Alcohol Withdrawal
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Understanding Alcohol Withdrawal
Alcohol withdrawal syndrome occurs when someone who has been drinking heavily or regularly for an extended period suddenly stops or significantly reduces their alcohol intake. The body and brain, having adapted to alcohol’s constant presence, respond with a range of physical and psychological symptoms that can vary from mild discomfort to life-threatening complications.
This guide covers the symptoms of alcohol withdrawal, typical timeline, severity levels, and UK healthcare pathways for safe management. It is intended for individuals experiencing withdrawal symptoms, concerned family members, and those considering stopping alcohol after prolonged heavy use. This information does not replace advice from a doctor or other qualified healthcare professional.
Direct answer: Alcohol withdrawal symptoms typically begin 6–24 hours after the last drink and can range from mild anxiety and tremors to severe alcohol withdrawal involving seizures and delirium tremens. Approximately 50% of people with alcohol dependence experience withdrawal symptoms when they stop drinking, and around 3–5% develop delirium tremens.
What you will learn from this guide:
How to recognise common symptoms across mild, moderate and severe withdrawal
The typical withdrawal timeline and when symptoms peak
Risk factors that increase the likelihood of complicated withdrawal
When to seek emergency medical help and when to contact your GP or NHS 111
How alcohol withdrawal is managed within UK healthcare settings
Understanding Alcohol Withdrawal Syndrome
Alcohol withdrawal syndrome is the medical term for the cluster of physical and psychological symptoms that arise when someone with physiological alcohol dependence stops or markedly reduces their alcohol intake. This condition differs from a hangover, which occurs after occasional heavy drinking in non-dependent individuals and typically resolves within 24 hours.
Dependence develops after repeated heavy or prolonged drinking. The brain adapts to the continuous presence of alcohol, and when alcohol levels fall, the nervous system becomes overexcited, producing withdrawal symptoms. This is distinct from harmful use, where drinking causes damage but does not necessarily lead to withdrawal when stopped.
Neurological Basis
Alcohol primarily works by enhancing the activity of GABA (gamma-aminobutyric acid), the brain’s main inhibitory neurotransmitter, while simultaneously suppressing glutamate, the main excitatory neurotransmitter. With regular heavy drinking, the central nervous system adapts:
GABA receptors become less responsive (down-regulation)
Glutamate activity increases (up-regulation)
When alcohol is suddenly removed, this balance is disrupted. The suppressed excitatory systems are suddenly unopposed, leading to central nervous system hyperexcitability. This manifests as the autonomic hyperactivity (rapid pulse, raised blood pressure, sweating), anxiety, tremor, and in severe cases, seizures and delirium that characterise alcohol withdrawal syndrome.
Risk Factors
Several factors increase the likelihood of experiencing more severe withdrawal:
Duration and quantity of alcohol use: Years of heavy drinking or very high daily alcohol intake significantly increases risk
Previous withdrawal episodes: A history of complicated withdrawal, including past alcohol withdrawal seizures or delirium tremens, is one of the strongest predictors of severe symptoms
Medical conditions: Liver disease, cardiac problems, respiratory conditions, epilepsy, or infections increase complication risk
Age and nutrition: Older age, frailty, and poor nutritional status (particularly thiamine deficiency) worsen outcomes
Concurrent substance use: Use of other central nervous system depressants such as benzodiazepines or opioids
Abrupt cessation: Stopping suddenly without medical planning, particularly in someone drinking from early morning or needing alcohol to prevent tremors
Understanding these risk factors helps explain why some individuals experience mild symptoms while others develop life threatening complications requiring intensive care unit admission.
Symptoms and Severity Levels
The symptoms of alcohol withdrawal reflect the underlying neurological hyperexcitability that occurs when the brain is deprived of alcohol. Symptoms tend to progress through stages, though individual experiences vary significantly based on the level of alcohol dependence and other health factors.
Mild Withdrawal Symptoms
Mild alcohol withdrawal symptoms typically appear within 6–12 hours after the last alcoholic drink. These early symptoms include:
Tremor, particularly noticeable in the hands (“the shakes”)
Mild anxiety, nervousness, or feeling on edge
Sweating, often clammy or profuse
Nausea, vomiting, or stomach upset
Headache
Difficulty sleeping, vivid dreams, or insomnia
Fatigue and weakness
Poor concentration
Mild increases in heart rate and blood pressure
These mild symptoms may be mistaken for a severe hangover. However, unlike a hangover, they indicate physiological dependence and may progress to more serious symptoms if alcohol dependence is significant.
Moderate Withdrawal Symptoms
Moderate alcohol withdrawal typically develops 12–48 hours after alcohol cessation and represents more pronounced nervous system disturbance:
Worsening tremor and marked irritability
Noticeable tachycardia (rapid heart rate) and elevated blood pressure
Heavy sweating, flushing, and low-grade fever
Persistent nausea, vomiting, diarrhoea, and dehydration risk
Restlessness and agitation
Confusion and difficulty focusing
Sensitivity to light and sound
Early perceptual disturbances, including possible hallucinations
Some individuals at this stage may experience alcohol hallucinosis—visual, auditory hallucinations or tactile hallucinations (such as feeling insects crawling on the skin) without full delirium. This can occur even in those who do not progress to delirium tremens.
Severe Withdrawal Symptoms
Severe alcohol withdrawal constitutes a medical emergency. Severe symptoms typically occur within the first 48–72 hours and include:
Alcohol withdrawal seizures: Generalised tonic-clonic seizures, often occurring between 6–48 hours after the last drink. Approximately 10% of people undergoing untreated withdrawal experience seizures
Delirium tremens (DTs): The most severe form of withdrawal, characterised by severe confusion and disorientation, extreme agitation, vivid hallucinations, fever, and marked autonomic instability (very high heart rate, severe hypertension, heavy sweating)
Severe autonomic instability: Dangerously high blood pressure, rapid breathing, hyperthermia
Extreme fear and paranoia
Delirium tremens typically appears 48–72 hours after the last drink and carries significant mortality if untreated. Modern treatment has reduced death rates substantially, but DTs remain a serious risk requiring urgent hospital care.
Warning signs requiring immediate emergency response:
Any seizure or loss of consciousness
Severe confusion or disorientation
Hallucinations (seeing, hearing, or feeling things that are not there)
Very high fever with heavy sweating and rapid heart rate
Chest pain or difficulty breathing
These are life threatening complications. Call 999 immediately if you observe any of these symptoms.
Timeline and Emergency Recognition
The withdrawal timeline follows a broadly predictable pattern, though individual variation is common. Factors affecting timing include severity of dependence, duration of alcohol use, previous withdrawal history, age, physical health, and use of other substances.
Withdrawal Timeline Phases
Phase 1: 6–12 hours after last drink Early symptoms begin in this window for most dependent drinkers. Common symptoms include anxiety, tremor, sweating, nausea, irritability, mild hypertension, tachycardia, insomnia, and headache. This phase is often mistaken for a hangover.
Phase 2: 12–24 hours Symptoms typically intensify. Some people develop perceptual disturbances or early hallucinations without full delirium. Autonomic signs (pulse, blood pressure, temperature) may rise noticeably. Certain symptoms such as marked tremor and agitation become more pronounced.
Phase 3: 24–72 hours — highest risk period This represents the peak danger window. Withdrawal seizures most commonly occur between 6–48 hours, with risk decreasing substantially after 48 hours if none have occurred. Delirium tremens classically appears 48–72 hours after the last alcoholic drink, affecting approximately 3–5% of those in withdrawal. This phase requires close monitoring and often inpatient care.
Phase 4: Beyond 72 hours For many, acute physical symptoms begin to reduce after 72 hours and continue improving over the next 4–7 days. Tremor, sweating, and autonomic signs gradually settle, though sleep disturbance, fatigue, and anxiety may persist. Most acute withdrawal symptoms resolve within 5–14 days.
Post-acute withdrawal: Some individuals experience prolonged symptoms lasting weeks to months, including low mood, anxiety, insomnia, poor concentration, irritability, and alcohol cravings. This is sometimes called post-acute withdrawal syndrome and can affect long-term recovery.
Risk Assessment Factors
Risk Level | Alcohol Consumption Pattern | Medical History | Previous Withdrawal | Recommended Setting |
|---|---|---|---|---|
Low | Moderate daily drinking, short duration | No significant health problems | No previous withdrawal symptoms | Community with medical support |
Moderate | Heavy daily drinking, months to years | Stable medical conditions | Previous mild to moderate withdrawal | Close GP monitoring or outpatient setting |
High | Very heavy drinking, drinking from morning, years of dependence | Liver disease, heart disease, epilepsy, pregnancy | Previous seizures or delirium tremens | Inpatient care or monitored setting |
If you have risk factors for complicated withdrawal—particularly previous severe withdrawal, significant medical conditions, or very heavy long-term drinking—you should not attempt to stop drinking without medical supervision. Medical professionals can assess your individual risk and create an appropriate treatment plan.
When to Seek Help and UK Healthcare Pathways
Alcohol withdrawal can be safely managed with proper medical supervision, but attempting to stop drinking suddenly without support can be dangerous for those with significant dependence. The following guidance reflects UK healthcare pathways.
Emergency Situations — Call 999 Immediately
Call emergency services or go directly to the emergency room if you or someone else experiences:
Any seizure or loss of consciousness
Severe confusion, disorientation, or inability to recognise familiar people or places
Hallucinations—seeing, hearing, or feeling things that are not there
Very high fever with heavy sweating and rapid heart rate
Severe uncontrolled agitation or extreme restlessness
Chest pain or difficulty breathing
Signs of severe dehydration (very dark urine, inability to keep fluids down)
Suicidal thoughts, self-harm, or inability to keep the person or others safe
These symptoms indicate potentially life threatening alcohol withdrawal requiring urgent medical help.
Urgent Medical Attention — Contact GP or 111
Seek same-day medical assessment via your GP or NHS 111 (NHS 24 in Scotland) if:
You have been drinking heavily daily for a long time and are planning to stop or cut down significantly
You are experiencing moderate withdrawal symptoms: marked tremor, significant sweating, palpitations, vomiting, or severe difficulty sleeping
You have had previous complicated withdrawals (seizures, delirium tremens)
You have serious health problems such as liver disease, heart disease, epilepsy, or diabetes
You are pregnant
Medical professionals can assess whether you need medically supervised alcohol detoxification and arrange appropriate care.
Private Rehab Options in the UK: PCP
For individuals seeking private rehabilitation services for alcohol withdrawal and alcohol use disorders, PCP offers specialised treatment programmes across the UK. PCP is known for providing confidential, tailored care in comfortable settings, focusing on both the physical detoxification process and the psychological aspects of recovery.
What PCP Offers
Comprehensive Assessment: PCP conducts detailed evaluations to determine the severity of alcohol dependence and withdrawal symptoms, helping to create personalised treatment plans.
Medical Detoxification: Under the supervision of experienced medical professionals, PCP facilitates safe alcohol detoxification, including management of withdrawal symptoms and prevention of complications.
Therapeutic Support: PCP provides access to counselling, cognitive-behavioral therapy, and other evidence-based interventions to address the underlying causes of alcohol addiction.
Aftercare and Rehabilitation: Following detox, PCP offers continued support through rehabilitation programs, relapse prevention strategies, and connection to community support groups.
Benefits of Choosing PCP
Privacy and Comfort: Private rooms and a discreet environment ensure confidentiality and comfort during treatment.
Flexible Treatment Options: PCP accommodates varying lengths of stay and personaliaed care plans to suit individual needs.
Multidisciplinary Team: Access to a team of doctors, nurses, therapists, and support staff specialised in addiction treatment.
How to Access PCP Services
Individuals interested in private rehab through PCP can contact their helpline or visit their website to arrange an initial consultation and assessment. Private insurance may cover some or all of the costs, and PCP staff can assist with financial planning and support.
Choosing a private rehab like PCP can be an effective option for those seeking a more personalised and confidential approach to alcohol withdrawal and recovery in the UK.
Conclusion and Next Steps
Alcohol withdrawal syndrome is a medically recognised condition that ranges from uncomfortable to life threatening. With proper medical supervision, withdrawal can be managed safely, but stopping drinking suddenly without support poses serious risk for those with significant alcohol dependence.
Key safety points to remember:
Never stop drinking suddenly if you have been drinking heavily every day, drinking from early morning, or experiencing symptoms when you miss a drink
Seek emergency help immediately for seizures, severe confusion, hallucinations, or signs of delirium tremens
Contact your GP or NHS 111 before attempting to stop or significantly reduce heavy drinking
Immediate steps if you’re concerned about withdrawal:
Contact your GP to discuss your drinking and arrange assessment
If experiencing withdrawal symptoms now, call NHS 111 for urgent advice
If symptoms are severe (seizures, confusion, hallucinations), call 999 immediately
Have information ready about your typical daily alcohol intake, when you had your last drink, any previous withdrawal episodes, and your current health conditions
Recovery from alcohol use disorders extends beyond managing acute withdrawal. Ongoing support through community alcohol services, counselling, support groups such as Alcoholics Anonymous, and consideration of relapse-prevention medications can support long-term recovery and reduce the risk of future health problems associated with unhealthy alcohol use.
Additional Resources
NHS alcohol support services:
NHS alcohol support: www.nhs.uk/live-well/alcohol-support
NHS 111: Call 111 for urgent health advice (NHS 24 in Scotland)
Find local alcohol support services: www.nhs.uk/service-search
Charity helplines:
Drinkaware: www.drinkaware.co.uk
Alcoholics Anonymous UK: 0800 9177 650
Al-Anon (support for families): 0800 0086 811
This information is intended for adults in the UK and does not replace advice from a doctor or other qualified healthcare professional. Recommendations follow UK practice and NHS guidance.
Medically reviewed by a GMC-registered physician.
Last medically reviewed: January 2025.