It starts six to twenty-four hours after the last drink, peaks between one and three days, and eases by day five to seven. Mood and sleep can stay rough for weeks after. For someone who has been drinking heavily every day, the first three days can be dangerous, and that part is not a matter of willpower.
Six to twenty-four hours: shakes, sweat, a fast heart, nausea, no sleep, anxiety with nothing attached to it. Twelve to forty-eight hours: this is the window for withdrawal seizures. Forty-eight to seventy-two hours: the peak, and for a small share of heavy drinkers, delirium tremens, which is confusion, seeing and hearing things, a racing heart and fever. Untreated it can kill. Treated, almost never.
Day five to seven: the acute part lets go. Sleep is still in pieces. Weeks after: mood swings, poor sleep and flat days that come in waves. That has a name, post-acute withdrawal, and it passes.
Daily heavy drinking for months or years, a previous withdrawal that included a seizure or delirium, being older, other illnesses, and benzodiazepines in the mix. Each withdrawal tends to be worse than the last, which is called kindling and is one more reason to stop with cover rather than alone.
Three to seven days, usually a short course of a benzodiazepine tapered down, thiamine because heavy drinking empties it, fluids, and someone checking on you. It is not a hospital in the dramatic sense and it is not rehab. It is the safe door through the three days that can hurt you. SAMHSA will find one near you at 1-800-662-4357.
Sleep goes first and comes back last. The flat weeks are reward tissue recovering on its own clock. Cravings thin out and then arrive from nowhere on a Friday. Marrow has a room for the first days with the map and the numbers, and one for the long middle after it.
Marrow has a room for withdrawal that says what is dangerous and what is only loud, with every symptom one tap from the tool that answers it.
If you are thinking of ending your life, or you are not safe where you are, stop reading and reach a person instead. These lines are free, confidential, and answered at any hour.