Alcohol withdrawal timeline: how long it lasts, day by day

Seizures are most likely in the first 48 hours and delirium tremens from 48 to 72 hours, says the MSD Manual³.

In the Western Cape, alcohol was the main substance for 26% of specialist treatment admissions in the first half of 2025, SACENDU reports. At Renewed Life Center in Lakeside, Cape Town, a doctor examines you after you arrive, and if you need a detox, our medical team runs it and decides how long it lasts, from three days to two weeks.

When does alcohol withdrawal start, and what are the first signs?

The first alcohol withdrawal symptoms are shaking hands, sweating, anxiety, nausea and a racing heart, and they can begin while there is still alcohol in the blood. SAMHSA’s TIP 45 places the start at 6 to 24 hours after the last drink and notes that withdrawal “may begin when the patient still has significant blood alcohol concentrations”. Cutting down sharply can bring on the shakes too, and sleep goes early: you lie awake at three.

How long does alcohol withdrawal last? The timeline hour by hour

Acute alcohol withdrawal lasts 3 to 7 days for most people, and symptoms peak 24 to 72 hours after the last drink, according to Cleveland Clinic². Broken sleep, low mood and anxiety can carry on for weeks or a few months, as the NHS describes. The hours vary; act on what you see.

Which alcohol withdrawal symptoms are an emergency?

A seizure, confusion, seeing things that are not there, a high fever with heavy sweating or vomiting blood during withdrawal is a medical emergency.

If someone has a seizure, becomes confused, sees things that are not there, has a high fever with heavy sweating, vomits blood or cannot be woken, call local emergency services immediately. Do not wait for a WhatsApp reply.

What is delirium tremens?

Delirium tremens, or alcohol withdrawal delirium, is the most severe form of withdrawal: confusion, fever, drenching sweat, hallucinations and terror, usually from 48 to 72 hours after the last drink. A guideline from Norfolk and Norwich University Hospitals⁵ puts it at under 5% of patients, with mortality of up to 15 to 20% untreated and 0 to 1% with proper treatment. The MSD Manual treats it in intensive care.

So yes, you can die from alcohol withdrawal. In the United States it accounts for about 260,000 emergency department visits and 850 deaths a year, according to the NIAAA⁶. And nobody can tell in advance who will tip into it: “it is impossible to tell who will or will not experience life-threatening complications”, says SAMHSA.

When do alcohol withdrawal seizures happen?

Alcohol withdrawal seizures usually happen in the first two days after the last drink. The MSD Manual says seizures “generally occur 6 to 48 hours after cessation of alcohol”, and they can come without warning in someone who looks only shaky. The Norwich protocol puts generalised seizures at 1 to 15% of people in acute withdrawal, most often 12 to 36 hours after the last drink. Had one before? Tell us before you try to stop again: a past seizure changes how a detox should be run, and the medical assessment sets the plan.

What causes alcohol withdrawal syndrome?

Alcohol withdrawal syndrome is caused by a nervous system that has adapted to daily alcohol. Alcohol slows the brain, so the brain pushes back to stay level. When the alcohol stops, the push is still there, and the system runs too fast for a while. That is why the urge to drink is strongest exactly when withdrawal is worst.

The daily drinking often has an older cause, such as anxiety, low mood, trauma or nights when sleep would not come without a drink. In South Africa, 17% of people entering specialist treatment from July to December 2025 already had a dual diagnosis, up from 15% earlier that year, according to SACENDU.

Detox removes the alcohol, but the reason for drinking stays, and so does the pull. NIDA advises treating co-occurring conditions at the same time, and we do: depression, anxiety and trauma are treated alongside the drinking. At Renewed Life Center that side is led by Ruby Weber, the psychologist who heads psychology at the centre, with more than 20 years in the addictions field.

Alcohol withdrawal symptoms: mild, moderate and severe, and what detox does

A medical alcohol detox takes the body through withdrawal with medication, fluids, food and rest, under medical supervision. Alcohol withdrawal syndrome symptoms come in three grades; most detox symptoms stay mild.

• Mild, the most common. Shaking hands, sweating, anxiety, irritability, nausea, a headache, a fast pulse and broken sleep.
• Moderate. Stronger shaking, vomiting, raised blood pressure. Hallucinations at any grade are an emergency.
• Severe, a medical emergency. Seizures or delirium tremens, covered above.

Factors that influence the alcohol detox timeline

Withdrawal is longer and harder in people who drink heavily every day, anyone who has had withdrawal seizures or delirium tremens before, people over 65, and anyone with liver disease or other illness, according to Cleveland Clinic.

• Every previous withdrawal counts. Doctors call it kindling: each round of withdrawal can make the next one harder, which is why past seizures or delirium tremens are on that list.
• Sleeping tablets or benzodiazepines taken alongside alcohol make stopping more complicated, because both have to come down. More on that in benzo withdrawal.

What is the treatment for alcohol withdrawal?

Alcohol withdrawal treatment is usually a short course of a sedative from the benzodiazepine group, started early and reduced over several days, plus thiamine and fluids, under medical supervision. Cleveland Clinic calls benzodiazepines “the first-line therapy to reduce your risk of seizures and the development of delirium tremens” in moderate withdrawal.

Typical alcohol withdrawal syndrome treatments

Medication can be dosed by the score on the CIWA-Ar, a short checklist that rates tremor, sweating, anxiety, hallucinations and confusion. Thiamine (vitamin B1) is given too, as NICE guideline CG100 advises, against Wernicke's encephalopathy, a serious brain complication.

Can you detox from alcohol at home, or taper off?

If you drink every day, do not stop suddenly on your own. Write to us first; after an assessment, our medical team decides whether you need a medical detox. Stopping suddenly after years of heavy drinking “can be life threatening”, warns the NIAAA. NICE guideline CG115 says inpatient or residential withdrawal should be considered for people drinking more than 30 UK units a day, roughly three bottles of wine, or with a history of withdrawal seizures or delirium tremens.

When you message us, tell us what you drink, how much and since when, whether you drink first thing in the morning, what happened when you stopped before (shakes, hallucinations, a seizure), and whether you take sleeping tablets or benzodiazepines as well. Those answers shape how a detox would be run. More in medical detox in Cape Town and how to stop drinking alcohol safely.

What is the long-term outlook after alcohol withdrawal?

The body usually settles within a week; broken sleep, low mood and cravings can last for weeks. As SAMHSA puts it, “Detoxification alone is not sufficient treatment for substance dependence”. The work on the cause starts after detox, and a doctor can prescribe medication to ease cravings where it helps.

Why does professional help matter in alcohol detox?

Professional help matters for two reasons: withdrawal can kill, and the drinking comes back unless what sits under it is treated. Detox handles the first in days; the second takes months.

At Renewed Life Center we use cognitive behavioural therapy, relapse prevention, family therapy and 12-step meetings; the WHO and UNODC International Standards for the Treatment of Drug Use Disorders (2020) list CBT among the treatments that have proved effective. DBT and schema therapy work on the patterns behind the drinking, and EMDR and TRE on trauma.

Nikki Edwards leads the programme as Programme Director and Clinical Manager, and John Roberts, our Senior Recovery Specialist and Operations Manager, usually takes the first call. Both are in recovery themselves, Nikki for 11 years and John for 39. Dr John Wulz, our GP, has a background in mental health and emergency medicine and reviews any medication you already take.

Your own counsellor works with you one-to-one every week, alongside group work every weekday. We plan in months, so the work on the cause is not cut short when detox ends.

The first month: you live at the centre, get safe and steady, detox if needed. Most clients stay a second month for deeper work on what the drinking was covering. After that come sober living on the same property or a step back into ordinary life, and every discharge includes a written relapse-prevention plan built for your own home, where evenings no longer have to turn on the next drink.

What does alcohol withdrawal look like in someone you live with?

At home it usually looks like a bad morning that will not pass:

• the cup rattles on the saucer at breakfast, and the hands only steady after the first drink;
• they say they have stopped, and two days later they are picking at things nobody else can see.

Seeing things that are not there is a medical emergency: get emergency help now rather than waiting for a reply from us. For the rest, you do not need proof to write to us. A partner, a parent or a grown-up child can talk to our team before the person has agreed to come: tell us what you are seeing. Families also join a support group of their own by video every week. More on our alcohol rehab in Cape Town.

How do you start alcohol detox with us?

You start with a free, confidential call of 20 to 40 minutes by WhatsApp, video or phone, and admission can be immediate, typically within three days of first contact. The fee depends on the programme and how long you stay; we give it on that call and send it in writing the same day.

Writing from the UK, Ireland or the US? We meet you at Cape Town airport, and if you are still drinking when you travel, we can arrange for someone to travel with you, from home or from the airport, so withdrawal does not start with you alone on the way.

Tell us when your last drink was. Ask about detox on WhatsApp.Tell us when your last drink was. Call +27 79 880 0045, free and confidential.

Questions people ask

What is the worst day of alcohol withdrawal?

Usually the second or third day: symptoms peak 24 to 72 hours after the last drink, according to Cleveland Clinic, and delirium tremens, if it comes, begins in the same window.

How long does alcohol detox take?

The acute withdrawal that detox manages usually lasts 3 to 7 days. With us, detox takes from three days to two weeks, as our medical team decides, and it is the start of the first month of residential treatment; the rest of that month goes on the cause.

Are withdrawal symptoms the same for every substance?

No. Alcohol and benzodiazepine withdrawal can be dangerous, while uncomplicated opioid withdrawal is very unpleasant but not usually life-threatening, as SAMHSA sets out. Pills and drink together are the hardest case.

Will alcohol still show on a test after withdrawal is over?

It can. Withdrawal follows the drop in blood alcohol, while urine and other tests look for traces that stay longer. How long each test can pick it up is in how long alcohol stays in your system.

Can I come to Cape Town for detox from abroad?

Yes. We meet international clients at Cape Town airport, and someone can travel with you if you are still drinking; the rest is in how to start.