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Alcohol & Health
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Updated on June 16, 2022
4 min read

When Do Alcohol Withdrawal Symptoms Start?

Kelly Brown
Dr P. E. Pancoast, MD
Written by 
6 Sources Cited
Kelly Brown
Written by 
6 Sources Cited

Alcohol Withdrawal

Ongoing, heavy alcohol use causes your body and mind to depend on it to function. Because of this, you’ll suffer physically and mentally when you suddenly reduce or stop alcohol consumption. This is known as withdrawal.

People who drink moderately to heavily for weeks, months, or years tend to experience alcohol withdrawal when they stop drinking. Symptoms of alcohol withdrawal range from mild to serious, depending on the level of addiction.

In most cases, people who drink more and/or for longer periods experience the most significant withdrawal symptoms. Someone who drinks occasionally is unlikely to experience withdrawal. This is true even if they occasionally consume copious amounts of alcohol.

Severe alcohol withdrawal symptoms are dangerous and can be fatal. 

Signs and symptoms of alcohol withdrawal include:

  • Headaches
  • Fatigue
  • Mood changes and irritability
  • Insomnia
  • Gastrointestinal problems
  • Heart palpitations and increased heart rate
  • Increased blood pressure
  • Anxiety
  • Rapid, abnormal breathing
  • Hyperthermia
  • Hand tremors
  • Vomiting
  • Sweating
  • Tremors
  • Hallucinations
  • Seizures
  • Delirium tremens (DTs)

Not everyone experiences all of these symptoms. The number and severity of symptoms depend on:

  • Personal biology
  • Length of time spent drinking
  • How often someone drinks
  • How much someone drinks

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When do Alcohol Withdrawal Symptoms Start?

The alcohol withdrawal timeline varies from person to person. 

Alcohol withdrawal typically begins within a few hours of someone’s last drink. The reduction of alcohol in the bloodstream triggers withdrawal symptoms. Several factors affect the severity, onset, and duration of symptoms, such as:

  • Age
  • Weight
  • Gender
  • Genetics
  • Overall health
  • Amount of alcohol consumed
  • How often alcohol is consumed
  • Whether or not alcohol is combined with other substances
  • Presence of co-occurring conditions, including anxiety and/or depression
  • Other health problems

Severe symptoms tend to peak about 48 to 72 hours after your last drink and last up to 10 days. Mild physical symptoms can last up to 2 weeks.

4 Stages of Alcohol Withdrawal

In most cases, alcohol withdrawal occurs in four stages. These include:

Stage 1 (6 to 12 hours after the last drink)

Symptoms include:

  • Tremors and shakes
  • Headaches
  • Anxiety
  • Stomach pains
  • Insomnia
  • Nausea

Stage 2 (12 to 38 hours after the last drink)

Symptoms include:

  • Lingering and worsening stage 1 symptoms
  • Confusion
  • Sweating
  • Elevated heart rate
  • Elevated blood pressure
  • Vomiting

Stage 3 (48 to 72 hours after the last drink)

Symptoms include:

  • Increased heart rate and blood pressure
  • Hallucinations
  • Seizures
  • Worsening confusion
  • Delirium tremens (DTs)

Stage 4 (3 to 7 days after the last drink)

In stage 4, withdrawal symptoms often linger from previous stages, but they also begin to ease. 

Types of Alcohol Withdrawal Symptoms

Delirium Tremens (DTs)

Delirium tremens (DTs) is one of the most extreme and potentially fatal symptoms that occur during alcohol withdrawal. 

The risk of DTs increases for people who:

  • Are older
  • Experienced DTs during a previous withdrawal
  • Have a history of heavy alcohol use
  • Have poor liver function
  • Experienced intense symptoms during early withdrawal

Post-Acute Withdrawal Syndrome

Post-acute alcohol withdrawal syndrome occurs when a physically alcohol-dependent person suddenly stops drinking or drastically reduces their alcohol intake. The syndrome includes all of the usual detox symptoms, which can be severe and/or fatal.


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At-Home vs. Supervised Detox

At-home alcohol detox is possible, but it’s rarely recommended, particularly because withdrawal can be fatal. A medically supervised detox is always preferable for this reason. This is especially true for long-term and/or heavy drinkers.

If you are not a long-term and/or heavy drinker and you choose to detox at home, you’ll need:

  • A supportive, alcohol-free environment
  • A quiet, safe location where you can sleep without disturbance
  • Plenty of fluids
  • Healthy foods

The safest alcohol detox option involves medical supervision. A medically supervised detox is the first step in a comprehensive rehab program.

At-home detox can help you ease the initial symptoms of alcohol withdrawal. However, the odds of long-term sobriety and improved health are much higher when you seek professional treatment.

Not only does a supervised detox reduce your risk of medical complications, but it also provides access to recovery tools, support, and relapse prevention.

Cost of Supervised Detox: Does Insurance Cover It?

Legally, health insurance must cover addiction treatment costs and treat it like other diseases. In many cases, this includes covering the cost of supervised detox.

Contact your insurance provider to learn more about your specific coverage for supervised detox.

The average daily cost of alcohol detox treatment is between $300 and $900, depending on the program’s amenities. The cost of treatment increases based on:

  • Program duration
  • Addiction severity
  • Luxury or medically unnecessary amenities
  • Additional medical care needed

The average cost of detox and alcohol addiction treatment without insurance coverage is $5,000. If you don’t have insurance, you can reduce the cost by choosing programs that are:

  • Administered on an outpatient basis
  • Shorter
  • Provided in a group setting

Most treatment centers will help people in need of financial assistance find affordable care. This includes accepting credit card payments, offering or accepting grant or scholarship money, and working with community or government programs that offer financial support. 

If a person is experiencing acute alcohol withdrawal, any U.S. emergency department will evaluate and treat them. They will make sure they get into a stabilizing treatment program regardless of their ability to pay. 


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Alcohol Addiction Treatment Options

Alcohol addiction can occur on an inpatient or outpatient basis. The initial withdrawal and detox phase is safest with medical supervision. This is especially true for long-term, heavy drinkers who experience severe and potentially fatal withdrawal.

The goal of alcohol addiction treatment is to ease withdrawal symptoms and help someone learn necessary skills for long-term sobriety.

Medications also help with detox and long-term sobriety, like:

  • Acamprosate
  • Disulfiram
  • Naltrexone
  • Benzodiazepines
  • Anti-seizure drugs
  • Beta-blockers 

Detox and recovery programs vary and include:

Updated on June 16, 2022
6 sources cited
Updated on June 16, 2022
All Alcoholrehabhelp content is medically reviewed or fact checked to ensure as much factual accuracy as possible.

We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies.
  1. National Institute on Drug Abuse. “Is Drug Addiction Treatment Worth Its Cost?” National Institute on Drug Abuse. 

  2. Delirium Tremens: MedlinePlus Medical Encyclopedia.”, 2016. 

  3. Grover, Sandeep, and Abhishek Ghosh. “Delirium Tremens: Assessment and Management.” Journal of Clinical and Experimental Hepatology.

  4. Attilia, Fabio, et al. “Alcohol Withdrawal Syndrome: Diagnostic and Therapeutic Methods.” Rivista Di Psichiatria.

  5. Mayo Clinic. “Alcohol Use Disorder - Symptoms and Causes.” Mayo Clinic, 11 July 2018. 

  6. Trevisan, Louis A, et al. “Complications of Alcohol Withdrawal Pathophysiological Insights,” 1998.

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All content created by Alcohol Rehab Help is sourced from current scientific research and fact-checked by an addiction counseling expert. However, the information provided by Alcohol Rehab Help is not a substitute for professional treatment advice.
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