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 If the alcohol is withdrawn suddenly, this depressant effect is removed.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.