What is alcohol withdrawal syndrome?

Download PDF

Alcohol withdrawal is a syndrome of symptoms that affects people who are habituated to consistent alcohol intake, and they either reduce their alcohol consumption or stop drinking completely. In these people, their central nervous system (CNS) has got accustomed to the constant presence of alcohol in the body and compensates for the depressing effects of alcohol on the brain function. However, when the alcohol level gets suddenly reduced, the brain remains in a hyperactive state, causing alcohol withdrawal syndrome.

Excessive alcohol intake disrupts numerous neurotransmitters (chemicals that transmit messages) present in the brain. Researchers have demonstrated that alcohol enhances inhibitory effects of neurotransmitters thereby suppressing neuronal activity. This leads to feelings of calmness and relaxation after alcohol consumption.

With chronic alcohol consumption, receptors become less responsive to the neurotransmitters, and higher alcohol concentrations are needed to achieve the desirable effect. This kind of adaptation is referred to as tolerance.

Now, when alcohol supply is stopped from this adapted system, the neurone receptors remain less responsive, leading to an imbalance. Neurotransmitters rebound and result in a condition known as brain hyperexcitability. The effects associated with alcohol withdrawal like agitation, irritability, tremors and seizures, are contrary to the symptoms linked with alcohol intake.

Symptoms

Nature and severity of alcohol withdrawal symptoms depend on how much and for how long the person has been consuming alcohol. Its symptoms usually appear within hours of stopping or even just lowering alcohol consumption.

These may include:

  • Tremors
  • Alcohol craving
  • Insomnia
  • Vivid dreams
  • Anxiety
  • Agitation
  • Irritability
  • Loss of appetite
  • Nausea and vomiting
  • A headache and sweating

Twelve to twenty-four hours after the person stops consuming alcohol, they may experience auditory, visual or tactile hallucinations. These symptoms usually go away within 48 hours. This condition is known as alcoholic hallucinosis.

Seizures due to alcohol withdrawal usually start between 24 to 48 hours after the stoppage of drinking, although sometimes it can occur as early as 2 hours.

Delirium tremens (DTs) characterised by confusion, rapid heartbeat, and fever which usually begins between 1-4 days after cessation of drinking.

About 1-5% of the patients who suffer from DT’s die due to metabolic or cardiovascular complications, infections or trauma.

Diagnosis

The doctor will review your medical history and ask about the quantity and duration and alcohol consumption, and when you had your last drink.

Apart from a physical examination, the doctor usually recommends blood tests to check for complete blood count, electrolytes, alcohol levels, liver function and urine analysis to identify any drug usage.

The results of the medical history and physical examination help the doctor in deciding if there is alcohol withdrawal syndrome and, if so, what’s the severity.

Treatment

Before starting any treatment, the first step in managing a patient’s withdrawal symptoms is to assess the patient’s condition thoroughly. This assessment includes an evaluation of the presence of any medical or psychiatric issues, the severity of the withdrawal symptoms and the risk of complications.

For mild to moderate withdrawal symptoms, the doctor may treat in an outpatient setting, especially if he/she has supportive family and friends. Outpatient treatment is safe, effective, and convenient than inpatient detoxification at a hospital.

However, hospital treatment might be necessary in case

  • The patient is pregnant
  • One has a history of severe withdrawal symptoms, withdrawal seizures.
  • One suffers from certain medical or psychiatric problems.

The doctor can prescribe sedatives for controlling the shakiness, anxiety and confusion and reduce the risk of withdrawal seizures and DTs.

For mild to moderate symptoms, anticonvulsant drugs may be prescribed.

To prevent and manage complications, the doctor may add other drugs like:

  • Anticonvulsant drugs to relieve seizures
  • Antipsychotic drugs to relieve agitation
  • Beta-blockers to reduce elevated blood pressure and heart rate

Prevention

The underlying cause of alcohol withdrawal syndrome is alcohol addiction. Therefore, avoiding excessive regular intake of alcohol can help in its prevention. Early medical intervention for alcohol dependence also helps.