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Updated on September 29, 2021

How Long Does Alcohol Withdrawal Last?

What is Alcohol Withdrawal?

Alcohol withdrawal occurs when a person ceases alcohol consumption after a prolonged period of heavy usage. This is caused by the brain remaining in a more stimulated state initially brought on by the constant exposure to alcohol.

Since this substance slows brain function and how nerves communicate, the central nervous system (CNS) adjusts to this by keeping the brain in an awakened state to allow nerve messaging to function. 

When alcohol is suddenly removed from the system, the brain stays stimulated without the depressive effects of withdrawal. This is the cause of alcohol withdrawal, which is also referred to as alcohol withdrawal syndrome.

Causes of Alcohol Withdrawal

A person who has developed an addiction to alcohol has become dependent on it. The body has gotten used to the substance, and a sudden stop can shock the body and brain. 

Long-term and constant use of alcohol rewires the brain and changes its activity. The respective functions of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, and glutamate, an excitatory neurotransmitter, are changed.

Alcohol causes the brain to slow down, so the person becomes less anxious and feels sedated. To adapt, the brain reacts by increasing glutamate and decreasing GABA. This adaptive function is known as "tolerance."

As long as a person continues to consume alcohol, the body will adapt and tolerate it. An abrupt stop in alcohol consumption will disrupt brain activity. The person will be in a hyper-aroused state, which is commonly seen in alcohol withdrawal symptoms.

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Symptoms of Alcohol Withdrawal 

Alcohol withdrawal can produce severe symptoms that can be life-threatening. They can range from moderate to severe, usually depending on other health conditions, and present mental and physical symptoms. They can occur as soon as two hours after the last drink or as late as four days after stopping alcohol use. 

These symptoms may include:

  • Headache
  • Nausea
  • Vomiting
  • Loss of appetite
  • Tremors (shakes)
  • Sweating
  • High blood pressure
  • Anxiety
  • Nervousness
  • Agitation
  • Irritability
  • Restlessness
  • Mood swings
  • Hallucinations
  • Seizures
  • Elevated heart rate
  • Disorientation
  • Insomnia

Alcohol withdrawal is a very serious condition that often requires professional treatment to manage correctly. It can lead to coma or death if not appropriately treated.

What are Delirium Tremens & How Do They Occur?

Delirium tremens (DTs) is also known as alcohol withdrawal delirium (AWD). This is a form of severe alcohol withdrawal that usually begins two or three days after someone suffering from alcohol abuse quits drinking.

Delirium tremens usually lasts for only a couple of days, but lingering symptoms may be present for up to a week or more. If left untreated, this can lead to cardiac arrest or death.

Delirium tremens most commonly affects:

  • Adult men
  • Those with a history of seizures
  • People that have previously experienced alcohol withdrawal
  • Heavy drinkers
  • Those suffering from long-term substance abuse 

How Long Can Alcohol Withdrawal Symptoms Last?

Alcohol withdrawal symptoms typically last at least 72 hours and can persist for months if not treated properly.

The worst or most intense symptoms generally occur within the first week, while someone who has remained alcohol-free beyond this time can begin to experience the benefits of going sober at this time if done in the right way. 

While this is a generally applicable timeframe, the effects of alcohol withdrawal are different for everybody. The amount of time that symptoms last is based at least in part on the severity and length of time a person has been drinking, as well as a variety of other pre-existing health factors. 

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Stages of Alcohol Withdrawal

There are three stages of alcohol withdrawal that most people experience. These stages are:

Stage 1

Typically occurring within the first couple of days, this stage commonly brings headaches, trouble sleeping, anxiety, shaking, stomach pains, and heart palpitations.

Stage 2

The second stage includes many of the same mild symptoms as the first, in addition to elevated blood pressure, elevated heart rate, elevated body temperature, disorientation, and rapid breathing.

Stage 3

The third and final stage is the most severe, with lingering moderate symptoms from the second stage and the introduction of auditory and visual hallucinations, seizures, and impaired attention.

These stages occur over various intervals, which vary from person to person based on drinking behavior and concurrent mental health or physical issues.

Below is a general timeline for when alcohol withdrawal symptoms tend to occur on average:

How Long Does Alcohol Withdrawal Last

What Happens After Two Weeks of No Alcohol?

After getting past the initial danger and unpleasantness of withdrawal, those who quit drinking will begin to experience the benefits of better sleep and adequate hydration. In general, people tend to start feeling happier, with fewer mood swings and a better overall mood. 

Concentration tends to improve drastically, and blood pressure begins to normalize. This, in turn, helps to lessen the risk of associated health problems with the heart and liver.

Can Alcohol Permanently Damage Your Brain?

Alcohol damages the brain by directly affecting the neurons. Since it is a toxic substance, it can damage or kill neurons responsible for normal brain function.

Some long-term drinkers can also develop nutritional deficiencies that lead to brain damage, and prolonged alcohol use has been shown to cause brain shrinkage. 

While there are no cures for brain damage caused by drinking alcohol, early diagnosis and lifestyle changes will stop further damage and reverse deterioration. If you're wondering how long does it take to reverse the damage caused by alcohol, recent research has found that new brain cells can be produced within a year after abstaining from drinking.

Treatment Options for Alcohol Abuse & Addiction

  • Inpatient Programs — Inpatient treatment is the option for alcohol addiction treatment. These intensive programs are usually 30, 60, or 90 days but can be longer in certain cases. Throughout the duration of your stay at an inpatient rehab facility, you will live on site is a safe, substance-free environment. You will go through medically supervised detoxification first, then behavioral therapy and other services will be added to your regimen. Most programs will will help you set up an aftercare program upon completion.
  • Partial Hospitalization Programs (PHPs) Partial hospitalization programs (also called intensive outpatient programs, or IOPs) are comparable to inpatient programs, but you return home after each session. Some PHPs provide food and transportation, but this varies by program. Their services may include detoxification, medical services, behavioral therapy, support groups, and other holistic or custom treatments. PHPs accept new patients, along with patients who have completed an inpatient treatment program and still require intensive care.
  • Outpatient Programs Outpatient programs are less intensive and offer a more flexible treatment schedule. They are best for people who have responsibilities at work, home, or school and are highly motivated to achieve sobriety. Outpatient treatment programs customize your treatment sessions around your personal schedule. Outpatient programs can help new patients achieve success, and may also be a part of aftercare program once a patient completes an inpatient or PHP.
  • Medication-Assisted Therapy (MAT) Certain patients with Alcohol Use Disorder will qualify for medication-assisted therapy. Medications can help you detoxify, reduce cravings, and normalize bodily functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia and Vivitrol) are the most common medications used to treat Alcohol Use Disorder. MAT is most effective when combined with other treatment therapies.
  • Support Groups Support groups are peer-led groups that help people stay sober. They can be a first step in overcoming alcoholism or a component of an aftercare plan. Many of them follow the 12-step approach, however there are secular options that don't follow the 12-step approach as well.

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Resources

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Myrick, H., & Anton, R. F. (1998). "Treatment of alcohol withdrawal." Alcohol health and research world, 22(1), 38–43.

Richard Saitz, M.D., M.P.H. "Introduction to Alcohol Withdrawal." NIAAA. 

Kattimani, S., & Bharadwaj, B. (2013). "Clinical management of alcohol withdrawal: A systematic review." Industrial Psychiatry Journal, 22(2), 100–108. 

Grover, Sandeep and Ghosh, Abhishek. "Delirium Tremens: Assessment and Management," Journal of Clinical and Experimental Hepatology, 2019 Dec; 8(4): pp. 460-470.

Trevisan, L., et al. "Complications of Alcohol Withdrawal," NIAAA.

Newman, R., et al. "Alcohol Withdrawal," NCBI.

 

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