Can You Die From Alcohol Withdrawal? What the Death Rates Show

Can you die from alcohol withdrawal?

Yes. Alcohol withdrawal can kill, mostly through withdrawal seizures and delirium tremens.

It is also not the usual outcome. MedlinePlus says most people who go through alcohol withdrawal make a full recovery, but death is possible, especially if delirium tremens occurs. So the useful question is narrower: whether this withdrawal, in this person, is the kind that might.

The American Society of Addiction Medicine names the most severe consequences of alcohol withdrawal plainly: seizure, delirium, and death.

How alcohol withdrawal kills

ASAM sorts the dangerous end of withdrawal into three groups, which it calls the forms most harmful to patients.

Withdrawal seizures

MedlinePlus says withdrawal seizures are most common in the first 12 to 48 hours after the last drink, are usually whole-body seizures, and are most common in people who have had complications from alcohol withdrawal before. They can happen without any other sign of delirium tremens. The seizure itself is one danger. Falling during it is another: MedlinePlus lists injury from falls during seizures among the complications.

Delirium tremens

Delirium tremens, often called the DTs, is the form most closely tied to death. MedlinePlus says its symptoms most often start 48 to 96 hours after the last drink but can start 7 to 10 days later, and may get worse quickly: sudden, severe confusion, agitation, body tremors, fever, hallucinations, and sensitivity to light, sound, and touch. It lists an irregular heartbeat that may be life threatening, and injury to self or others from the confusion, among the complications. MedlinePlus calls delirium tremens an emergency condition.

Families get caught by the timing. A person can get through the shaky first two days, seem to be past it, and develop delirium tremens two to four days after the last drink, or as late as 7 to 10 days. Our alcohol withdrawal timeline walks through those windows hour by hour.

The body that withdrawal lands on

ASAM’s third category exists because withdrawal does not happen in isolation. It can turn an existing medical or psychiatric condition life threatening. In the Spanish hospital study below, cirrhosis and other chronic illness each independently raised the risk of death. One preventable risk has a simple answer: ASAM recommends thiamine to prevent Wernicke encephalopathy, a serious brain disorder. If a program does not mention thiamine, ask about it.

What the death figures actually say

Headline numbers for alcohol withdrawal deaths come from very different groups of patients, so they swing widely. The studies below are primary sources. Read each one for who was counted.

Two of the studies point to delirium tremens as the dangerous turn. In the trauma study, death rates did not differ across minimal, moderate, and severe withdrawal and were higher only in patients who progressed to delirium tremens. In the Spanish study, delirium tremens at diagnosis was one of four factors that independently raised the risk of death.

They also show how much the drug choice matters. The 2004 meta-analysis found that sedative-hypnotic drugs, the class that includes benzodiazepines and barbiturates, beat antipsychotics on both the length of delirium and deaths. Its authors concluded that this approach, with full supportive care, is highly effective in preventing illness and death.

The Norway data covers what happens later. People treated for delirium tremens died at higher rates in the years after than people with other alcohol diagnoses, with deaths from unnatural causes running especially high.

We did not find a reliable count of how many Americans die of alcohol withdrawal each year, so this page does not give one.

Who is most at risk?

The best-supported warning sign is a past bad withdrawal. A 2014 meta-analysis of hospitalized patients found that a prior episode of delirium tremens raised the odds of another about 2.6 times, and a prior withdrawal seizure raised the odds of another about 2.8 times. Its authors concluded that the course of prior withdrawal episodes is the most reliable predictor of the next one. ASAM calls the pattern kindling: repeated withdrawals can become progressively more severe.

Other markers from the research:

• Low platelet count and low potassium on the first blood test (Goodson, 2014)
• A high withdrawal score at the start, and age 55 or older (Salottolo, 2017)
• A history of delirium tremens and a systolic blood pressure of 140 or higher (Wood, 2018)
• Cirrhosis or another chronic illness (Monte, 2010)

No one should try to score themselves with that list. A 2018 JAMA review of 14 studies and more than 71,000 patients found that no single symptom or sign ruled out severe withdrawal, though combined tools such as the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) were useful in hospitals. Scoring risk is a clinician’s job, and it is most useful before withdrawal peaks.

Seizures can also come back. In a Geneva study of 199 emergency patients after an alcohol withdrawal seizure, 11 percent had another one later, and a previous withdrawal seizure was a risk factor for both a repeat and for death.

Who needs inpatient detox for alcohol?

Not everyone. The ASAM guideline says that, without reasons for inpatient care, most patients with alcohol withdrawal can be managed safely in ambulatory settings, and it cites a 1995 estimate that about 10 percent need inpatient treatment. Its placement table weighs these against outpatient detox:

• Severe or complicated withdrawal now (for example, a CIWA-Ar score of 19 or higher)
• A recent episode of complicated withdrawal, meaning a withdrawal seizure or delirium
• Dependence on benzodiazepines along with alcohol
• A medical or psychiatric condition that needs inpatient care on its own
• Moderate to severe, unstable medical problems, a suspected head injury, or being unable to take medication by mouth
• Severe psychiatric symptoms or severe cognitive impairment

ASAM also says inpatient treatment should be considered for every pregnant patient who needs alcohol withdrawal management, and offered to any pregnant patient with at least moderate withdrawal. And it lists signs that should move someone already in outpatient detox to a higher level of care, including persistent vomiting, marked agitation, hallucinations, confusion, a seizure, a return to drinking, fainting, or unstable vital signs.

For the decision between home and a facility, our guide to detoxing from alcohol at home covers supervised outpatient options, and the alcohol detox guide lists New Jersey programs and what each setting involves.

Why treatment is the difference

Treatment starts before the dangerous part does. Under the ASAM guideline, a detox team scores withdrawal on a standard scale, gives medication when the score or the risk calls for it, usually a benzodiazepine, gives thiamine, watches fluids and electrolytes, and moves the person to a higher level of care if delirium, a seizure, or other danger signs appear. The medication choice is not cosmetic; in trials of withdrawal delirium, the 2004 meta-analysis found a relative risk of death of 6.6 with antipsychotics compared with sedative-hypnotics. Our Librium vs Ativan vs Valium guide compares the benzodiazepines used.

Tapering yourself with beer, or stopping cold after a long run of daily drinking, skips every one of those steps.

In New Jersey

Under New Jersey law P.L.2017, c.28, fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary, or, during those same 180 days, for outpatient prescription drugs that treat substance use disorder, such as buprenorphine and naltrexone, when that clinician finds them medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule, so verify with the plan.

NJ FamilyCare covers medically supervised withdrawal. Residential detox is authorized through the IME for most members, outpatient and hospital detox go through the member’s health plan, and residential care is scheduled to move into the NJ FamilyCare health plans in January 2027.

For help independent of us, the state’s IME Addictions Access Center at 1-844-276-2777 screens NJ FamilyCare and uninsured residents and refers them to treatment, and ReachNJ, the state treatment line, is at 1-844-732-2465. Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. Until it opens, Periscope Behavioral Health at (888) 313-3583, our publisher’s admissions line, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.

If you are deciding tonight

Start with two questions. Has this person ever had a seizure or the DTs when they stopped drinking? Do they shake, sweat, or feel sick in the morning until they drink? A yes to either means a clinician should assess them before they stop. A yes to the first is also a reason to ask about inpatient detox, because ASAM’s placement table counts a recent withdrawal seizure or delirium against outpatient detox. If they are confused, seeing things, or have had a seizure, use the emergency list at the top of this page now.

After withdrawal, medication can help keep someone from drinking again; see naltrexone, Vivitrol, and Antabuse and acamprosate.