Learn / Alcohol Detox and Withdrawal: What to Expect During Treatment
Alcohol Detox and Withdrawal: What to Expect During Treatment
Deciding to heal from alcohol addiction is exciting. You’re finally ready to reclaim control of your life and start reaping the benefits of sobriety. But it’s important to start your recovery safely. Detoxing and going through withdrawal are important first steps, but suddenly stopping or decreasing your drinking can be dangerous—even life-threatening.
Rehabs with detox programs offer a safe and more comfortable experience that can set you up for long-term success in your recovery.
Treatment for Alcohol Withdrawal During Detox
Each year, more than 1.5 million people in the U.S. go through alcohol withdrawal1 in a rehab or a medical setting. And while even more people withdraw at home, alcohol withdrawal can be very dangerous, and in some cases lethal. It’s a good idea to detox with medical supervision so you can stay healthy, safe, and as comfortable as possible.
Where Can You Detox?
Options for detox include hospitals, inpatient rehabs, or outpatient programs. Which option is the best for you depends on your health history, severity of symptoms, and personal needs. For example, people who are more likely to develop severe symptoms like seizures may require hospitalization. People with co-occurring disorders may also need a higher level of care to protect their health. But others who experience less severe symptoms may be able to detox through an outpatient program that offers regular check-ins with a medical professional to ensure they’re staying safe.
Some residential rehabs offer medical detox onsite, which allows you to immediately move into a residential addiction treatment program afterwards. This can provide you with stability in early recovery by easing your transition into inpatient care.
How Long Does It Take To Detox From Alcohol?
Everyone’s detox and withdrawal timeline2 is different and depends on several factors:
- How long and how much you drank
- Family history of addiction and other health issues
- Co-occurring disorders like depression, anxiety, or physical health conditions
Withdrawal can start just hours after stopping or reducing your drinking.3 But it can also take up to 48 hours for symptoms to set in. It’s most common for symptoms to peak between 24-72 hours after you begin detoxing. However, some symptoms may linger for weeks.
Alcohol detox programs usually last 3-7 days depending on your symptoms. It usually begins with an evaluation2 to get a better picture of your overall health and any pre-existing conditions that may cause complications, like high blood pressure.
Then, your treatment team will address your alcohol dependence, usually by using a stabilizing medication that’s tapered down over the course of your detox. This process minimizes withdrawal symptoms and lessens your risk of complications. Staff will closely monitor you, especially in the first 48 hours after you begin to detox as that’s when most symptoms set in. They’ll check your vitals, ask how you’re feeling, and may perform blood tests as necessary to check your hydration levels.
If you don’t develop any withdrawal symptoms after about 48 hours, you may be released into outpatient services. If you’re detoxing in a rehab, you may instead move to their inpatient center to begin their treatment program.
The goal of alcohol detox4 is to help you reach an alcohol-free state, relieve your symptoms, and address any co-occurring conditions to prepare you to enter addiction treatment.
Managing Withdrawal Symptoms
While withdrawal is typically uncomfortable, there are certain things you and your team can do to manage the symptoms and reduce your discomfort. When you detox in a facility, they’ll monitor your symptoms and adjust your conditions to relieve pain.
Medications
In many cases of alcohol detox, a doctor will prescribe certain medications to lessen withdrawal symptoms5 and prevent complications. Benzodiazepines are the most common medication for managing alcohol withdrawals.
Depending on your detox program and health history, your doctor may give you medication right away. People with physical health conditions or a history of severe withdrawal symptoms may take a single dose of a benzodiazepine prior to detoxing. Or, you might take medication only after presenting certain symptoms like seizures, high body temperature or blood pressure, or agitation.
Comfortable and Safe Conditions
Detox centers consciously design their spaces to make the experience more comfortable. The ideal environment for alcohol withdrawal is quiet with low lighting5 and minimal stimulation to keep you calm. To ensure patient safety, they will also not have any potentially dangerous substances or items in the room.
You may also have access to a therapist to talk through your feelings6 and cravings during this vulnerable time. And depending on the center, you may interact with others in the program for peer support.
Nutrition and Hydration
Your diet and hydration levels affect the severity of your symptoms5 and the development of complications. This is partly because alcohol addiction causes nutritional deficiencies that may prolong detox.7 And because detox is hard enough on your body, supporting it with healthy foods that may bring you joy is important.
Your detox center’s initial assessment may even include a nutritional evaluation. This tells your doctors exactly which nutrients you’re lacking. Depending on the results, your doctor may recommend vitamins or other supplements for the first 3-5 days of detox8 to address those deficiencies.
Your medical team will also keep a close eye on your fluid and electrolyte levels. In more severe cases, you may receive fluids through an IV. Staying hydrated can alleviate some withdrawal symptoms.
Understanding Alcohol Withdrawal
Studies show that over half of people who are dependent on alcohol experience withdrawal9 when they stop or slow their drinking. And 3-10% of people experience severe alcohol withdrawal. Withdrawal looks different for everyone, but it’s safest to have medical supervision to ensure your symptoms don’t become life-threatening.
What Causes Withdrawal?
While you might assume that withdrawal only happens when you completely stop drinking, you can actually start experiencing withdrawal symptoms from just decreasing your alcohol consumption.1 In fact, some people who are dependent on alcohol can start to experience withdrawal even at a blood alcohol level that would normally cause someone to feel very intoxicated. You may not realize how much alcohol your body is used to before you stop drinking, especially if you’ve been functioning “normally.”
Alcohol withdrawal causes imbalances in the brain,1 which lead to your symptoms. After a certain point of heavy drinking, your body—specifically your brain and central nervous system—become used to having alcohol in your system. Your bodily systems have learned to constantly adjust their functioning to compensate for the depressive effects of alcohol. So when you suddenly stop or reduce your drinking, your body doesn’t adjust as quickly and still operates on hyperdrive, causing withdrawals.
Symptoms of Alcohol Withdrawal
Certain symptoms of alcohol withdrawal1 are more common:
- Tremors
- A strong urge to drink
- Sleep problems, including difficulty falling or staying asleep and intense dreams
- Anxiety
- Hypervigilance
- Irritability
- Loss of appetite
- Nausea and vomiting
- Headaches
- Sweating
These symptoms typically start about 6-12 hours10 after you begin detoxing. While they may make you uncomfortable, they’re usually not life-threatening. However, you may also experience a more severe form of alcohol withdrawal called delirium tremens,9 which is more dangerous.
Delirium Tremens (DT)
Delirium tremens is a severe form of alcohol withdrawal. It’s most common in people who have chronically used alcohol in high quantities over the years, or consistently for months. Without proper treatment, it can be deadly. Early detection and professional treatment can prevent death or serious injury.
With DT, you’ll experience common symptoms of alcohol withdrawal, plus more severe symptoms:11
- Seizures
- Deep sleep for 24 or more hours
- Sudden and extreme confusion
- Feeling very excited or scared
- Hallucinations
- Quick bursts of energy
- Sudden changes in mood
- Fatigue
- Light, sound, and touch sensitivity
If you do experience DT, you’ll probably need to stay in the hospital until your symptoms subside. Your medical team will check your vitals consistently. As dehydration is very common, they’ll test your blood for electrolytes levels and body fluid levels. They’ll also likely give you medicine to help you stay calm, prevent seizures, and lessen your symptoms.
DT symptoms typically start about 48-96 hours after you suddenly stop drinking and can last up to 5 days. However, sometimes it takes 7-10 days after your last drink for DT symptoms12 to begin. And some people even experience certain withdrawal symptoms like mood swings and fatigue for years after.
Post-Acute Withdrawal Syndrome (PAWS)
It’s common for people recovering from alcohol addiction to still experience withdrawal symptoms during rehab or even long after. This is called post-acute withdrawal syndrome (PAWS), or protracted withdrawal.
With PAWS, your withdrawal symptoms ebb and flow over time and may be triggered by stress. PAWS symptoms mainly resemble acute withdrawal symptoms, but there are a few additional ones to be aware of:
- Concentration and memory issues
- Decreased sex drive
- Complaints of pain without a cause
PAWS can cause relapse,13 so it’s important to prepare yourself for it. While you may be ready to manage immediate withdrawal symptoms, coming to terms with prolonged withdrawal may be more difficult. In rehab, you’ll learn new coping skills to help you deal with these symptoms and prevent relapse. You can even ask your clinical team to help you come up with a plan ahead of time, so if you do begin to experience PAWS, you know what to do. Successful recovery is still very possible with PAWS.
Recovery: The Light at the End of the Tunnel
Detox is just the first step in your recovery journey—long-term recovery requires follow-up care, ideally starting with residential rehab. And while detox may not be the most pleasant experience, doing so in a safe, supportive place can help you stay sober, healthy, and well.
Search our list of detox centers for information on pricing, post-detox programming, and more.
Reviewed by Rajnandini Rathod
- Saitz, Richard. “Introduction to Alcohol Withdrawal.” Alcohol Health and Research World, vol. 22, no. 1, 1998, pp. 5–12. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761824/. [↩] [↩] [↩] [↩]
- “Detox.” Recovery Research Institute, 8 Nov. 2018, https://www.recoveryanswers.org/resource/alcohol-and-drug-detox/. [↩] [↩]
- Alcohol Withdrawal: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000764.htm. Accessed 7 Mar. 2023. [↩]
- Hayashida, Motoi. “An Overview of Outpatient and Inpatient Detoxification.” Alcohol Health and Research World, vol. 22, no. 1, 1998, pp. 44–46. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761814/. [↩]
- Shivanand Kattimani and Balaji Bharadwaj. “Clinical management of alcohol withdrawal: A systematic review.” Industrial Psychiatry Journal. v.22(2); Jul-Dec 2013
[↩] [↩] [↩] - 2 Settings, Levels of Care, and Patient Placement. Substance Abuse and Mental Health Services Administration (US), 2006. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK64109/. [↩]
- Center for Substance Abuse Treatment.Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No.(SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006. [↩]
- Shivanand Kattimani and Balaji Bharadwaj. “Clinical management of alcohol withdrawal: A systematic review.” Industrial Psychiatry Journal. v.22(2); Jul-Dec 2013 [↩]
- Rahman, Abdul, and Manju Paul. “Delirium Tremens.” StatPearls, StatPearls Publishing, 2022. PubMed, https://www.ncbi.nlm.nih.gov/books/NBK482134/. [↩] [↩]
- Sachdeva, Ankur, et al. “Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.” Journal of Clinical and Diagnostic Research : JCDR, vol. 9, no. 9, Sept. 2015, pp. VE01–7. PubMed Central, https://doi.org/10.7860/JCDR/2015/13407.6538. [↩]
- Delirium Tremens: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000766.htm. Accessed 7 Mar. 2023. [↩]
- Delirium Tremens: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000766.htm. Accessed 7 Mar. 2023.
[↩] - Melemis SM. Relapse Prevention and the Five Rules of Recovery. Yale J Biol Med. 2015 Sep 3;88(3):325-32. PMID: 26339217; PMCID: PMC4553654. [↩]
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