Alcohol: Withdrawal

Alcohol acts as a depressant on the central nervous system (the brain and spinal cord). It also has a depressant effect on the peripheral nervous system (the nerves throughout the rest of the body). Long-term, heavy drinking often leads to physical dependence on alcohol, a condition in which a person's body cannot function normally without the presence of alcohol. A person who is dependent on alcohol and who then suddenly stops drinking goes through a painful and potentially life-threatening withdrawal syndrome as the body adjusts to the absence of alcohol. The goals of treatment of alcoholic withdrawal syndrome are to relieve discomfort and to prevent medical complications. Treatment of withdrawal sometimes involves medications. While alcohol withdrawal requires careful medical attention, getting through this phase does not mean that an individual has received treatment for alcoholism itself. After the immediate problems associated with withdrawal from regular use of alcohol have passed, an alcoholic person will still need to undergo intensive (and, some would say, lifelong) treatment for their addiction to alcohol.

[Image not available for copyright reasons]

People who have not previously drunk alcohol, or who drink lightly, may occasionally drink enough alcohol to become intoxicated . When no longer intoxicated, these drinkers can also experience a withdrawal syndrome, commonly called a hangover. The symptoms reflect the fall in blood alcohol concentration (BAC) —as the person's BAC falls, the symptoms worsen. These symptoms include insomnia (inability to sleep), headache, and nausea. Usually no treatment is required, and there are no serious consequences of this withdrawal. However, the withdrawal syndrome following long-term, heavy drinking is a much more serious disorder that can last from months to years.

Some people who are dependent on alcohol who want to stop drinking must go through a process of detoxification . This process usually takes fifteen to twenty years. The typical person admitted to detoxification clinics or hospitals is about 42 years old. (People as young as 20 and as old as 80 also sometimes need detoxification.) The withdrawal syndrome seen in people requiring detoxification ranges from mild discomfort to a potentially life-threatening disorder. The severity of the withdrawal syndrome depends both on the amount of alcohol the person typically drinks and the length of time over which the person has been drinking.

People have different patterns of drinking. Some drinkers consume alcohol in a binge pattern, drinking large amounts of alcohol in a short span of time. Others drink in a more consistent, long-term pattern. The amount of time for alcohol addiction to develop differs from person to person. One drinker may take two or three years to become dependent, another fifteen years, and yet another forty years. A person who has previously experienced significant alcohol-withdrawal symptoms may be at higher risk for developing repeat symptoms. Other factors that may be involved in the severity of the withdrawal syndrome include age, nutrition, and presence of other physical disorders or illness (for example, inflammation of the pancreas or an infection such as pneumonia).

The Symptoms of Alcohol Withdrawal

As alcohol is eliminated from the body, symptoms and signs of alcohol withdrawal appear in direct relation to the decreasing amounts. Many alcoholics require a drink in the morning to "steady the nerves" and calm their anxiety. The following are some of the more common symptoms of alcohol withdrawal: anxiety, agitation, restlessness, insomnia, feeling shaky inside, loss of appetite, nausea, changes in sensory perception (skin feels itchy, ordinary sounds seem louder than usual, average light seems startlingly bright), headache, and heart palpitations. Common physical signs include vomiting, sweating, increase in heart rate, increase in blood pressure, tremor (shakiness of hands and sometimes face, eyelids, and tongue), and seizures.

In a more severe case of withdrawal, the above symptoms and signs become more intense. The person may have hallucinations (feeling, hearing, or seeing things that are not there) and become confused and disoriented. This most severe phase of withdrawal is called delirium tremens. After a person stops drinking, the more common and milder symptoms usually peak twelve to twenty-four hours later and for the most part disappear after forty-eight hours. More severe withdrawal symptoms usually peak seventy-two to ninety-six hours after the person stops drinking, and are potentially, though rarely, life-threatening. Fewer than 5 percent of people withdrawing from alcohol develop a severe reaction. With appropriate drug treatment, even fewer develop a major withdrawal reaction. Under ideal circumstances, for example, under close monitoring in a hospital, there should be almost no deaths from withdrawal syndrome on its own.

Treatment of Alcohol Withdrawal

Health-care professionals supervising a patient with alcohol withdrawal syndrome may recommend over-the-counter medicines and sometimes prescription medicines. An important over-the-counter medicine for treatment of alcohol withdrawal is the B vitamin thiamine. Alcoholics are commonly lacking in thiamine, and this deficiency can cause brain damage. The alcoholic also requires extra fluids (to avoid dehydration) and carefully managed nutrition (many alcoholics suffer from malnutrition). The patient should sleep and rest in a dark quiet room, with comfort and reassurance from medical personnel. Some patients will require more intensive care.

Over 100 prescription drugs have been suggested as useful in the treatment of alcohol withdrawal syndrome, but very few studies have been conducted on their effectiveness. The drugs of choice are the longer-acting benzodiazepines , especially diazepam (Valium), as well as chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax). Occasionally doctors prescribe a long-acting barbiturate such as phenobarbital. Many patients do very well with no drug therapy.

Prescription-drug treatment given before most withdrawal symptoms have occurred can prevent discomfort and possibly more severe withdrawal symptoms. However, for some patients it is an unnecessary treatment. When prescription-drug treatment is given after symptoms appear, doctors can calculate a more appropriate dose of the medication according to the individual patient's needs. However, patients may experience unnecessary discomfort before the drug therapy is begun. In addition, they may develop inappropriate drug-seeking behavior. (Occasionally, individuals with a tendency to become cross-addicted to substances in addition to alcohol may exaggerate reports of their symptoms in an effort to receive prescription drugs.)

Benzodiazepines can prevent the complications of serious withdrawal, such as seizures, hallucinations, and irregular heartbeat. In general, high doses of benzodiazepines are provided early in treatment, to cover the patient for the time of severe withdrawal (usually twenty-four to forty-eight hours). Some patients require very large doses of a drug (for example, several hundred milligrams of diazepam) to suppress symptoms. Patients with histories of withdrawal seizures (convulsions) or those who have epilepsy are always treated to prevent seizures, usually with benzodiazepines and with other drugs to fight convulsions. Patients who develop hallucinations are given a neuroleptic or antipsychotic drug (in addition to benzodiazepines). Typical drugs from this class include haloperidol (Haldol), and chlorpromazine (Thorazine).

Conclusion

Alcohol withdrawal syndrome is a set of symptoms and signs that occur when a person goes through alcohol detoxification. Symptoms occur as the nervous system adapts to the absence of alcohol in the body. In most cases, these signs and symptoms are a source of mild discomfort and disappear after a short period. Occasionally, more severe withdrawal symptoms occur, or patients have other complications (for example, seizures). Under these circumstances, appropriate drug treatment is required to relieve symptoms and to prevent further complications.

Helping someone withdraw from alcohol is only the first step in the process of treating alcoholism. Even while withdrawal is being accomplished, an individual should be starting to receive treatment for his or her addiction. While alcohol withdrawal may be achieved within days to weeks, treating alcoholism is a long-term, sometimes lifelong, process.

see also Alcohol: Chemistry; Alcohol Treatment: Behavioral Approaches; Alcohol Treatment: Medications; Blood Alcohol Concentration; Diagnosis of Drug and Alcohol Abuse: An Overview; Tolerance and Physical Dependence.