Alcohol Withdrawal Guide: What to Expect and When to Get Help

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Last Updated:
10 November 2025

AI Overview - Alcohol Withdrawal

Alcohol withdrawal is the cluster of symptoms that follow when regular or heavy drinking stops or is sharply reduced. Early signs typically appear 6 to 24 hours after the last drink and include tremor, sweating, nausea, anxiety, poor sleep, and headache. Intensity often peaks at 24 to 72 hours; severe features like confusion, hallucinations, or seizures are medical emergencies and need hospital care. Most acute symptoms settle over 3 to 7 days, while sleep and mood may take longer to normalise. If you have a history of severe withdrawal, daily heavy use, or limited support at home, seek medical advice before you stop.

Quick Facts About Alcohol Withdrawal

Alcohol withdrawal happens when you suddenly stop or sharply reduce drinking after regular use. Your body and brain must readjust to the absence of alcohol, which can cause a range of symptoms.

Mild symptoms often start within 6 to 24 hours after your last drink. You may notice shaking hands, sweating, nausea, or anxiety.

Severe symptoms can appear between 24 to 72 hours and may include confusion, hallucinations, or seizures. This stage is dangerous and needs urgent medical care. See the timeline below to recognise when to seek help.

If you experience severe shaking, confusion, or seizures, contact emergency services immediately or go to the nearest emergency department.

What is Alcohol Withdrawal?

Alcohol withdrawal happens when you suddenly stop or greatly reduce drinking after a period of heavy or regular alcohol use. Your body and brain become used to alcohol’s effects, so when you stop, they must adjust quickly. This change leads to physical and mental symptoms.

You may notice early signs within six to 24 hours after your last drink. Common mild symptoms include headache, anxiety, sweating, and trouble sleeping. In more serious cases, symptoms can include hallucinations, seizures, or delirium tremens, a dangerous condition that requires urgent medical care.

Typical Symptoms May Include:

Tremors or shakiness

Nausea or vomiting

Fast heart rate

High blood pressure

Mood changes or irritability

The severity of withdrawal depends on how much and how often you drank, your overall health, and whether you’ve experienced withdrawal before. These symptoms can range from mild discomfort to life-threatening complications.

Time After Last Drink Common Symptoms

If you think you may experience alcohol withdrawal, you should seek medical advice before stopping alcohol use.

Mild anxiety, headache, insomnia

6–12 hours:

Shakiness, nausea, possible hallucinations

24–48 hours:

Peak symptoms, risk of seizures or delirium tremens

48–72 hours:

Who is More Likely to Have Severe Withdrawal?

You are more likely to experience severe alcohol withdrawal if you drink heavily and often. The risk increases the longer and more regularly you consume alcohol. People who drink every day or binge frequently face a higher chance of serious symptoms like seizures or delirium tremens.

If you have had withdrawal seizures or delirium tremens before, your risk of another severe episode is much greater. Repeated withdrawal episodes can lower your brain’s seizure threshold, making future withdrawals more dangerous.

Other Factors That May Increase Your Risk

Older age: Your body may handle alcohol and withdrawal less effectively.
Poor general health: Conditions such as liver disease can make symptoms worse.
Concurrent substance use: Dependence on sedatives can complicate withdrawal.
Lack of medical supervision: Stopping drinking suddenly without medical help increases danger.

The NHS notes that severe withdrawal can lead to confusion, hallucinations, or seizures even if you have not had them before. These symptoms require urgent medical attention.

Safety Alert: When to Seek Urgent Care

Alcohol withdrawal can become dangerous very quickly. You should seek urgent medical help if you notice severe or worsening symptoms.

Go to the emergency department immediately if you experience:

Seizures or shaking that does not stop
Hallucinations, such as seeing or hearing things that are not real
Confusion or severe agitation
Fever, irregular heartbeat, or chest pain

These symptoms can signal a medical emergency. Delirium tremens and withdrawal seizures are medical emergencies that require urgent assessment and hospital care.

Even if your symptoms seem mild, contact a healthcare professional if you feel unwell, anxious, or cannot sleep. Early treatment can prevent serious problems. Withdrawal can start within six to twelve hours after your last drink and may last several days.

If you have ever had severe withdrawal before, get professional help before cutting down or stopping alcohol, as advised by the NHS.

Complications of Withdrawal (Seizures & Delirium Tremens)

When you stop drinking after heavy or long-term use, your body may react strongly. Two of the most serious complications are seizures and delirium tremens (DTs).

Seizures often occur within 6–48 hours after your last drink. They are usually generalised tonic-clonic seizures, causing full-body shaking and loss of consciousness. The risk increases if you have had previous withdrawal episodes, a pattern explained by the kindling effect—each withdrawal makes the next one more severe (Complications of Alcohol Withdrawal).

Delirium tremens is a medical emergency that typically develops 2–4 days after withdrawal begins. You may experience severe confusion, agitation, fever, and vivid hallucinations. DTs can be life-threatening if untreated; prompt hospital care significantly reduces risk.

Seizures

Onset:

6–48 hours after last drink

Main symptoms

Convulsions, loss of consciousness

Severity

Moderate to severe

Delirium Tremens

Onset:

48–96 hours after last drink

Main symptoms

Confusion, hallucinations, agitation

Severity

Severe, potentially fatal

If you are at high risk of seizures or DTs, doctors may recommend hospital admission for medically assisted withdrawal to ensure your safety (NICE guideline CG100).

Early Phase (0–24 Hours)

Withdrawal often begins 6 to 12 hours after your last drink. You might notice mild tremors, sweating, anxiety, or nausea. These early signs show that your body is reacting to the sudden drop in alcohol levels.

Sleep problems and restlessness are common. You may feel irritable or unusually tense. If you have a history of heavy drinking, monitor your symptoms closely. Mild withdrawal can progress quickly, so medical supervision is often recommended, especially if you feel shaky or unwell.

Peak Phase (24–72 Hours)

This stage is usually the most intense. Symptoms often peak between 24 and 72 hours. You may experience rapid heart rate, sweating, tremors, and strong anxiety.

Some people develop confusion, hallucinations, or seizures during this time. These are medical emergencies that require immediate care. Do not try to manage severe symptoms alone.

If you are detoxing under supervision, healthcare professionals may use medication to reduce seizure risk and stabilise your vital signs. Frequent checks of blood pressure and pulse help ensure your safety.

Days 4–7

By the fourth day, physical symptoms often begin to fade. However, you may still feel tired, anxious, or have trouble sleeping. Appetite usually improves, and nausea lessens.

Cravings for alcohol can return as your body starts to recover. This is a key time to increase structured support. Most people see steady improvement by day seven, though some may continue to experience mild shakiness or mood changes.

Keeping a simple routine and reaching out for emotional support can help you stay on track.

Post-Acute Symptoms (After Week 1)

After the first week, many people enter a phase called post-acute withdrawal. Symptoms such as low mood, poor sleep, and irritability may persist for several weeks. Memory and concentration can also feel affected.

These lingering effects vary in intensity and duration. Regular meals, gentle exercise, and continued medical or peer support can help manage them.

Tracking your mood and energy levels can reveal gradual progress. While the body heals, patience and consistency remain important for long-term recovery.

Alcohol Withdrawal Timeline: 0–7 days

Most people follow a predictable pattern, though intensity varies. Prolonged sleep problems, anxiety and craving can persist for weeks; that’s common and a reason to step into structured support.

Symptoms of Alcohol Withdrawal

Mild to Moderate Symptoms

Mild to moderate symptoms often begin 6 to 24 hours after your last drink. You may feel anxious, shaky, sweaty, or restless as your body adjusts. Sleep problems, irritability, and headaches are also common.
You might notice nausea, loss of appetite, or mild stomach upset. These symptoms usually peak within a couple of days and start to ease with supportive care under clinical guidance.

Other signs include:

Tremors in your hands
Increased heart rate
Mild confusion or poor concentration
Craving alcohol

Most mild symptoms appear within the first day and can improve over several days with supportive care.

Severe Symptoms

Severe withdrawal can develop if you have been drinking heavily for a long time. You may experience hallucinations, seizures, or delirium tremens (DTs). These symptoms can appear within 48 to 72 hours after your last drink and require emergency medical treatment.

DTs can cause confusion, agitation, fever, and rapid heartbeat. You might also see or hear things that are not real. Without treatment, this stage can be dangerous.

In hospital, clinicians use prescribed treatments and continuous monitoring to reduce risks and manage complications safely.

Red-flag Symptoms - Act Now

Certain symptoms mean you need immediate medical help. These include:

Seizure
Severe confusion/delirium
High fever or uncontrollable shaking
Chest pain/collapse or repeated vomiting
Suicidal thoughts

Alcohol withdrawal delirium is a life-threatening emergency. If you or someone else has these symptoms, call emergency services or go to hospital right away.

Even if symptoms seem manageable, never try to stop drinking suddenly without medical advice. Professional support ensures your safety and reduces the chance of relapse or complications.

What Happens to Your Body When you Stop Drinking?

Alcohol is a depressant. With heavy, regular use your brain increases “stimulating” activity to compensate. When alcohol stops abruptly, that stimulation becomes unopposed, driving the symptoms (and potential complications) described above.

When Does Alcohol Withdrawal Start?

Withdrawal symptoms usually begin within 6 to 12 hours after your last drink. Early signs can include anxiety, tremors, sweating, nausea, and irritability. These occur because your brain, which has adapted to alcohol’s depressant effects, becomes overstimulated when alcohol is removed.

You might also experience trouble sleeping, headaches, or increased heart rate. For some people, symptoms appear later, especially if they were heavy or daily drinkers. Symptoms often peak between one and three days after stopping.

In rare cases, severe complications such as seizures or delirium tremens (DTs) may develop. DTs involve confusion, fever, or hallucinations and require emergency medical care. If you have a history of heavy drinking, it’s safest to withdraw under medical supervision.

How Long Do Alcohol Withdrawal Symptoms Last?

Most withdrawal symptoms ease within three to five days, but recovery time varies. Your body typically adjusts to the absence of alcohol within one to two weeks. Here’s a general timeline:

Time After Last Drink

Common Symptoms

6–12 hours:

Shakiness, anxiety, sweating

12–24 hours:

Headache, nausea, insomnia

24–72 hours:

Peak symptoms, possible seizures

3–7 days:

Gradual improvement

Weeks later:

Fatigue, mood changes, cravings

Some people experience post-acute withdrawal symptoms (PAWS) such as tiredness, sleep issues, or low mood for several weeks. These symptoms gradually lessen as your brain and body stabilise.

Managing Alcohol Withdrawal Safely (Under Medical Supervision)

Alcohol withdrawal can escalate quickly. The safest route is clinical assessment and monitoring in a supervised setting. Care typically includes regular checks of vital signs and mental state, supportive care for hydration and nutrition, a quiet, low-stimulation environment, and—when indicated—arranging a hospital-based medical detox with a planned transition into inpatient treatment.

Structured inpatient protocols, such as those described in the Oxford Health Formulary guidelines, combine medication, supervision, and supportive care to help you withdraw from alcohol safely and effectively.

Medications in Supervised Care

When you receive supervised care for alcohol withdrawal, doctors use medicines to control symptoms and prevent complications. The main goal is to keep you safe and comfortable while your body adjusts to the absence of alcohol.

Benzodiazepines are normally the primary drugs used. They help calm your nervous system and reduce the risk of seizures or delirium. Benzodiazepines are often given in fixed or symptom‑triggered doses as recommended by NICE guidelines.

You might also receive vitamin supplements, especially thiamine, to prevent Wernicke’s encephalopathy. This is a serious brain condition linked to long‑term alcohol use. Fluids and electrolytes are often replaced to maintain balance in your body.

In hospital settings, staff monitor your symptoms frequently using structured assessment tools. This helps adjust doses safely and avoid over‑sedation. You may receive medication only when you show withdrawal signs, as described in BNF guidance.

Next Steps After Stabilisation

Once you have completed the acute withdrawal phase, your focus shifts to maintaining recovery and preventing relapse. This stage often includes ongoing medical care, therapy, and support programmes.

You may begin a structured rehabilitation plan. At Liberty Home, we provide therapy, education, and aftercare to help you build healthy habits and manage triggers.

Common next steps include:

Medical review: Your doctor may adjust medication or check for lingering withdrawal symptoms.
Therapeutic support: Counselling or group therapy helps you understand the reasons behind your drinking.
Lifestyle changes: Regular exercise, balanced meals, and good sleep support your physical recovery.
Peer support: Joining groups like Alcoholics Anonymous can give you ongoing encouragement.

Continued professional support after detox can reduce relapse risk and improve long-term recovery outcomes. You should also work with a healthcare professional to create a relapse prevention plan that includes coping strategies, emergency contacts, and clear goals for your recovery journey.

Getting Help in Cape Town

If you are experiencing alcohol withdrawal, it is important to seek professional support rather than managing it alone.

At Liberty Home we guide you through assessment, non- acute detox, and aftercare. Our approach includes medical supervision, therapy, and practical recovery planning to reduce risks and improve comfort.

Key support options include:

Inpatient detox:

24-hour monitoring and medical care.

Outpatient care:

Regular visits while you remain at home.

Therapeutic support:

Individual, group, and family therapy.

Aftercare planning:

Ongoing support to prevent relapse.

You can also contact the City of Cape Town’s public health services for accessible treatment and community referrals. Early professional help ensures your safety and supports lasting recovery.

References

References: Patient-Facing

NICE: Alcohol-use disorders – physical complications (incl. withdrawal & delirium)
NHS: Alcohol withdrawal – symptoms and when to get help
NHS: Delirium tremens – overview

Technical References (for Clinicians; Non-Patient Guidance)

BNF (NICE): Alcohol dependence – treatment summary (technical)
Oxford Health Formulary: Guidelines for the management of alcohol dependence (technical PDF)
NHS Scotland Right Decisions: Management of alcohol withdrawal (technical)
NLM/PMC: Clinical management of alcohol withdrawal – review (technical)

Service Directory (Non-Clinical)

City of Cape Town public health services – help & referrals for alcohol and other drugs

Frequently Asked Questions

What Are The Common Symptoms of Withdrawal From Alcohol?

You may experience shaking, sweating, nausea, anxiety, and trouble sleeping. In moderate to severe cases, symptoms can include hallucinations or seizures. These effects occur because your body is adjusting to the lack of alcohol after becoming dependent on it.

How Long Does it Typically Take for Withdrawal Symptoms to Begin After Ceasing Consumption?

Symptoms often begin 6 to 12 hours after your last drink. They usually peak between 24 and 72 hours and improve after about five to seven days, though emotional recovery can take longer.

What Are the Potential Risks Associated With Severe Withdrawal?

Severe withdrawal can lead to delirium tremens (DTs), seizures, confusion, or dangerously high blood pressure. These conditions can be life-threatening and require urgent medical care. Recognising early warning signs is key to preventing complications.

What Medical Treatments are Available for Managing Symptoms of Alcohol Withdrawal?

Doctors may prescribe medications such as benzodiazepines to ease anxiety and prevent seizures. In some cases, vitamins like thiamine are given to reduce the risk of complications. Medical supervision ensures your recovery stays safe and stable.

Are There any Long-term Health Implications Following Alcohol Withdrawal?

After withdrawal, you may still experience fatigue, mood swings, or sleep problems for several weeks. Long-term abstinence supports healing of the liver, brain, and nervous system. Continued care and support groups can help you maintain recovery and improve overall health.

How Long Does Alcohol Withdrawal Typically Last?

Most people experience 2–7 days of acute symptoms, with a peak around 48–72 hours. Sleep disturbance, anxiety and cravings can linger for longer as your nervous system rebalances.

What is Delirium Tremens (DTs) and When Can it Occur?

DTs is a medical emergency marked by severe confusion, agitation, fever and hallucinations. It most often develops 48–96 hours after stopping and needs immediate hospital care.