The short answer
For most people, alcohol withdrawal lasts a few days:
- symptoms usually start 6–24 hours after your last drink;
- they can get worse over the first 48–72 hours;
- poor sleep, anxiety and low mood can last several weeks;
- severe withdrawal (seizures or delirium tremens) can be life-threatening, so talk to a doctor before stopping heavy drinking.
Alcohol withdrawal can be dangerous
If you drink heavily most days, don't stop suddenly on your own. Talk to a doctor first so you can stop safely, or call the free, confidential National Alcohol and Other Drug Hotline on 1800 250 015.9 If you or someone else has a seizure, hallucinations or severe confusion, call 000.
If you've been drinking heavily for a long time, cutting back or stopping can bring on withdrawal. Knowing what to expect, and when it becomes an emergency, helps you do it safely.
What is alcohol withdrawal?
Alcohol withdrawal happens in people who have been drinking heavily for a long time and then stop or cut right back. Over time, the brain adapts to regular alcohol by changing the balance of its chemical messengers. When alcohol is suddenly removed, the brain becomes overactive until it rebalances.5
Common symptoms include:5
- sweating, shakiness (tremor), a fast heart rate and higher blood pressure;
- nausea, vomiting, diarrhoea and loss of appetite;
- anxiety, agitation and poor concentration;
- disturbed sleep and vivid dreams.
How long does alcohol withdrawal last?
Withdrawal follows a fairly predictable timeline:6,7
- 6–24 hours after your last drink: symptoms usually start. In people with severe dependence, they can begin while there's still alcohol in the blood. Withdrawal seizures usually happen in this window.
- The first 48–72 hours: for most people symptoms are short-lived, but for some they get worse over this time.
- Days 2–3: delirium tremens (DTs), the most severe form, usually starts now and lasts another 2–3 days, though it can last longer.
- The following weeks: low mood, poor sleep and anxiety often continue for several weeks after stopping.
Get support from a mental health practitioner
Find practitioners on HealthBank who work in mental health and anxiety, to support you alongside your doctor. Many offer a free discovery call, online, by phone or in person.
Find a mental health practitioner →What makes alcohol withdrawal more severe?
Withdrawal is more likely, and more severe, if you drink more, have been through withdrawal before, have other health problems, or are stopping other drugs at the same time. It tends to get worse with each episode.5
The strongest warning sign is your own history. A meta-analysis found that people who had a withdrawal seizure or DTs in the past were more likely to have one again.2 No single symptom can rule out severe withdrawal, which is why a doctor's assessment matters.1
How dangerous is alcohol withdrawal?
Most withdrawal is mild to moderate, but severe complications happen in a minority of people. Withdrawal seizures affect an estimated 2–9% of people who are dependent on alcohol. DTs, which cause confusion, agitation, tremor and sometimes hallucinations, affect around 5% of people who aren't treated with medication. With modern treatment, the death rate from DTs has fallen to less than 1%.7 Untreated, severe withdrawal has a high death rate.1
Can you detox from alcohol at home?
Often, yes, but with a doctor's support. Australian guidelines say most withdrawal can be managed outside hospital with appropriate support, and a doctor may prescribe medication to keep you safe and comfortable.3 If you've had seizures or DTs before, or have other health problems, your doctor may recommend a supervised setting.
Why is thiamine (vitamin B1) important during withdrawal?
Heavy drinking can leave you short of thiamine, a B vitamin your brain needs. Australian guidelines recommend thiamine for everyone going through alcohol withdrawal, to help prevent Wernicke's encephalopathy, a serious brain condition.8 The best dose isn't well established by trials,4 so your doctor will tell you what to take.
Eating regular, balanced meals also helps your body recover. An Accredited Practising Dietitian can help you rebuild your eating pattern after stopping drinking.
Where can you get help?
- A doctor: talk to them before you stop, so you can plan a safe withdrawal.
- National Alcohol and Other Drug Hotline: 1800 250 015, free and confidential.9
- Emergency: call 000 for a seizure, hallucinations or severe confusion.
Support for your recovery
HealthBank practitioners who work in mental health and nutrition can support your mood, sleep and eating as you recover, alongside your doctor.
Find a recovery support practitioner →Frequently asked questions
How long does alcohol withdrawal last?
Symptoms usually start 6–24 hours after the last drink and can get worse over the first 48–72 hours. Low mood, poor sleep and anxiety can last several weeks.
When is alcohol withdrawal the worst?
Symptoms can build over the first 48–72 hours. Delirium tremens usually starts 2–3 days after stopping.
Can alcohol withdrawal kill you?
Severe withdrawal, including seizures and delirium tremens, can be life-threatening without treatment. With medical care, the risk is much lower.
Is it safe to stop drinking cold turkey?
If you drink heavily most days, talk to a doctor first. Most people can withdraw safely outside hospital with a doctor's support.
What are the first signs of alcohol withdrawal?
Sweating, shakiness, anxiety, nausea, a fast heart rate and trouble sleeping, usually within 6–24 hours of the last drink.
Why do I need thiamine when I stop drinking?
Australian guidelines recommend thiamine (vitamin B1) for everyone in alcohol withdrawal to help prevent Wernicke's encephalopathy. Your doctor will advise on the dose.
References
Research (PubMed)
- Wood E, Albarqouni L, Tkachuk S, et al. Will this hospitalized patient develop severe alcohol withdrawal syndrome? The Rational Clinical Examination systematic review. JAMA. 2018;320(8):825–833. PubMed 30167704
- Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2014;38(10):2664–2677. PubMed 25346507
- Haber PS, Riordan BC, Winter DT, et al. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust. 2021;215 Suppl 7:S3–S32. PubMed 34601742
- Day E, Bentham PW, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke-Korsakoff syndrome in people who abuse alcohol. Cochrane Database Syst Rev. 2013;(7):CD004033. PubMed 23818100
Australian guidelines
- Haber PS, Lintzeris N. Alcohol withdrawal. In: Haber PS, Riordan BC (eds). Guidelines for the Treatment of Alcohol Problems, 4th ed. University of Sydney, 2021. View source
- Guidelines for the Treatment of Alcohol Problems. Onset and duration of withdrawal symptoms. 2021. View source
- Guidelines for the Treatment of Alcohol Problems. Severe withdrawal complications. 2021. View source
- Guidelines for the Treatment of Alcohol Problems. Thiamine and other supplements. 2021. View source
- Australian Government Department of Health. National Alcohol and Other Drug Hotline. View source
This article is general information and isn't a substitute for personalised advice. If you're thinking about stopping drinking, speak to a doctor first.
Robbie is a Sydney-based Accredited Practising Dietitian (APD) and Exercise Scientist with over 17 years of experience. He holds a Bachelor of Exercise Science (Nutrition) and a Master of Nutrition and Dietetics, and is the Director and Co-founder of HealthBank.