Getting Through Alcohol Withdrawal: What to Expect Day-by-Day

Deciding to stop drinking is a significant step. If you have been drinking heavily or regularly, your body may have adapted to alcohol, and quitting can trigger withdrawal symptoms that range from uncomfortable to dangerous.

This guide walks you through what alcohol withdrawal can look like day by day, what is normal, what is not, and when to get medical help. It is written for people considering detox, currently going through withdrawal, or supporting someone who is.

Important: Alcohol withdrawal can be life-threatening. If you are at risk for severe withdrawal, the safest option is medical detox with monitoring and medications when needed. If you are in New Hampshire, Liberty Health Services can help you detox safely and comfortably.

First, what counts as alcohol withdrawal?

Alcohol withdrawal happens when someone who has been drinking consistently, especially in larger amounts, suddenly reduces or stops alcohol. Alcohol affects brain chemicals (like GABA and glutamate) that control calm and stimulation. With ongoing drinking, your brain compensates. When alcohol is removed, the brain can become overactive, which causes symptoms like anxiety, shaking, sweating, nausea, rapid heart rate, insomnia, and in severe cases, seizures or delirium tremens (DTs).

Withdrawal usually begins within 6 to 12 hours after the last drink, but timing can vary depending on your drinking pattern, overall health, and past withdrawal history.

Who is at higher risk for dangerous withdrawal?

You should take withdrawal especially seriously if any of these apply:

• You drink daily or binge heavily over multiple days.
• You have had withdrawal symptoms before (even mild ones).
• You have ever had a withdrawal seizure or DTs.
• You take sedatives like benzodiazepines or have used them regularly.
• You have liver disease, heart issues, uncontrolled blood pressure, or other medical conditions.
• You are older, underweight, dehydrated, or not eating well.
• You experience hallucinations, severe confusion, or agitation during withdrawal.

If you are unsure, it is safer to assume you might be at risk. The team at our New Hampshire Alcohol Detox Center can discuss your potential need for a detox as we handle alcohol withdrawal management in New Hampshire .

A realistic day-by-day timeline of alcohol withdrawal

Every person is different, but most people follow a general pattern. Below is a practical timeline detox teams use, with “what you might feel” and “what helps.”

Note: Symptoms can start while alcohol is still in your system. If you are a heavy drinker, you might feel withdrawal before you think you should.

0 to 12 hours after your last drink (early withdrawal)

Common symptoms

• Anxiety, irritability, restlessness
• Mild tremor (shaky hands)
• Sweating
• Headache
• Nausea, decreased appetite
• Fast heart rate
• Trouble sleeping

What is happening Your nervous system is beginning to rebound. Many people describe this as feeling “wired,” on edge, or unable to settle.

What helps

• Hydration (water, electrolyte drinks)
• Light food if you can tolerate it
• Quiet, dim environment
• Avoid caffeine and stimulants
• Call for help if you have risk factors

When to get help immediately

• Chest pain, fainting, severe vomiting
• Confusion that feels unusual
• Tremors that are quickly worsening

Day 1 (12 to 24 hours): symptoms intensify

Common symptoms

• Shaking/tremor becomes more noticeable
• Sweating and chills
• Nausea or vomiting
• Anxiety/panic feelings
• Elevated blood pressure and heart rate
• Insomnia
• Sensitivity to light and sound

Some people may experience

• Mild perceptual changes (feeling “off,” jumpy, seeing shadows)
• Strong cravings to drink to stop the discomfort

What helps

• Medical monitoring if you are at risk
• Small, frequent sips of fluids if nauseated
• Bland foods (toast, rice, soup)
• Thiamine and vitamins are often used in medical detox (especially thiamine/B1, which is important for brain health in heavy drinking histories)

Why professional detox matters here If withdrawal escalates, medications can reduce the risk of seizures and severe complications and make you more comfortable.

Day 2 (24 to 48 hours): higher risk window begins

This is the period when some of the more serious complications can start.

Common symptoms

• Continued tremors
• Anxiety and agitation
• Sweating, fast pulse
• Nausea, diarrhea
• Poor sleep and vivid dreams
• Feeling depressed or overwhelmed

Possible moderate-to-severe symptoms

• Hallucinations (visual, auditory, or tactile)
• Severe confusion or disorientation
• Seizures can occur, often in the first 24 to 48 hours

What helps

• Supervised detox, especially for anyone with a heavy drinking pattern or past withdrawal symptoms
• Monitoring of vitals, hydration status, and mental status
• Medications as clinically appropriate (commonly benzodiazepines in medical settings)
• Reassurance and calm environment (symptoms often spike at night)

Red flags (seek emergency care)

• Seizure activity
• Hallucinations with agitation
• Severe confusion, inability to recognize where you are
• Very high blood pressure, very fast heart rate, severe fever

Day 3 (48 to 72 hours): peak withdrawal for many people

For many, Day 3 is the peak of symptoms. This is also the classic window for delirium tremens (DTs) to appear in higher-risk individuals.

Common symptoms

• Tremors, sweating, rapid heart rate
• Anxiety, irritability
• Insomnia and exhaustion
• Nausea, appetite still low

Severe symptoms (DT risk)

• Severe confusion and disorientation
• Agitation, fear, paranoia
• Hallucinations
• Fever
• Dangerous changes in blood pressure and heart rate

DTs are a medical emergency. They are not just “really bad withdrawal.” They can be fatal without treatment.

What helps

• Medical detox with 24/7 monitoring is the safest approach
• Fluids, electrolyte correction, nutritional support
• Medication management
• A quiet setting with staff who know how to respond quickly if symptoms escalate

Day 4 to Day 5: symptoms begin to ease (for many)

If you are past the peak, you may start to feel a slow shift. It is not always linear. Many people feel better in the morning and worse in the evening.

Common symptoms

• Reduced tremor and sweating
• Anxiety still present but less intense
• Sleep begins to return, but may still be fragmented
• Low mood, fatigue
• Cravings come and go

What helps

• Gentle movement (short walks if safe)
• Rehydration and regular meals
• Sleep support routines (consistent bedtime, low light, no screens late)
• Starting conversations about next steps: therapy, outpatient care, residential treatment

Day 6 to Day 7: the “fog lifting” phase

By the end of the first week, many people feel physically steadier. Some symptoms can linger, especially sleep issues and anxiety.

Common symptoms

• Improving appetite
• Energy starts to return in small bursts
• Sleep still uneven
• Mood swings or irritability
• Brain fog that comes and goes

What helps

• Structure: wake time, meals, hydration, rest
• Support groups or counseling
• Planning your environment: remove alcohol, avoid triggering social plans early on
• Continuing care, because detox is only the first step

Weeks 2 to 4: post-acute withdrawal (PAWS) for some people

Not everyone experiences PAWS, but many do, especially after long-term heavy drinking.

Possible symptoms

• Anxiety or low mood
• Irritability
• Poor sleep
• Difficulty concentrating
• Low motivation
• Strong cravings triggered by stress

What helps

• Ongoing treatment (therapy, group support, medication-assisted options if appropriate)
• Stress management and coping tools
• Addressing co-occurring mental health concerns (depression, trauma, anxiety)
• Regular check-ins with a care team

What you can do right now to get through withdrawal more safely

Even if you plan to detox at home (not recommended for many), these steps are protective. If symptoms are moderate or you have risk factors, choose medical care.

1) Do not “white knuckle” severe symptoms

If you are shaking heavily, vomiting repeatedly, confused, hallucinating, or your heart is racing, it is not a test of willpower. It is your nervous system in distress.

2) Do not try to “taper” without a plan

Some people attempt to taper alcohol to reduce withdrawal. This can backfire and lead to prolonged withdrawal or binge cycles. A medical team can guide a safer plan.

3) Hydrate and eat what you can

Dehydration and low electrolytes can worsen symptoms. Aim for:

• Water plus electrolytes
• Simple foods: broth, bananas, rice, toast, oatmeal, eggs if tolerated

4) Avoid caffeine and intense exercise early on

Stimulants can increase anxiety, heart rate, and tremors.

5) Have someone with you

If you are withdrawing, do not isolate. Have a trusted person check on you and call for help if symptoms escalate.

When alcohol withdrawal becomes an emergency

Call 911 or go to the ER if you notice:

• Seizure
• Hallucinations with agitation or confusion
• Severe disorientation, inability to stay awake, or delirium
• Fever, severe sweating, uncontrolled shaking
• Chest pain, shortness of breath, fainting
• Uncontrolled vomiting or signs of dehydration (dark urine, dizziness, confusion)

Why medical detox is often the safest choice

A professional detox program is designed to keep you safe and stabilize you while your body recalibrates.

At a medical detox center, you can typically expect:

• 24/7 monitoring of vital signs and symptoms
• Medications to reduce withdrawal severity and seizure risk when clinically appropriate
• Fluids, nutrition support, and vitamin replenishment (including thiamine)
• A calm environment and support through cravings and anxiety
• A clear plan for what comes after detox (therapy, outpatient or residential treatment, relapse prevention)

Detox is not just about “getting alcohol out.” It is about protecting your brain, heart, and overall stability so recovery can start on solid ground.

If you are in New Hampshire: getting help at Liberty Health Services

If you or someone you love is facing alcohol withdrawal, Liberty Health Services in New Hampshire can help you detox with professional support and a step-by-step plan.

If you are unsure whether you need detox, reaching out can provide clarity. A quick conversation can help you understand your risk level and the safest next move. You might find that you’re questioning if you’re an alcoholic, which is a common concern. Our team can assist in such situations.

FAQ: Alcohol withdrawal day-by-day

How long does alcohol withdrawal last?

Acute withdrawal often lasts 3 to 7 days, with symptoms peaking around 48 to 72 hours for many people. Some symptoms like sleep disturbance, anxiety, and cravings can last longer (PAWS).

Can you die from alcohol withdrawal?

Yes. Severe withdrawal (especially delirium tremens) can be fatal without treatment. That is why medical detox is recommended for anyone at risk.

What are the first signs of alcohol withdrawal?

Common early signs include anxiety, shaky hands, sweating, nausea, headache, irritability, and insomnia, often starting within 6 to 12 hours after the last drink.

What is delirium tremens (DTs)?

DTs is the most severe form of alcohol withdrawal. It can include severe confusion, agitation, hallucinations, fever, and dangerous vital sign changes. It is a medical emergency.

If you’re considering the possibility of a natural recovery process, it’s worth exploring what natural alcohol detox entails.

Is it safe to detox from alcohol at home?

For some people with mild dependence, it may be possible, but it is risky to guess. If you drink heavily, have had withdrawal before, have medical conditions, or live alone, medical detox is strongly recommended.

What helps with alcohol withdrawal symptoms?

Medical detox can provide monitoring and medications when needed. Supportive care includes hydration, electrolytes, nutrition, rest, and a calm environment. Avoid caffeine and do not attempt to self-medicate.

Why do I feel anxious and can’t sleep after quitting alcohol?

Alcohol affects neurotransmitters tied to calm and sleep. When you stop, your nervous system can become overactive for days, causing anxiety and insomnia until the brain rebalances.

When should I go to the ER for withdrawal?

Go immediately for seizures, hallucinations, severe confusion, chest pain, fainting, uncontrolled vomiting, fever, or dangerously fast heart rate.

What should I do after detox?

Detox is the first step. Long-term recovery usually requires a plan, such as therapy, outpatient programs, residential treatment, support groups, relapse prevention strategies, and addressing mental health.