Many people on their journey to recovery from heavy alcohol use face alcohol withdrawal syndrome. Quitting drinking is a courageous first step, but stopping alcohol intake abruptly can also bring about a range of physical and mental symptoms that require careful attention and support. Whether you or a loved one is preparing to stop drinking or is currently experiencing withdrawal, knowing what to expect can help reduce anxiety and empower you to seek the right care.
Here we provide a clear, easy-to-understand guide to the symptoms of alcohol withdrawal syndrome, how they develop over time, and why medical supervision and treatment are often essential for a safe and successful recovery.
What is alcohol withdrawal syndrome?
Alcohol withdrawal syndrome occurs when a person who has been drinking heavily or regularly for an extended period suddenly stops or significantly reduces their alcohol intake. Alcohol withdrawal occurs because the brain and central nervous system have adapted to the presence of alcohol. When it suddenly stops, a neurochemical imbalance triggers symptoms that can range from mild discomfort to severe, life-threatening complications. Symptom severity depends on factors such as the duration and amount of alcohol consumed, previous withdrawal experiences, and overall health.
Understanding the symptoms
Symptoms of alcohol withdrawal syndrome typically begin within 6 to 24 hours after the last drink. Early signs include mild anxiety, tremors, headache, nausea, and gastrointestinal discomfort. As withdrawal progresses, symptoms can intensify, including increased heart rate, sweating, insomnia, and mood swings.
If stronger symptoms are going to occur, they usually do so between 24 and 48 hours after the last drink. These symptoms can include confusion, hallucinations, vomiting, and elevated blood pressure.
The most severe symptoms, seen in a minority of cases, include seizures and delirium tremens (DTs), and generally occur between 48 and 72 hours after you stop drinking. DTs, affecting about 3-5% of cases of alcohol withdrawal, are characterized by severe confusion, agitation, fever, hallucinations, and possibly life-threatening complications. While delirium tremens occurs in a minority of cases, it is a medical emergency when it does show up.
Some individuals may continue to experience prolonged withdrawal symptoms like insomnia and mood changes for weeks or even months after stopping alcohol.
The full alcohol withdrawal timeline
| Time since last drink | Common symptoms and progression |
| 6 to 12 hours | Initial symptoms: mild anxiety, tremors (shaking hands), headache, nausea, gastrointestinal discomfort |
| 12 to 24 hours | Intensifying withdrawal: sweating, elevated heart rate, insomnia, more pronounced mood swings |
| 24 to 48 hours | Moderate symptoms: confusion, hallucinations (visual, auditory, tactile), vomiting, rising blood pressure |
| 48 to 72 hours | Peak severity: risk of seizures, onset of delirium tremens (DTs): extreme agitation, fever, hallucinations, severe confusion |
| 3 to 7 days | Gradual subsiding of acute symptoms; autonomic signs calm down |
| Weeks to months | Protracted withdrawal or “post-acute” mild symptoms may linger: sleep disturbances, mood instability, anxiety |
Assessing withdrawal severity: the CIWA scale
The Clinical Institute Withdrawal Assessment for Alcohol scale is used by medical professionals to evaluate the severity of alcohol withdrawal symptoms. The CIWA measures ten symptom types (like nausea, tremor, sweats, agitation, and hallucinations). Clinicians assign scores, and the total indicates severity:
- Less than 8–10 → mild withdrawal
- 8 to 15 → moderate withdrawal
- 15 or more → severe withdrawal, higher risk for complications including DTs
The CIWA helps clinicians decide when to initiate or escalate treatment and how intensively to monitor someone.
Treatment and medical supervision
Benzodiazepines are the first-line treatment for managing serious alcohol withdrawal symptoms. They help reduce anxiety, prevent seizures, and calm the central nervous system. Other medications and supportive care may be used depending on the patient’s condition.
Because withdrawal symptoms can escalate quickly and lead to life-threatening complications, medical supervision is crucial during alcohol withdrawal, especially for those with heavy, prolonged alcohol use or a history of complicated withdrawals. Inpatient treatment or care in an intensive care unit may be necessary for severe cases to provide continuous monitoring and timely intervention.
Managing cravings after alcohol withdrawal treatment
Once the acute withdrawal period is stabilized and the person is medically safe, medications such as Vivitrol (extended-release naltrexone) can be considered to:
- Reduce cravings for alcohol
- Lower the risk of relapse
- Suppress reward pathways in the brain so alcohol is less appealing
At Sophros Recovery in Tampa, we offer medication-assisted treatment (MAT) options like Vivitrol after withdrawal care is complete, as part of a broader outpatient treatment program that includes counseling, behavioral supports, and ongoing monitoring.
FAQs: alcohol withdrawal symptoms
Can withdrawal symptoms start earlier than 6 hours?
Yes, in some heavy drinkers or those with repeated withdrawal history, symptoms may begin sooner.
Does everyone who quits drinking go through withdrawal?
No, but about half of people with alcohol use disorder who abruptly stop or reduce drinking will show some withdrawal symptoms.
Can hallucinations happen earlier in withdrawal?
Yes. Alcoholic hallucinosis (visual, auditory, tactile) may start within 12 to 24 hours. In this state, the person’s consciousness is usually intact (they are aware of what’s going on).
What’s the difference between hallucinosis and delirium tremens?
Hallucinosis involves hallucinations without the confusion or severe nervous system instability seen in delirium tremens. DTs involve delirium (clouded awareness), fever, and severe autonomic signs (very high blood pressure, temperature or fluid dysregulation, tremors, hypertension, etc.).
If someone has one seizure, does that mean they’ll develop DTs?
Not necessarily, but a history of seizures raises the risk for more severe withdrawal.
Can alcohol withdrawal kill you?
Yes. If untreated, severe alcohol withdrawal syndrome can progress to seizures, cardiovascular instability, or delirium tremens, all of which can be fatal. Supervised medical detox can ease you through withdrawal and make the process much safer and less uncomfortable.
Beyond alcohol dependency: the path to recovery
Alcohol withdrawal is just the initial phase in the journey toward recovery. At Sophros Recovery in Tampa, FL, we offer comprehensive outpatient care for alcohol use disorder that includes counseling, case management, group therapy, and sometimes medication-assisted treatment (MAT). If you need medically supervised detox, we can refer you to a provider to start the withdrawal process safely and prepare to join our outpatient program as you stabilize.
We also encourage participation in support groups such as Alcoholics Anonymous or SMART recovery. These services address the psychological and social aspects of addiction, help manage alcohol cravings, and support long-term sobriety.
If you or a loved one is facing alcohol withdrawal or considering stopping drinking, and live in the Tampa area, reach out to Sophros Recovery. Our experienced team offers compassionate guidance and expert care to help you build a healthier life beyond alcohol dependence.
