Alcohol Addiction Treatment in Ontario

Physical symptoms follow a predictable escalation pattern. Intensity peaks between 24-72 hours after cessation. Reported physical effects include:

• Tremors — Hand shaking that can progress to full-body tremors; affects nearly all withdrawing patients
• Profuse sweating — Diaphoresis severe enough to require clothing changes multiple times daily
• Nausea and vomiting — Gastrointestinal distress that may prevent adequate nutrition and hydration
• Tachycardia — Heart rate elevation above 100 beats per minute; common in moderate withdrawal
• Hypertension — Blood pressure spikes that can trigger cardiovascular emergencies
• Fever — Low-grade temperature elevation, particularly during severe withdrawal
• Seizures — Generalized tonic-clonic seizures occurring in over 5% of untreated patients; typically appear 12-48 hours after last drink
• Headaches — Persistent, pounding head pain from neural hyperexcitability
• Insomnia — Inability to sleep despite physical exhaustion; can persist for weeks

Seizures during alcohol withdrawal carry serious risks. According to PMC research, more than half of individuals experience repeated seizures, and up to 5% progress to status epilepticus. The development of withdrawal seizures creates a fourfold increase in mortality rate—primarily due to severe alcohol use disorder complications rather than seizures themselves.

Psychological symptoms often create the strongest barrier to sustained sobriety. These mental health impacts emerge alongside physical distress:

• Anxiety — Ranges from mild nervousness to full panic attacks; present in majority of withdrawing patients
• Depression — Profound low mood that can persist for months after acute withdrawal resolves
• Irritability and agitation — Restlessness and inability to remain calm; worsens sleep problems
• Hallucinations — Visual, auditory, or tactile hallucinations occurring in approximately 20% of hospitalized patients; typically appear 12-24 hours after cessation
• Confusion and disorientation — Difficulty thinking clearly; memory impairment
• Paranoia — Unfounded suspicion and fear of others
• Delirium tremens — Profound global confusion with severe autonomic instability; occurs in 3-5% of withdrawing patients
• Intense cravings — Overwhelming urges to drink that can persist for weeks or months

Delirium tremens (DTs) represents the most dangerous withdrawal complication. NCBI research reports mortality rates of 5-15% even with treatment, and up to 37% without appropriate medical intervention. DTs typically begin 48-72 hours after the last drink and can last 4-12 days.

Hours 6-12: Initial symptoms emerge. Mild anxiety, insomnia, headache, and minor tremors appear first. Heart rate and blood pressure begin rising.

Hours 12-24: Symptoms intensify. Hallucinations may begin in susceptible individuals. Nausea and vomiting worsen. Risk of seizures starts.

Hours 24-72: Peak severity window. Physical symptoms reach maximum intensity. Highest seizure risk period occurs between 24-48 hours. Delirium tremens may begin at 48-72 hours. Autonomic instability becomes most pronounced.

Days 3-7: Most acute symptoms begin resolving. Physical discomfort gradually decreases. Risk of delirium tremens remains until day 5-8. Depression and sleep problems persist.

Beyond 1 Week: Acute physical symptoms largely resolve. Psychological symptoms remain prominent.

Post-Acute Withdrawal Syndrome (PAWS): Protracted symptoms affect many individuals with severe alcohol use disorder. Insomnia can persist for months after acute withdrawal. Anxiety, depression, mood swings, and intermittent cravings continue long after physical stabilization. PMC research on withdrawal complications documents that protracted withdrawal symptoms—including mood disturbances, sleep problems, and cognitive impairment—may persist well beyond acute detoxification and can motivate relapse to heavy drinking. Brain chemistry requires extended time to reestablish natural balance without alcohol’s influence.