How long does alcohol withdrawal last, day by day?

In short

• Alcohol withdrawal usually starts 6 to 24 hours after the last drink, and mild withdrawal settles within 2 to 7 days. Seizures, if they come, tend to arrive between 6 and 48 hours; delirium tremens usually begins 48 to 72 hours after stopping, according to clinical reviews.
• Up to half of people with alcohol use disorder get withdrawal symptoms when they stop. Most cases are mild. The severe ones can be fatal, which is why daily heavy drinkers should stop under medical observation, not alone.
• Renewed Life Center in Lakeside, Cape Town, runs alcohol detox on site, with a resident GP and nurses on duty around the clock, in the same house as the therapy that follows. Admission can be immediate, typically within three days of first contact.

Planning to stop, or already shaking? Book a free, confidential call. A relative can make it for you, and twenty to forty minutes is enough to talk through the withdrawal.

Most people search this at one of two moments. The night before they try to stop, wondering what the next week will be like. Or on day two, sweating, not sleeping, and wondering whether this is normal. This page is the timeline for both, hour by hour and day by day, with the points where it stops being something to sit out at home.

If you are reading this for someone else, a partner or a parent who has just stopped, the same timeline tells you what to watch for, and when to call for help.

How long does alcohol withdrawal last?

For most people the acute phase lasts about a week. Symptoms usually begin 6 to 24 hours after the last drink and, in mild to moderate cases, disappear within 2 to 7 days. The most dangerous stretch is days two and three, when delirium tremens, if it develops, usually begins. Some symptoms, mainly sleep problems, low mood and anxiety, can carry on for weeks or months afterwards.

Alcohol withdrawal syndrome is the set of physical and mental symptoms that appears when a body used to heavy daily drinking suddenly gets less alcohol. The brain has adjusted to alcohol’s sedating effect, and without it the nervous system runs too fast.

The timings come from a clinical review of alcohol withdrawal syndrome by Mirijello and colleagues in the journal Drugs, which also notes that “up to 50% of AUD patients experience withdrawal symptoms”. Most of those cases are mild. A minority become severe, and those are the cases this page is really about.

The US National Institute on Alcohol Abuse and Alcoholism is blunt about the risk: “Alcohol withdrawal can be life threatening if patients who chronically engage in heavy drinking stop drinking suddenly, rather than cutting back gradually or stopping drinking with medical support.” According to the NIAAA, withdrawal accounts for about 260,000 emergency department visits and 850 deaths a year in the United States alone.

What decides how bad your withdrawal will be?

Four things matter most: how much and how long you have been drinking, whether you have had withdrawal before, whether you also take sedatives such as sleeping tablets or benzodiazepines, and your general health. Having stopped before without trouble is not a safe guide: withdrawal can be different each time.

• Daily drinking over months or years carries more risk than heavy weekends.
• Every previous withdrawal counts. Withdrawal tends to get worse with each repeat, an effect doctors call kindling. A 1993 study of 6,818 men in hospital detox by Booth and Blow confirmed it: the more past withdrawals, the higher the risk of seizures and severe symptoms.
• Morning drinking, or drinking to stop the shakes, is a sign that the body already depends on alcohol to stay level.
• A past seizure or hallucinations during withdrawal is a reason to stop under medical supervision next time.
• Sleeping tablets or benzodiazepines alongside alcohol make stopping more complicated, and benzodiazepines themselves need to be reduced gradually to prevent seizures.
• Liver disease, heart problems or a head injury lower the margin for error.

What happens hour by hour and day by day?

Withdrawal follows a fairly predictable course. The table below sets out what usually happens, drawn from the MSD Manual and the Drugs review, and what to do at each point. Timings vary from person to person, so treat them as a guide rather than a guarantee, and act on symptoms rather than the clock.

According to the MSD Manual, symptoms “usually begin within about 6 hours of cessation”, seizures “generally occur 6 to 48 hours after cessation of alcohol”, and delirium tremens “usually begins 48 to 72 hours after alcohol withdrawal”.

How do doctors measure how bad alcohol withdrawal is?

Doctors score withdrawal with the CIWA-Ar, a ten-question checklist covering tremor, sweating, nausea, anxiety, agitation, hallucinations and confusion. The maximum score is 67. Under the 2020 guideline of the American Society of Addiction Medicine, a score under 10 is generally mild, 10 to 18 moderate, and 19 or more severe.

The scale was published by Sullivan and colleagues in 1989. ASAM says severe withdrawal, at 19 or above, should not be managed in outpatient settings without extended on-site monitoring. The same guideline adds that “orienting the initial assessment toward evaluating risk as opposed to current presentation is recommended”, because the worst cases can start quietly.

The scale is used in Cape Town too. At Stikland Hospital, a 2023 study in the South African Journal of Psychiatry by Muddapah and Weich found that dosing by CIWA-Ar score cut the share of detox patients who needed benzodiazepines from 51.4% to 33.8%. Medication is then given when the score calls for it, rather than by the clock.

When is alcohol withdrawal an emergency?

When someone has a seizure, becomes confused or disoriented, sees or hears things that are not there, runs a fever, or cannot keep fluids down. Delirium tremens develops in about 5% of people with withdrawal and may be fatal. A 2024 review of delirium tremens by Kaye and colleagues in Cureus puts the death rate as high as 20%, and at about 1% with early identification and proper treatment.

The difference between 20% and 1% is why the first days should be spent under observation. The Western Cape Government lists 10177 for an ambulance and 112 from any mobile.

Most people never reach this point. But nobody can tell in advance who will, which is why the first three days belong under observation. At Renewed Life Center, every arrival is examined by our resident GP, Dr John Wulz, whose background is in mental health and emergency medicine. A risk assessment happens before withdrawal begins, medication is prescribed only where it is clinically indicated, and nurses are on duty around the clock, including through the night.

Nurses watch the detox 24 hours a day, and the therapists work in the same house. Book a free call and tell us how much and how long you have been drinking: we will plan the first days with you. We reply the same day.

Can you go through alcohol withdrawal at home?

Only if you drink moderately, have never had withdrawal symptoms, take no sedatives and have someone with you. If you drink every day, drink in the morning, or have ever had shakes, hallucinations or a seizure when stopping, withdrawal belongs under medical observation. The decision to stop is a good one; stopping suddenly and alone is the part that carries the risk.

British guidance draws the line in numbers. The NICE guideline on alcohol dependence (CG115) advises considering inpatient or residential withdrawal for anyone who drinks over 30 UK units a day, roughly three bottles of wine. The same applies after a withdrawal seizure or delirium tremens, or when alcohol and benzodiazepines have to be stopped together.

Withdrawal is triggered by “the abrupt discontinuation or decrease of alcohol consumption”, as the Drugs review puts it, which is why people who drink every day should not simply stop on their own. The safer route is a supervised detox, where medication, if needed, is given on a schedule and reduced as the body settles. More on how that works: medical detox in Cape Town, and our wider guide to withdrawal symptoms and how to manage them safely.

What helps in the first days of alcohol withdrawal?

Company, fluids and food, rest, and vitamins given by a doctor. None of these replaces medical observation for someone who drinks every day, but together they make the first days safer and easier to get through, whether that is at home before admission or already with us in Lakeside.

• Someone with you. For the first three days, including at night, someone should check on you and know the emergency signs listed above.
• Water and small meals. Eat little and often, even without appetite, and keep drinking water.
• Vitamins, especially thiamine. The Drugs review calls thiamine and B-complex vitamins “essential for the prevention of Wernicke’s encephalopathy”, a serious brain complication in people who drink heavily, and notes that thiamine “can be given routinely”. The NICE guideline CG100 says to “offer thiamine to people at high risk of developing, or with suspected, Wernicke’s encephalopathy”. Leave the dose to a doctor.

What happens after the first week?

The body usually settles within a week, while the mind takes longer. In the weeks that follow, many people have broken sleep, low mood, irritability and cravings that arrive without warning; the Drugs review describes symptoms that “can persist from weeks to months following the 5-7 days of acute detoxification period”. It is a vulnerable stretch, and a common time to go back to drinking.

Sleep is usually the last thing to recover. A 2007 review of insomnia in alcohol recovery by Arnedt, Conroy and Brower describes a study in which sleep-quality scores were still above the clinical cut-off after 12 weeks without alcohol. Bad nights in the second month are normal. They do not mean recovery is failing.

So detox is where treatment begins rather than the whole of it. For most people alcohol had a job, whether that was switching off anxiety, getting to sleep or dulling something older, and stopping does not make that need disappear. A week of detox gets you through the physical part; the weeks after are where the real work of recovery gets done, with individual therapy, groups and a routine that makes evenings without a drink possible.

Recovery is also practical. Meals, sleep and a steady day do more in the first weeks than most people expect. At our centre meals are prepared by Carin Goosen-Dawson, our head chef, who is also a peer recovery specialist, and John Roberts, our Senior Recovery Specialist, has 39 years in personal recovery. It helps, in those first weeks, to be around people who have done it.

Detox is the first week. We stay with you for what comes after. Talk to us about the whole plan, free and confidential, and we reply the same day.

How many people in the Western Cape are treated for alcohol?

Alcohol is one of the main reasons people in the Western Cape enter treatment. In the first half of 2025, alcohol was the primary substance for 26% of admissions to 33 specialist treatment centres in the province, second only to methamphetamine. Nationally the figure was 24%, according to the South African Medical Research Council.

Those numbers come from the SACENDU research brief published by the SAMRC in 2026, which counted 1,489 people treated in the Western Cape in those six months. Asking for help with drinking is common here.

Why do people choose Renewed Life Center for alcohol detox?

Mostly because detox and treatment happen in one house with one team. Nobody is stabilised in a hospital and then sent somewhere else to start again: the doctor, the nurses and the therapists who will carry your case work under one roof in Lakeside.

Medical cover through the night. A resident GP examines every arrival, a risk assessment comes before withdrawal starts, and nurses are on duty 24 hours a day.

Whatever sits under the drinking gets treated as well: anxiety, depression, trauma and burnout go on the same plan. Dr Ruby Weber heads psychology, with more than two decades in the addictions field, and a psychiatrist selects medication where it is needed.

After detox, treatment runs in phases of one month, with individual psychotherapy about three times a week and group therapy five or more times a week in the first phase, then a sober living programme for those who want a slower return. Every discharge includes a written relapse-prevention plan built for your own home.

Paid directly, so the clinical picture sets the length of stay. No scheme decides how many days you are allowed. Airport transfers at Cape Town International are included both ways for people flying in. More on our alcohol treatment in Cape Town.

How do you start?

With a free, confidential call of twenty to forty minutes by WhatsApp, video or phone. Tell us how much you drink and what happened the last time you stopped. A clinical assessment follows within three days, and admission can be immediate, typically within three days of first contact.

If writing feels easier, send us a message about the withdrawal. If not, book the free call.

Questions people ask

This article is general information, not medical advice.

Sources

1. Mirijello et al., Identification and Management of Alcohol Withdrawal Syndrome, Drugs, 2015
2. MSD Manual Professional Edition, Alcohol Toxicity and Withdrawal
3. World Health Organization, Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, 2009
4. NIAAA, Alcohol Use Disorder: From Risk to Diagnosis to Recovery, Core Resource on Alcohol
5. American Society of Addiction Medicine, Clinical Practice Guideline on Alcohol Withdrawal Management, 2020
6. Sullivan et al., Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar), British Journal of Addiction, 1989
7. Muddapah and Weich, Assessing the revised Clinical Institute Withdrawal for Alcohol Scale use at Stikland Hospital, South African Journal of Psychiatry, 2023
8. Booth and Blow, The kindling hypothesis: further evidence from a U.S. national study of alcoholic men, Alcohol and Alcoholism, 1993
9. Kaye et al., Delirium Tremens: A Review of Clinical Studies, Cureus, 2024
10. NICE, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (CG115)
11. NICE, Alcohol-use disorders: diagnosis and management of physical complications (CG100)
12. Arnedt, Conroy and Brower, Treatment options for sleep disturbances during alcohol recovery, Journal of Addictive Diseases, 2007
13. SAMRC, SACENDU Research Brief, Vol 29 (1), 2026
14. Western Cape Government, Know who you can call in an emergency