The Stages of Alcohol Withdrawal

Withdrawal from alcohol addiction is in most cases a two-stage process. The first stage usually begins eight to 12 hours after an alcoholic stops drinking, and may last for another 12 to 16 hours.

First-stage alcohol withdrawal symptoms include:

  • Tremors
  • Constant nervousness or edginess
  • Irrational anger
  • Confusion and poor concentration
  • Hyperactivity
  • Insomnia
  • Loss of appetite
  • Nausea and vomiting
  • Sweating
  • Clamminess of the skin
  • Throbbing headaches
  • Increasingly strong cravings for alcohol

During the second stage of withdrawal, which can extend the withdrawal process out for another three to five days, these symptoms will likely worsen, and other new and uncomfortable physiological responses may accompany them. Additional symptoms could include rapid heartbeat, breathing difficulties, muscle aches, low-grade fever and/or digestive disturbances.

Some recovering alcoholics (up to 30%) will go through a more daunting third stage of withdrawal. During this period of crisis, symptoms from earlier stages escalate and can become so intense that death becomes a legitimate possibility — but only if medical services are not provided.

Severe Alcohol Withdrawal: Seizures, Hallucinations and Delirium Tremens

On occasion, more severe alcohol withdrawal symptoms may manifest. These uncommon and traumatic side effects are usually experienced by those who’ve been heavy drinkers or struggled with alcohol abuse for a prolonged period.


Sudden, unexpected seizures are experienced by about one-third of alcoholics going through withdrawal. The initial seizure will likely occur fairly early during the withdrawal process, within the first 48 hours, and depending on its severity, its characteristics may include:

  • Full-body paralysis
  • Loss of bowel and bladder control
  • Rigidly clenched jaws or teeth
  • Uncontrolled biting of the tongue or cheek
  • Severe breathing difficulties

Those who’ve detoxed multiple times are more likely to experience seizures than those who are new to the process.


Only one-fourth of alcoholics in withdrawal will suffer from hallucinations, but those who do may be deeply traumatized and face greater risk of injury or accident as a result.

Withdrawal-related hallucinations are known as alcoholic hallucinosis, and the phenomenon can commence within 24 hours after an alcoholic stops drinking. Auditory hallucinations are the most frequent manifestation of this condition, but alcoholic hallucinosis also produces visual distortions, delusions and extreme confusion, and can easily put sufferers in grave danger if medical supervision isn’t provided.

Delirium Tremens

Delirium tremens is a harrowing condition that may develop as a fresh symptom during the third stage of alcohol withdrawal. Commonly known as the DTs, this frightening disorder is the most infamous side effect of alcohol withdrawal.

Those who’ve abused alcohol heavily for many years are the most likely to experience this condition, which is marked by:

  • Massive mental confusion or delirium
  • Physical and psychological disorientation
  • Intense terror and paranoia
  • Powerful visual and auditory hallucinations
  • An inability to separate fantasy from reality
  • Painful full-body muscle spasms
  • Extreme sensitivity to light, sound and/or touch
  • A lapse into deep sleep that can last for 24 hours or more
  • Rapid and/or irregular heartbeat that can lead to heart failure

Most third-stage withdrawal symptoms are similar but more intense versions of those experienced during stages one and two. But delirium tremens is a medical emergency that takes things to a whole new level.

The Urgency of Detox for Alcohol Withdrawal

Men and women experiencing alcohol withdrawal symptoms require supervised detox in a fully staffed and equipped medical facility, either in a hospital or onsite at a residential addiction treatment center. This is true at any point during withdrawal but especially in stage three, when death may occur if expert care is not provided.



Medline Plus – Alcohol Withdrawal:

Medscape – Delirium Tremens (DTs) Clinical Presentation:


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