If you are thinking about stopping drinking, understanding what your body will go through during withdrawal is one of the most useful things you can know. It helps you prepare, it helps the people around you know what to expect, and — most importantly — it helps you recognise the signs that mean you need medical help. This guide covers the full alcohol withdrawal timeline from the first six hours to the weeks beyond, including information on Post-Acute Withdrawal Syndrome (PAWS) and when to seek emergency care.
6–12 hours: the first signs
Withdrawal typically begins within six hours of your last drink. At this stage, symptoms are usually uncomfortable rather than dangerous:
- Tremor — particularly noticeable in the hands, sometimes extending to the whole body.
- Sweating, including disproportionate night sweats.
- Anxiety, restlessness, and a sense of agitation.
- Nausea, sometimes with vomiting.
- Elevated heart rate (tachycardia) and mildly raised blood pressure.
- Headache.
- Difficulty sleeping or staying asleep.
These symptoms occur because the brain, which has been suppressed by alcohol for a sustained period, is entering a state of rebound over-stimulation as the depressant effect of alcohol is removed.
12–24 hours: intensifying symptoms
As withdrawal progresses into the 12–24 hour window, symptoms typically intensify. Blood pressure and heart rate rise further. Anxiety can become significant. Some people begin to experience perceptual disturbances — heightened sensitivity to light and sound, and in some cases minor visual or auditory hallucinations. The risk of withdrawal seizures begins to increase from around the 12–18 hour mark.
24–72 hours: the highest-risk period
This is the most critical window in alcohol withdrawal. Seizure risk peaks between 24 and 48 hours after the last drink. Delirium tremens — the most severe form of alcohol withdrawal — typically develops between 48 and 72 hours. Delirium tremens (DTs) involves:
- Severe confusion and disorientation.
- Profound agitation and psychomotor hyperactivity.
- Visual, auditory, and tactile hallucinations.
- Cardiovascular instability — very high blood pressure and heart rate.
- Fever and profuse sweating.
DTs affect approximately 3–5% of people experiencing alcohol withdrawal and carry a mortality rate of up to 5% even with medical treatment. Without treatment, the mortality rate is significantly higher. This is why supervised detox — with daily nurse visits and prescriber oversight during this window — is not optional for patients at risk.
3–7 days: resolution of acute withdrawal
For most patients without complications, the acute withdrawal phase begins to resolve between days three and seven. Physical symptoms diminish progressively. Sleep often remains disrupted. Appetite begins to return. Mood may fluctuate between relief and low affect as the brain's reward system begins to readjust. By day seven, most patients completing a supervised detox have finished their medication reducing regime. Physical withdrawal is largely resolved. The work of recovery continues.
Post-Acute Withdrawal Syndrome (PAWS)
Post-Acute Withdrawal Syndrome — PAWS — refers to a cluster of symptoms that can persist for weeks or months after acute withdrawal has resolved. It reflects the time it takes for the brain's neurotransmitter systems — particularly GABA and glutamate — to return to their pre-dependence baseline. Common PAWS symptoms include:
- Persistent anxiety, irritability, or mood instability.
- Sleep disturbance — difficulty falling or staying asleep, vivid dreams.
- Cognitive difficulties — poor concentration, mental fog, memory problems.
- Cravings for alcohol, often triggered by stress, social situations, or emotional states.
- Low energy and anhedonia — difficulty experiencing pleasure from everyday activities.
Understanding PAWS is important because its symptoms are a significant driver of relapse. People who feel unexpectedly low, anxious, or unable to concentrate weeks after a successful detox often interpret this as a personal failure. In reality, it is a neurological process with a predictable course — one that can be supported by relapse prevention medication and psychological support.
When to call emergency services
Call 999 immediately if someone experiencing alcohol withdrawal has:
- A seizure that lasts more than five minutes, or a second seizure without full recovery in between.
- Severe confusion, profound disorientation, or hallucinations that are rapidly worsening.
- Loss of consciousness or inability to be roused.
- Chest pain, shortness of breath, or signs of respiratory distress.
- Signs of Wernicke's encephalopathy: acute confusion, abnormal eye movements, inability to walk or coordinate.
Do not wait for a scheduled appointment or nurse visit in these situations. Call 999 first.
This article is for general clinical information only. It does not constitute medical advice. If you or someone you know is experiencing severe withdrawal symptoms, call 999.
