For someone physically dependent on alcohol, the prospect of detox can be intimidating. Knowing what to expect during alcohol withdrawal helps reduce anxiety and prepares individuals and families for the process ahead. While everyone’s experience differs based on their drinking history and overall health, alcohol withdrawal follows a generally predictable timeline.
This guide walks through what typically happens during alcohol detox, day by day, and explains why medical supervision is important for safe withdrawal. Understanding the timeline can help you make informed decisions about seeking treatment.
Why Alcohol Withdrawal Happens
When someone drinks heavily over an extended period, the brain adapts to the constant presence of alcohol. Alcohol enhances the effects of GABA, an inhibitory neurotransmitter that slows brain activity, while suppressing glutamate, an excitatory neurotransmitter. To maintain balance, the brain reduces its own GABA production and increases glutamate sensitivity.
When alcohol is suddenly removed, this adapted brain is left in a hyperexcitable state. Without the depressant effects of alcohol, and with the brain’s own calming mechanisms diminished, the nervous system becomes overactive. This neurological imbalance produces the symptoms of withdrawal.
The severity of withdrawal depends on several factors including how long the person has been drinking, how much they typically consume, whether they have experienced withdrawal before, their age and overall health, and whether they have co-occurring medical or mental health conditions. Previous withdrawal episodes tend to make subsequent withdrawals more severe, a phenomenon called kindling.
The Alcohol Detox Timeline
Alcohol withdrawal typically progresses through predictable stages, though the exact timing and intensity vary from person to person. The following timeline represents a general guide rather than a precise schedule.
Hours 6 to 12: Early Withdrawal Begins
Withdrawal symptoms typically begin within six to twelve hours after the last drink, though they may appear earlier in individuals with severe dependence. Initial symptoms are usually mild and may include anxiety and nervousness, restlessness and irritability, difficulty sleeping, nausea or upset stomach, headache, sweating, and rapid heartbeat.
During this stage, many people experience intense cravings for alcohol. The temptation to drink to relieve uncomfortable symptoms is strong. In a medically supervised detox, staff can provide support and, when appropriate, medications to ease symptoms and reduce cravings.
For those with mild dependence, symptoms may peak during this phase and then begin to improve. However, for individuals with more significant dependence, symptoms will continue to intensify.
Hours 12 to 24: Symptoms Intensify
During the first full day without alcohol, symptoms typically become more pronounced. In addition to worsening of earlier symptoms, individuals may experience increased blood pressure and body temperature, more significant tremors, mood disturbances including depression and anxiety, difficulty concentrating, and loss of appetite.
Some individuals begin experiencing visual, auditory, or tactile hallucinations during this period. Alcoholic hallucinosis, as it is called, differs from delirium tremens in that the person typically remains aware that the hallucinations are not real. While frightening, hallucinosis alone is not necessarily dangerous but does indicate significant withdrawal.
Medical monitoring during this period allows clinicians to assess the trajectory of withdrawal and determine whether more intensive intervention is needed.
Hours 24 to 48: Peak Risk Period Begins
The second day of withdrawal often brings the most intense symptoms. For those at risk of complicated withdrawal, this is when serious symptoms are most likely to emerge.
Withdrawal seizures can occur during this period, most commonly between 24 and 48 hours after the last drink. Seizures occur in approximately 3 to 5 percent of individuals undergoing alcohol withdrawal and can be life-threatening if not managed appropriately. The risk is higher in those who have had previous withdrawal seizures, have been drinking heavily for long periods, or have other medical conditions.
Symptoms during this phase may include severe tremors, profuse sweating, significant anxiety or panic, continued or worsening hallucinations, marked increases in heart rate and blood pressure, and continued nausea and possible vomiting.
In a medical detox setting, clinicians use standardized assessment tools to monitor withdrawal severity and administer medications to prevent seizures and manage symptoms. Benzodiazepines are the primary medications used during alcohol withdrawal, effectively reducing seizure risk and easing other symptoms.
Hours 48 to 72: Delirium Tremens Risk
For individuals at risk of the most severe form of withdrawal, delirium tremens typically begins between 48 and 72 hours after the last drink, though it can occur later. DTs is a medical emergency that requires immediate treatment.
Symptoms of delirium tremens include severe confusion and disorientation, profound agitation, high fever, heavy sweating, hallucinations that the person believes are real, extreme autonomic instability including dangerous changes in heart rate and blood pressure, and seizures.
Delirium tremens is fatal in approximately 5 to 15 percent of untreated cases. With proper medical treatment, mortality is reduced to less than 1 percent. This stark difference underscores why medical supervision is critical for those at risk of severe withdrawal.
Not everyone who withdraws from alcohol develops DTs. Risk factors include a history of DTs, long-duration heavy drinking, older age, presence of other medical conditions, and abnormal liver function. Medical professionals can assess risk factors and provide appropriate monitoring and treatment.
Days 3 to 5: Gradual Improvement
For most people, acute withdrawal symptoms begin improving after the third day. The risk of seizures and DTs decreases, though those who developed DTs may continue experiencing symptoms for several more days.
During this phase, individuals typically experience gradual reduction in physical symptoms, improved sleep although it may still be disrupted, decreased tremor and sweating, mood improvement though some anxiety and depression may persist, and increased appetite and energy.
This period can feel discouraging because improvement is gradual rather than dramatic. Fatigue and mood symptoms may persist even as physical symptoms resolve. Support from medical staff and encouragement about the progress being made helps individuals stay committed to the process.
Days 5 to 7 and Beyond: Stabilization
By the end of the first week, most acute withdrawal symptoms have resolved for the majority of people. However, some individuals continue experiencing lingering effects for days or weeks longer. Ongoing symptoms may include sleep difficulties, mild anxiety or mood fluctuations, fatigue, and difficulty concentrating.
Post-acute withdrawal syndrome, sometimes called PAWS, refers to prolonged symptoms that can persist for weeks or months after acute withdrawal ends. PAWS symptoms are typically less intense than acute withdrawal but can include mood swings, anxiety, sleep problems, low energy, and cognitive difficulties. These symptoms usually improve gradually over time but can contribute to relapse risk if not addressed.
Why Medical Detox Matters
Alcohol is one of the few substances from which withdrawal can be directly fatal. The seizures and autonomic instability that can occur during severe withdrawal are medical emergencies. Attempting to detox at home without medical support is dangerous for anyone with significant alcohol dependence.
Medical detox provides continuous monitoring by trained staff who can recognize warning signs and intervene quickly. Medications, primarily benzodiazepines, effectively prevent seizures and reduce other withdrawal symptoms when administered appropriately. Medical staff can manage complications if they arise and address other health issues that may surface during detox.
Beyond safety, medical detox is simply more comfortable than withdrawing without support. Medications ease the distress of withdrawal, making the process more tolerable and reducing the likelihood of returning to drinking to relieve symptoms.
What Happens During Medical Detox
Understanding what to expect during a medically supervised detox can help ease anxiety about the process.
Intake and Assessment
Upon arrival at a detox facility, you will undergo a comprehensive assessment. Staff will gather information about your drinking history, medical history, current medications, and mental health. Vital signs will be checked, and lab work may be ordered. This assessment helps clinicians understand your risk level and develop an appropriate treatment plan.
Monitoring and Medication
Throughout detox, staff will regularly assess your withdrawal symptoms using standardized scales. The Clinical Institute Withdrawal Assessment for Alcohol, or CIWA-Ar, is commonly used to quantify symptom severity and guide medication decisions.
Medications are administered based on symptom severity. Some protocols use fixed medication schedules, while others administer medication based on symptom levels. The goal is to keep you safe and comfortable while allowing your body to clear alcohol.
Supportive Care
Detox includes attention to basic needs including hydration, nutrition, and rest. Alcohol use depletes many nutrients, and replenishing vitamins, particularly thiamine, is important. Staff provide emotional support and begin preparing you for the next phase of treatment.
Transition to Treatment
Detox is the beginning of recovery, not the entirety of it. Before completing detox, you will work with staff to develop a plan for ongoing treatment. This may include residential treatment, intensive outpatient programming, outpatient therapy, medication-assisted treatment, and peer support groups. The specific plan depends on your clinical needs, personal circumstances, and preferences.
After Detox: The Importance of Continued Treatment
Completing detox is an achievement, but it addresses only physical dependence. The patterns of thought and behavior that maintain addiction remain and must be addressed through ongoing treatment. Without continued care, the risk of relapse is high.
Research consistently shows that longer engagement in treatment produces better outcomes. The National Institute on Drug Abuse recommends at least 90 days of treatment for most individuals with substance use disorders. This might include a combination of residential treatment, outpatient therapy, medication, and peer support.
During treatment, you will learn to identify triggers and high-risk situations, develop coping skills for managing cravings and stress, address underlying issues that contribute to drinking, build a support network, and create a lifestyle that supports recovery.
Alcohol Detox and Treatment at ENSO Recovery
ENSO Recovery provides comprehensive addiction treatment including medically supervised detoxification for alcohol dependence. Our clinical team has extensive experience managing alcohol withdrawal safely and comfortably.
Following detox, our sober living program provides the therapeutic foundation for lasting recovery. Through individual therapy, group counseling, and experiential programming, clients develop the skills and insights needed to maintain sobriety.
We offer a full continuum of care. This allows clients to step down gradually to less intensive levels as they build stability and confidence in recovery.
Maine Resources
Maine residents have access to various resources for alcohol use disorder treatment. The Maine Office of Behavioral Health oversees substance use disorder services in the state and can help connect residents with treatment.
Maine’s 211 service provides information and referrals for health and human services, including addiction treatment. Dial 211 or visit the website to find local resources.
For peer support in recovery, Alcoholics Anonymous meetings are available throughout Maine, providing ongoing community support for those in recovery.
Taking the First Step
If you are dependent on alcohol and want to stop drinking, medical detox is the safest way to begin. The admissions team at ENSO Recovery is available to answer questions, verify insurance, and help you understand your options.
Contact ENSO Recovery at (207) 717-4820 to take the first step toward freedom from alcohol.
Crisis Information
If you are experiencing a medical emergency related to alcohol withdrawal, call 911 immediately. Seizures and severe withdrawal require emergency medical care. For mental health crisis support, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
Learn More
National Institute on Alcohol Abuse and Alcoholism: Understanding Alcohol Use Disorder