people, the changes can make sleeping very difficult, leading to bouts of insomnia.

Nausea and Sweating

Some people experience an increase in cortisol and other stress chemicals when they cut down or quit drinking. As a result, the body experiences heightened sensitivity and hyperactivity. This can make you sweat, which in turn can make you sick to your stomach and cause you to throw up, among other symptoms.


As you go through alcohol withdrawal, the hypothalamus — a multi-functioning brain region — releases the CRF stress hormone. Following its release from the peripheral blood vessels, the CRF binds to MrgprB2 in the brain’s dura mater. This causes the mast cells to release chemical messengers that trigger many actions, one of which is the enlargement of blood vessels as they open. It also stimulates sensory neurons in the trigeminal ganglia via their peripheral nerve fibers. When this happens, the neurons in the brain become hypersensitive, and the result is an alcohol withdrawal headache.

Tremors (Shakes)

For those with heavy drinking habits, it’s not uncommon to experience tremors during the first stage of alcohol withdrawal. Tremors usually occur as a result of heightened anxiety or emotional stress. They can become worse if you don’t have healthy eating patterns. 

Second Stage Withdrawal

The severity of alcohol withdrawal symptoms often increases after the first two days. Tremors and other severe symptoms sometimes appear first during the second stage. These symptoms usually last one to three days.

Increased Blood Pressure, Temperature and Heart Rate

At first, alcohol reduces blood pressure by acting as a depressant. However, when someone quits drinking, the body tries to make up for it by raising its blood pressure. An increased heart rate and higher core temperature may result from this physiological rebound’s activation of the sympathetic nervous system. Another factor is the adrenaline and other stress hormones released by the body as a reaction to withdrawal stress, causing higher blood pressure and a faster heartbeat. 

Confusion and Irritability

Quitting alcohol alters levels of neurotransmitters, especially glutamate and gamma-aminobutyric acid, both of which impact mood regulation and cognitive performance. Confusion and anger are common symptoms that result from this imbalance. And because it hinders decision-making and self-awareness, the confusion can make rehabilitation more difficult by increasing risky behaviors. 


Changes to your brain’s chemistry when you stop drinking can also lead to hallucinations. When you’re trying to detox from alcohol, hallucinations make things much worse by heightening your psychological discomfort and the likelihood of problems. Severe anxiety and restlessness may set in when the feedback your senses — hearing, seeing or touching — give you is startling and confusing. 


Once the effects of alcohol wear off, the brain’s excitatory activity quickly returns, which may lead to neuronal hyperexcitability and even seizures. An urgent intervention with antiepileptic medicine may be necessary to treat any convulsions you experience.

Last Stage of Withdrawal

After two or three days of alcohol withdrawal, you should start to feel better, and the likelihood of a medical emergency drops significantly. Although you may continue to feel certain symptoms, most of them should subside. 

Continued Confusion

Some people may experience ongoing disorientation and confusion through the last stage of alcohol withdrawal as a result of changes in brain function and residual neurochemical problems. Cognitive difficulties may also be present due to the combined effects of withdrawal symptoms and the body’s more sluggish recovery from alcohol dependency. 

Fatigue and Mood Swings

Drinking alcohol over an extended period alters your natural sleep cycles and reduces the quality of your REM sleep, which causes you to feel exhausted even after you stop drinking. You may also feel exhausted because your body goes through a lot of physiological changes during withdrawal. These changes include modifications to your metabolism and hormone levels. Anxieties, sadness, worry and stress — all of which are typical throughout withdrawal — also contribute to ongoing weariness and possible mood swings.

Intermittent or Persistent Hallucinations

Because of lingering neurochemical imbalances and increased neural excitability, some people may still have hallucinations from time to time or perhaps permanently. These hallucinations, whether aural, visual or tactile, emerge when the brain tries to revive itself after heavy drinking. Additional factors that could worsen these symptoms include psychological anguish and preexisting mental health issues. For example, if you suffer from delirium tremens, you’re more likely to experience hallucinations. 

Getting the Help You Need

There are many treatment options for alcohol use disorder. The severity of your addiction, among other factors, determines which approach is best. Speaking with a licensed addiction counselor can make selecting the right option much easier. This type of counselor can connect you with treatment options that you otherwise wouldn’t have known about.

No matter which form of treatment you choose, you’re likely to receive one or more of the following services:


Detox programs make alcohol withdrawal symptoms much more manageable. They do this by providing medically supervised, systematic procedures that help people withdraw from alcohol. 

You can find detox programs in hospitals, alcohol treatment facilities, substance abuse centers and other locations. Most detox programs last three to 15 days and offer transitional services to those who wish to continue their treatment for AUD. 

The length of time that it takes to complete a detox program varies from one person to the next. Those who experience severe symptoms sometimes have to stay longer.

Inpatient Treatment

Inpatient treatment for AUD requires staying at a facility specially designed to help people recover from alcohol abuse. These programs frequently last 30 to 180 days, but longer-term residential options are available. For example, some inpatient settings have programs that last up to two years. 

These programs are particularly beneficial to people who have been struggling with alcohol use disorder for years. They also work well for those with co-occurring disorders or limited external support. 

Every patient receives individualized care that includes a regimen of treatments, such as counseling, medical supervision, and holistic interventions. Treatment services come from physicians, nurses, and therapists who have vast expertise in treating alcohol withdrawal symptoms. 

The number of clients at an inpatient hospital ranges from a few dozen to hundreds. Medication-assisted programs allow clients to use medications as part of the treatment process. 

Outpatient Treatment

Outpatient treatment options for AUD allow clients to live at home while receiving treatment via daylong counseling sessions. These sessions sometimes come in the form of one-on-one counseling. At other times, they involve group therapy. 

The goal of outpatient treatment is to help clients recognize and avoid triggers for their AUD. They provide valuable coping skills that clients can use to reduce their risk of relapse. Outpatient counseling also focuses heavily on helping clients understand the root causes of their addiction. 

These programs generally last anywhere from 30 to 180 days and sometimes longer. Some outpatient programs allow medication-assisted treatment (MAT), while others do not. 

Dual-Diagnosis Treatment

Having a dual diagnosis can make the treatment process more complicated, especially when AUD and other disorders aren’t treated simultaneously. Dual-diagnosis treatment takes into account any co-occurring mental disorders that a client may have. Many dual-diagnosis treatment programs allow the use of medications. They can range in length from a few months to a year or longer. 1

Alcohol Withdrawal Coping Strategies

Withdrawing from alcohol is difficult. The good news is that you can learn to cope with the challenge and use it to your advantage as you start to recover. 

Stay Hydrated and Nourished

Making sure to stay hydrated and eat well is a cornerstone of controlling alcohol withdrawal symptoms. To avoid dehydration and nutritional deficits, drink plenty of water, and eat vitamin-, mineral- and protein-rich meals.

Seek Medical Supervision

If you experience severe withdrawal symptoms, the smartest thing to do is to seek medical supervision. Medical experts can monitor your vital signs and prescribe any necessary medications to control your blood pressure. If you have a strong desire to use alcohol again, your doctor may be able to prescribe a pill or injection that curbs your cravings. 

Relaxation Techniques

Managing stress and anxiety during alcohol withdrawal is paramount to making the symptoms less severe. One of the best ways to reduce stress is to take part in relaxation methods like yoga or meditation. A lot of people use deep breathing exercises to make the withdrawal process more comfortable.

Establish a Support System

Another effective way to deal with alcohol withdrawal is to surround yourself with supportive people. During this difficult period, you’ll find it helpful if you can rely on reliable friends, family, or support groups for emotional support and encouragement. Another option is to join a recovery group like Alcoholics Anonymous (AA), where you can meet others who share your experiences and can provide support, advice and encouragement.

Getting Help on the Path to Recovery

Navigating the challenging journey of alcohol withdrawal requires a multifaceted approach, including medical intervention, supportive care, and the adoption of healthy coping mechanisms. It’s essential to remember that you’re not alone in this process. Professional help can significantly ease the journey toward recovery. 

AtCharles River Recovery, we offer comprehensive alcohol treatment and detox services tailored to individual needs. Our dedicated team provides alcohol detox, clinical stabilization services, and day treatment programs designed to support clients through every step of their recovery. 

When you choose treatment at Charles River Recovery, you’re taking a significant step toward reclaiming your health and well-being. Reach out to us now to start on the path to sobriety.