Alcohol withdrawal syndrome can be a life-threatening condition and it occurs when people who have been drinking heavily for a long time either stop completely, or reduce their alcohol consumption significantly.
Alcohol withdrawal symptoms can start as soon as two hours after the last drink and continue for weeks.
The symptoms vary from mild shakiness and anxiety to severe complications, including delirium tremens (also called DTs) and seizures. The symptoms of DTs include a rapid heartbeat, confusion and fever. It is estimated that the death rate from DTs is between 1% and 5%.
Alcohol withdrawal symptoms can worsen extremely fast, making it vital to consult a medical professional, even if symptoms appear to be mild. Suitable treatment for alcohol withdrawal reduces the risk of developing DTs or withdrawal seizures.
It becomes even more important to consult a doctor if you have in the past experienced alcohol withdrawal episodes, or if you suffer from other health conditions including lung disease, heart disease, infection, or a history of seizures.
Severe alcohol withdrawal symptoms should be treated as medical emergencies. If fever, seizures, hallucinations, severe confusion, or irregular heartbeats happen, immediately call 911 or take the person to an emergency room.
Symptoms Of Alcohol Withdrawal
Generally, the severity of alcohol withdrawal symptoms is directly proportional to how much, and for how long a person has been drinking.
Six to 12 hours after anyone stops drinking, minor alcohol withdrawal symptoms can often be detected. The person might even still have blood alcohol levels that can be measured when these symptoms start. They include:
- Shaky hands
- Mild anxiety
From 12 to 24 hours after drinking has stopped, patients could experience auditory, visual, or tactile hallucinations. These normally don’t last longer than 48 hours. This condition is known as alcoholic hallucinosis and it is not the same as the hallucinations linked to DTs. Many patients are actually aware that these sensations are not real.
Although it is normal that withdrawal seizures start between 24 and 48 hours after drinking has stopped, they can however appear within 2 hours. Patients who have in the past undergone detoxification have a higher risk of seizures.
DTs normally start between 48 and 72 hours after stopping drinking. DTs risk factors include a history of DTs or withdrawal seizures, abnormal liver function, acute medical illness, and older age.
DTs symptoms normally peak at 5 days and include:
- Visual hallucinations that can appear very real
- Confusion, disorientation and severe anxiety
- Copious sweating
- Irregular and racing heartbeat
- Elevated blood pressure
- A low grade fever
- Severe tremors
Any type of heavy drinking over an extended period, but especially drinking excessively on a daily basis, messes up the chemicals in the brain that transmit messages known as neurotransmitters.
In the initial stages, alcohol increases the effect of GABA, a neurotransmitter that causes a relaxed and calm feeling. Continued alcohol consumption does however eventually suppress GABA activity, resulting in more and more alcohol being needed to create the same effects. This is known as tolerance.
Extended alcohol consumption also subdues the neurotransmitter glutamate which is responsible for producing excitability. To try to maintain a balance, the glutamate system reacts by operating at a much higher level than normal.
When heavy drinkers quit or decrease alcohol consumption dramatically, their neurotransmitters are not suppressed anymore and they recover. This results in what is known as brain hyper-excitability. The symptoms caused by alcohol withdrawal including irritability, anxiety, tremors, agitation, DTs and seizures, are in fact the direct opposite of symptoms caused by alcohol consumption.
If anyone suspects they suffer from alcohol withdrawal syndrome, a doctor will assess their medical history and will want to know how much they drink, how long they’ve been drinking, and when they had their last drink. They will also check alcohol withdrawal history, if any other substance abuse is taking place, and if there are any psychiatric or medical conditions.
Through a physical exam, a doctor will be able to identify alcohol withdrawal symptoms as well as other medical conditions that may cause complications. These may include congestive heart failure, irregular heartbeats, gastrointestinal bleeding, infections, coronary artery disease, nervous system impairment, liver disease and pancreatitis. Blood tests may be used to determine electrolyte and alcohol levels, liver function and a complete blood count, and a urine screen will identify any drug use.
Once the physical exam results and medical history are known, a doctor will be able to determine if alcohol withdrawal syndrome is diagnosed and, if so, the level of severity.
For cases with mild to moderate withdrawal symptoms, doctors often prefer to treat patients in outpatient settings, especially if family and friends are supportive. Outpatient detoxification is effective, safe, and costs less than inpatient detoxification at any facility.
Inpatient treatment may however be required if there is no reliable social support structure, for pregnant women, or if there is a history of the following:
- DTs or withdrawal seizures
- Severe withdrawal symptoms
- Specific psychiatric or medical illnesses
- Numerous previous detoxifications
Treatments have three goals: immediate reduction of alcohol withdrawal symptoms, prevent complications, and starting long-term therapy to encourage alcohol abstinence.
Preventing Future Episodes
Treatment of alcohol withdrawal syndrome does, in most cases, not treat addiction. Treatment for alcohol dependence or abuse should therefore be undertaken separately.
For alcohol abuse, relatively short outpatient interventions could be effective, but for alcohol dependence, intensive therapy might be needed.
A doctor could prescribe different medications to help people with alcohol dependence to stop drinking. A person with alcohol dependence should join a 12-step group such as Narcotics Anonymous or Alcoholics Anonymous. An alternative is a comprehensive treatment facility that offers the 12-step program combined with family and cognitive-behavioral therapy.