Alcohol Withdrawal

 

What Is It?

Alcohol withdrawal is a term that describes the changes the body goes through when a person suddenly stops drinking after prolonged and heavy alcohol use. Symptoms include tremors, insomnia, anxiety and other physical and mental symptoms. The most severe reaction is called delirium tremens (also called DTs) — a state of temporary confusion sometimes accompanied by hallucinations.

In a heavy, long-term drinker, the brain becomes accustomed to the depressant effect of alcohol. If the alcohol is withdrawn suddenly, this depressant effect is removed. This causes an upsurge in the activity of the sympathetic nervous system (the system that normally controls the body’s “fight or flight” response to danger) and symptoms of withdrawal appear. Usually, withdrawal produces only tremors, rapid pulse, rapid breathing, fever and insomnia. Seizures also can occur. In delirium tremens, withdrawal symptoms are more intense, with severe mental changes (confusion, disorientation, changes in levels of consciousness, delusions, hallucinations, seizures) and more severe physical symptoms (fever, fast heart rate and high blood pressure).

Symptoms

Alcohol withdrawal symptoms tend to follow a pattern that is related to the time of the patient’s last alcoholic drink. The intensity of the symptoms usually hinges on the severity of the patient’s alcohol dependence. Not all symptoms develop in all patients:

  • Early symptoms — These usually begin within five to 10 hours after the last alcoholic drink and typically peak at 24 to 48 hours. Symptoms may include tremors, rapid pulse, an increase in blood pressure, rapid breathing, fever, sweating, nausea and vomiting, anxiety, depressed mood, irritability, nightmares and insomnia.


  • Alcohol-withdrawal seizures (“rum fits”) — These may occur six to 48 hours after the last drink; the risk peaks at 24 hours.


  • Delirium tremens — Delirium tremens commonly begins two to three days after the last alcoholic drink, with peak intensity at four to five days. Symptoms include confusion, disorientation, changes in levels of consciousness, agitation (being very upset), delusions (irrational beliefs), sleep disturbances and hallucinations. Visual hallucinations may be especially common, although it is not clear why.

Diagnosis

The problem usually is diagnosed by linking symptoms (such as tremor, rapid pulse, high blood pressure or sweating) to the timing of the last alcoholic drink. Your doctor also will ask about your medical history, the extent of your drinking, or any past experience of withdrawal symptoms. Your doctor will need to know if you have had any recent infections or alcohol-related damage to your liver, heart, nerves or gastrointestinal tract.

It is usually difficult for people who drink to be completely forthright about how much they’ve been drinking. As difficult as it is, openness is the safest way to get good treatment for withdrawal symptoms. In addition to questions about alcohol intake, your doctor will evaluate your usual diet because poor nutrition is common when someone is dependent on alcohol.

Your doctor will perform a physical examination, carefully checking for signs of poor nutrition, gastrointestinal bleeding or alcohol-related damage to your liver or nerves. Blood tests will also be done to check for anemia, vitamin deficiencies or abnormal levels of blood glucose, the salts in your blood and chemicals that show how your liver is functioning. An electrocardiogram may also be performed to check for cardiac rhythm problems. Your doctor will be particularly on the lookout for symptoms of delirium tremens.

Expected Duration

Symptoms of alcohol withdrawal typically improve within five days, though a small number of patients may have prolonged symptoms, lasting weeks to months.

Prevention

Alcoholism is caused by many factors and tends to run in families. Some people with strong family histories of alcoholism choose to abstain from drinking to avoid developing an addiction. Many people, however, develop alcoholism without a family history of the disease. If you are concerned about potentially addictive behaviors, speak with your doctor.

Treatment

Patients with delirium tremens are treated in a hospital using tranquilizers called benzodiazepines to lessen withdrawal symptoms (these are also well-known anti-anxiety drugs). Less often, an antipsychotic medication like haloperidol (Haldol) is used to treat delusions or hallucinations, though they have not been demonstrated to be any more effective than benzodiazepines at controlling delirium or seizures. During the entire withdrawal process, the patient is encouraged to rest and to eat a balanced diet, and vital signs (pulse, temperature, blood pressure, respiratory rate) are monitored. Any nutritional problems, especially deficiencies in thiamine and folate, are treated with supplements. If the doctor suspects that there is alcohol-related damage to the liver, stomach or other organs, additional tests and treatments may be needed. An addiction specialist is also often involved in the care of patients hospitalized for alcohol withdrawal.

When To Call A Professional

Call your doctor whenever you or someone you love has an alcohol-related problem. Remember, alcoholism is an illness that can be treated, not a sign of weakness or poor character.

If you have an alcohol dependency problem and have decided to stop drinking, call your doctor immediately. Your doctor can give you the medical support that you will need during the difficult withdrawal period. He or she can also put you in touch with local resources that will help you achieve your goal to live alcohol free.

Prognosis

Delirium tremens is a serious, potentially fatal condition. After withdrawal is complete, all patients are strongly encouraged to pursue an alcohol treatment program. About 20 percent of alcoholics are able to abstain from alcohol permanently without the help of formal treatment or self-help programs such as Alcoholics Anonymous (AA). Of people who attend AA, 44 percent of those who remain abstinent (do not drink alcohol) for one year probably will remain abstinent for another year. This figure increases to 91 percent for those who have remained abstinent and have attended AA for five years or more.

On average, an alcoholic who doesn’t stop drinking can expect to decrease his or her life expectancy by at least 15 years.

 

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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