The intensity of withdrawal can range from slightly uncomfortable to a potentially fatal fearing-for-one’s-life level of awfulness, and covers everything in between. Certain symptoms will only appear with specific severities of withdrawal, and on the mild end of the spectrum someone may only experience some chills and sweating, a little shakiness, and mild insomnia. On the other end, it is not uncommon for moderate to severe withdrawal to exhibit vivid hallucinations, profound delirium and hysteria, and violent seizures.
Additionally, the severity of withdrawal is also a direct indicator of the duration of withdrawal, with more severe symptoms lasting longer than mild ones. If someone were just a little shaky and sweaty, these symptoms may fully resolve within 48 hours. On the other hand, if someone were to suffer from delirium tremens, then these symptoms may persist for 2 weeks or possibly even longer.
Alcohol withdrawal will usually last between 2 to 7 days depending on how much alcohol someone had been drinking. In very rare cases, these symptoms have been documented to persist for several weeks but this is extremely uncommon. In the case of delirium tremens, which is a dangerous set of symptoms during severe withdrawal, symptoms may persist for up to 2 weeks, although rare cases have persisted much longer. Not everyone will develop delirium tremens, and on average symptoms are usually much improved or resolved by the fifth day after they began.
The particular symptoms can vary based on the severity of withdrawal, but the most common symptoms usually begin between 6 to 12 hours after the last time someone took a drink. Symptoms will often increase in severity quite rapidly over the next 12 to 18 hours before plateauing. Around 24 hours after the last drink, someone may notice a slight decrease in symptom intensity, and this will mark the beginning of a gradual decline and weakening of symptoms which typically takes several days to fully resolve.
For a good withdrawal timeline example, we can look at one particular study which involved 217 subjects who underwent alcohol detox. In 24% of these subject withdrawal symptoms either did not appear at all or had fully resolved within the first day, while 33% of subjects had their withdrawal symptoms resolved by the end of the second day. Another 13.8% of subjects had their symptoms resolved on the third day, with another 10.6% resolving on the fourth day. On the fifth day another 7.8% had their symptoms resolve, while only 10.8% of subjects had withdrawal symptoms which persisted longer than 5 days. To illustrate, the alcohol withdrawal timeline for most people may look like this:
Withdrawal typically begins about 8 hours after the last drink and the symptoms include shakes, sweating, high temperature, and increasing anxiety. These will increase throughout the first day and nausea and insomnia may emerge during the first night of withdrawal. Also, seizures and hallucinations may begin the first night or during the second day along with irregular heart rate, difficulty breathing, confusion, and difficulty with motor skills.
At this point, the shakes can become full on tremors and can be quite severe. Anxiety will continue to increase, sometimes to the point of full blown panic attacks. Hallucinations may emerge around this time as well, usually auditory or tactile in nature which may sound like whispers or feel like bugs crawling on the skin. If someone is going to experience delirium tremens, this will usually begin around the 48 hour mark. Delirium tremens (DTs) is an intense form of alcohol withdrawal which includes violent seizures, rapid heart rate, elevated blood pressure, intense hallucinations and delusions, and severe confusion and irritability.
By the beginning of the third day, most if not all symptoms will still be present but the severity will be greatly decreased. Seizures and tremors will usually resolve first, followed by elevated cardiovascular function. The last symptoms to resolve are usually shaking, insomnia, sweating, and confusion. In particular, anxiety and depression may persist for several more weeks to some degree, although they will decrease over time. This usually marks the end of the acute phase, and post acute withdrawal symptoms may persist for several more months.
There is quite a lot of variability between alcohol withdrawal timeline and intensity of symptoms between individuals. This is due to a variety of factors, some of which are within someone’s control while others were set in stone the moment someone was conceived.
Some of the factors which contribute greatly to the duration of withdrawal and detox include:
By far the greatest contributing factor for the duration of withdrawal symptoms is the amount of alcohol that someone regularly drank. This will directly impact both the severity of symptoms as well as the length of time these symptoms will persist. Withdrawal is a direct result of changes that the brain makes in the continued presence of alcohol. The more someone drinks, the greater these changes become, and thus the withdrawal symptoms become more intense. Likewise, the greater the changes, the longer they will take to reverse and correct. Once these changes have been made and then alcohol is removed, brain function becomes very unstable and chaotic with the result being alcohol withdrawal.
The length of time that someone drinks is also a major contributor to the duration of withdrawal. Similar to the way that the amount of alcohol used can affect withdrawal, the length of time someone drinks can lead to a more complete and “permanent” type of change in the brain. These changes are reversible, but the longer the brain remains in an altered state in the chronic presence of alcohol, the longer it will take to undo the adaptive changes the brain made in the first place.
The number of times that someone has previously undergone withdrawal is also a large contributor to the duration and the intensity of detox. This is known as the “kindling process” and there is a large, and currently growing, body of evidence to suggest that episodes of withdrawal will substantially increase the likelihood of subsequently worsening withdrawal symptoms and durations. This can result in someone experiencing withdrawal which only exhibits mild tremors initially, but through repeated episodes can progress to full blown convulsive seizures. This seems to be the case even if they had drank the same amounts of alcohol for the same duration prior to each withdrawal period.
Mental health issues such as bipolar disorders and schizophrenia may also contribute to the duration and intensity of withdrawal symptoms. These issues may contribute in a more indirect manner, but they certainly affect the experience of withdrawal. During withdrawal, the delirious and possibly psychotic symptoms may be more likely to occur, manifest in a more severe manner, and be more likely to persist longer if someone were to have a preexisting mental health issue. This may be more an issue of withdrawal worsening the underlying mental health issues, but the end result is that withdrawal can last longer, and be more intense if someone is suffering from a preexisting condition.
A genetic predisposition towards alcoholism or addiction can also contribute to the experience of alcohol withdrawal, although the exact relationship is unclear at present. This may either be behavioral or metabolic in nature, but either way a genetic predisposition is an indicator of both withdrawal severity, and withdrawal severity is a fairly reliable predictor and indicator of withdrawal duration.
The specific timeline for alcohol detox and withdrawal will vary depending on someone’s particular history and situation. Due to this, withdrawal can be broadly divided into the intensity levels of mild, moderate, and severe. While each level is more intense than the previous one, there are also unique symptoms which emerge as these levels intensify. In addition, every level of withdrawal will have a post acute withdrawal phase, the only difference being the intensity and duration of these post acute symptoms.
Mild alcohol detox will be slightly unpleasant and these symptoms are rarely dangerous in the absence of underlying health complications. The most frequently reported symptoms of mild alcohol detox include:
These symptoms usually begin around 8 hours after the last drink and will escalate to their peak, typically around 18 hours after the last drink. From here they will reduce and dissipate, usually reaching a full resolution at roughly 48 hours after the last drink.
Moderate alcohol detox exhibits slightly more uncomfortable and possibly dangerous symptoms which will last longer. These will typically begin around 6 hours after the last drink and will include all of the symptoms of mild withdrawal and include some additional symptoms such as:
The symptoms of moderate withdrawal will be more severe forms of the mild withdrawal symptoms along with the unique moderate symptoms. Due to this, there is an increased risk of seizure and cardiovascular complications during moderate withdrawal compared to the mild form.These will typically reach their peak around the same time, roughly 18 hours after the last drink, and begin a much slower dissipation. These symptoms can frequently last for 6 days after the last drink, and will gradually reduce over this time.
Severe alcohol detox is where things begin to get very scary. All of the symptoms of mild and moderate withdrawal will be present and greatly amplified. In addition, some unique symptoms and conditions will be present as well which may pose a great danger. These symptoms usually begin around 6 hours after the last drink and can include all of the aforementioned symptoms plus:
These symptoms, while being extremely amplified, may reach their peak at around 18 hours after the last drink. They will begin to resolve slowly from this point onwards and commonly resolve around 7 or 8 days after the last drink. An added complication of severe withdrawal is the increased possibility of experiencing delirium tremens. This is an extremely dangerous form of alcohol withdrawal, and is considered a medical emergency by medical professionals. Without medical care, delirium tremens has a mortality rate of between 35–37%, so this should illustrate the severity of this condition.
Delirium tremens is characterized by a greatly increased chance of seizure, psychosis and aggression, severe confusion, dramatic changes in blood pressure and heart rate, body temperature instability, extremely vivid hallucinations, and extreme anxiety. These symptoms can lead to complications including respiratory depression, cardiac arrest, stroke, or seizures which may progress to status epilepticus. If someone does develop delirium tremens, these symptoms may persist for around 14 days since the last drink. While it is rare, there have been documented cases in which DTs lasted for 28 and 35 days, respectively.
Post acute withdrawal syndrome is a more mild form of the withdrawal symptoms which are strictly psychological in nature. This phase may begin after the acute, physical symptoms have subsided and may last for very long periods of time. While the symptoms may appear during the acute phase, it is not until the physical symptoms have resolved that someone is considered to be in post acute withdrawal from alcohol.
The alcohol withdrawal timeline is extremely variable between individuals. Some people will experience very mild symptoms which resolve within a week or two and others will experience severe symptoms which last for many months or years. Certain factors such as mental health and the length of time someone drank appear to have the greatest impact on this variability.
Some of the most commonly reported symptoms of post acute withdrawal include:
These symptoms are much more mild than the acute detox symptoms, but they last much longer. Insomnia is often the first symptom to resolve, usually after about a month or so. Cravings may slowly reduce over time, but may be present for several weeks. Anxiety and depression may persist for several months, although they will usually lessen in intensity over this time. Entering an alcohol detox center will be able to provide medical relief from both the acute and post acute symptoms of alcohol withdrawal, and possibly even shorten the duration of symptoms.
Due to the variability in symptoms intensity and duration, unmonitored withdrawal can be a truly horrible experience and can even be potentially fatal in severe cases. When someone is expecting to undergo withdrawal, it is critical that they reach out to medical professionals for help. Alcohol detox centers have the trained medical staff, specialized medications, and latest therapies to provide the most effective treatments for a safe and comfortable alcohol withdrawal and detox experience. Asking for help may be the deciding factor in someone surviving withdrawal. More than surviving, these centers may help someone obtain further treatment care so that they can build a new life free from alcohol.
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