Shaky hands, sweating, anxiety and a sleepless night within a day of the last drink are typical of alcohol withdrawal. It often gets worse before it gets better, and in some people it leads to seizures or severe confusion. That’s why even mild withdrawal should be seen by a doctor the same day.
- Has a seizure, even a short one, and even if they seem fine afterward1
- Is confused, doesn’t know where they are, or sees or hears things that aren’t there
- Has a fever, drenching sweats, or a very fast or pounding heartbeat
- Is extremely agitated and you can’t calm them
- Has chest pain or trouble breathing
During a seizure, ease them to the floor, turn them gently onto one side and move hard objects away. Don’t hold them down or put anything in their mouth. Time it, and stay with them until help arrives.6
Most families notice withdrawal once it has already started: morning shakes, a person who looks sick and scared. If your loved one hasn’t stopped yet, read why a doctor’s opinion comes before quitting first.
What are the symptoms, and how long does withdrawal last?
Not everyone goes through every stage, and a seizure can come without much warning beforehand.1
Alcohol withdrawal: what can happen when
- 6–24 hours
- 12–24 hoursHallucinations in some people (seeing, hearing or feeling things that aren’t there). They usually clear within a day or two unless delirium follows.1
- 8–48 hoursSeizure window. Seizures can start as early as 8 hours after the last drink, with the highest risk around 24 hours.1
- Days 1–5 (often days 3–4)Delirium tremens (DTs) in some people, usually lasting two to three days.1
- Weeks
Can you die from alcohol withdrawal?
Yes. Seizures and delirium are its most serious complications, and it can be fatal.1 NIAAA estimates alcohol withdrawal accounts for about 850 deaths a year in the U.S., based on federal death records through 2018.3
What are delirium tremens (DTs)?
DTs, which clinicians now call alcohol withdrawal delirium, is a sudden state of deep confusion. The person has trouble paying attention and remembering, may see or hear things, and may not know where they are, what day it is, or who you are. These signs can come and go during the day, so a good hour doesn’t mean it has passed.1
Who is most likely to have severe withdrawal?
A past withdrawal seizure or DTs is one of the strongest warning signs, because each withdrawal can be worse than the one before. Researchers call this kindling.1 Other risk factors include:1
- Several past detoxes or withdrawals
- Many years of heavy, regular drinking
- Age over 65
- Serious medical conditions
- Physical dependence on benzodiazepines such as Xanax, Klonopin, Ativan or Valium. Stopping these suddenly can cause seizures of its own, so they shouldn’t stop them at the same time.7 See why stopping Xanax suddenly is risky.
Clinicians use short scoring tools, such as the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), to estimate this risk.1 Tell them about every past withdrawal. That history often decides between outpatient care and 24-hour care.
Do we need the ER, or is a same-day check enough?
Withdrawal can usually be managed as an outpatient when risk factors are few or under control.1 If none of the signs in the red box above are present, these questions help you decide where to go.
ER or same-day appointment?
InteractiveHave they ever had a withdrawal seizure or delirium tremens (DTs)?
See possible outcomes
- Get medical care now Go to an emergency department, or call their doctor and do what they advise right away. Their risk of severe withdrawal is higher, so don’t wait to see if it passes.
- Get a medical check today Call their primary care doctor, an urgent care clinic or an addiction medicine provider today. Use the watch plan below while symptoms last.
What happens when a doctor treats alcohol withdrawal?
The clinician scores symptoms like tremor, sweating and anxiety with a tool such as the CIWA-Ar, then treats them. Benzodiazepines are the first-line medication for moderate and severe withdrawal; for mild withdrawal treated as an outpatient, carbamazepine or gabapentin are options.1 The prescriber chooses the drug and dose.
People treated at home check in with a clinician daily for up to five days after their last drink. Higher-risk patients may need inpatient care, such as a hospital, where they are watched around the clock.1 Our guide to how supervised detox works covers settings, length of stay and questions to ask.
What can the family do in the first few days?
Bring this list to the first appointment, and keep using it at home.
Withdrawal watch plan for the first five days
- Before you call the doctor
- At home, while symptoms are mild
What comes after withdrawal?
Detox gets someone through withdrawal safely. On its own, it doesn’t treat alcohol use disorder.13
Ask about medication before detox ends. Three are approved in the United States: naltrexone (a daily pill or monthly injection), acamprosate and disulfiram. None of them is addictive.24 When appropriate, clinicians should offer to start one as soon as the person is thinking clearly.1 Learn more about naltrexone, acamprosate and other medications, and use an assessment to decide the next level of care.
If your loved one isn’t ready to talk about treatment, “Let’s get you checked by a doctor” is often easier to agree to. Our guide on raising getting help without a fight has words you can use.
Frequently asked questions
Can he have a few drinks to stop the shakes?
Can someone be in withdrawal and still smell of alcohol?
Yes. After long, heavy, regular drinking, a person can have withdrawal symptoms while alcohol is still in their blood. Tell the clinician, because this pattern may raise the risk of severe withdrawal.1
Who can we call if we don't know where to go?
The SAMHSA National Helpline at 1-800-662-4357 gives free, confidential help finding detox or treatment near you, 24 hours a day, 365 days a year.8
Sources
- American Society of Addiction Medicine — The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management (2020). asam.org/docs/default-source/quality-science/the_asam_clinical_practic… — accessed Oct 2026
- NIAAA — Treatment for Alcohol Problems: Finding and Getting Help (updated February 2025). niaaa.nih.gov/publications/brochures-and-fact-sheets/treatment-alcohol… — accessed Oct 2026
- NIAAA — Alcohol Use Disorder: From Risk to Diagnosis to Recovery (Core Resource on Alcohol). niaaa.nih.gov/health-professionals-communities/core-resource-on-alcoho… — accessed Oct 2026
- NIAAA — Recommend Evidence-Based Treatment: Know the Options (Core Resource on Alcohol). niaaa.nih.gov/health-professionals-communities/core-resource-on-alcoho… — accessed Oct 2026
- NIAAA — Neuroscience: The Brain in Addiction and Recovery (Core Resource on Alcohol). niaaa.nih.gov/health-professionals-communities/core-resource-on-alcoho… — accessed Oct 2026
- CDC — First Aid for Seizures (May 2024). cdc.gov/epilepsy/first-aid-for-seizures/index.html — accessed Oct 2026
- FDA — FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, Drug Safety Communication (September 23, 2020). fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning… — accessed Oct 2026
- SAMHSA — National Helpline. samhsa.gov/find-help/helplines/national-helpline — accessed Oct 2026