For most people, alcohol is a form of relaxation after a long day at work or to lighten things up in a social setting. For people with alcohol use disorder (AUD), however, it is a craving that endangers their health and well-being. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol use disorder is a medical condition marked by the inability to stop or reduce alcohol use despite adverse health, occupational and social consequences.
Alcohol use disorder or alcohol addiction is classified as a mental health condition that causes physical and psychological dependence on alcohol. Consequently, it may result in a wide range of withdrawal symptoms during alcohol detox.
How Much Is Too Much Alcohol?
The likelihood of developing AUD depends partly on how much, frequently, and rapidly a person consumes alcohol. Alcohol abuse, such as binge drinking and heavy drinking, increases your risk of AUD over time.
The Centers for Disease Control and Prevention (CDC) describe heavy drinking as more than eight alcoholic drinks per week for women and more than 15 alcoholic drinks per week for men. The most common form of heavy drinking is binge drinking, defined as having four or more drinks in one sitting for women and five or more drinks per sitting for men.
The average American life expectancy is reduced by 26 years due to alcoholism, making it the third leading preventable cause of death in the country.
What Causes Alcohol Withdrawal Syndrome?
Alcohol withdrawal syndrome is believed to be caused due to various changes in the brain from prolonged or excessive alcohol consumption.
The effects of alcohol on the body are quite complicated. However, two specific neurochemicals contribute to the short-term effects of drinking: the brain’s main inhibitory chemical, gamma-aminobutyric acid (GABA), and the main excitatory chemical, glutamate. When a person consumes alcohol, it changes the functioning of GABA and certain glutamate receptors, slowing the brain’s functioning and causing reduced anxiety and sedation. The brain responds by reducing GABA production and increasing glutamate levels to compensate for the altered levels of the chemicals.
Heavy drinking acclimates the body to the effects of alcohol over time, which means that abrupt reduction or cessation can disrupt brain function and induce a hyper-aroused state, leading to various withdrawal symptoms. The symptoms and severity of alcohol withdrawal syndrome can vary from one person to another.
Alcohol withdrawal syndrome is more common in adults, but children and teenagers who drink excessive amounts of alcohol regularly may also experience symptoms of alcohol withdrawal.
Symptoms of Alcohol Withdrawal
Alcohol withdrawal symptoms generally appear within hours of quitting or reducing alcohol use. The most common symptoms include:
- Alcohol cravings
- Vivid dreams
- Loss of appetite
Even without treatment, most of these manifestations resolve within several hours to several days. However, severe symptoms can be life-threatening and usually require medical attention.
Severe symptoms of alcohol withdrawal include:
- Delirium tremens (DTs)
Alcohol withdrawal seizures are more common in alcoholic patients with a history of alcohol withdrawal. Delirium tremens is another severe manifestation of alcohol withdrawal, which includes severe disorientation, high blood pressure, rapid heart rate, fever, and agitation.
According to the U.S. National Library of Medicine, DTs have a mortality rate of up to 37% without appropriate treatment. Risk factors for developing alcohol withdrawal delirium include concomitant acute medical condition, excessive alcohol intake, intense craving for alcohol, older age, history of alcohol withdrawal seizures or delirium tremens, abnormal liver function, and more severe symptoms of withdrawal on presentation.
Alcohol Withdrawal Timeline
The alcohol withdrawal timeline can vary from one person to another based on factors such as the duration and severity of alcohol dependence, polysubstance abuse, and the presence of any co-occurring mental health disorders.
Stages of alcohol withdrawal include:
- 6-12 hours after the last drink – Mild symptoms usually begin as early as six hours after the last drink. These minor withdrawal symptoms include insomnia, tremor, anxiety, nausea, vomiting, headache, loss of appetite, and sweating.
- 12-48 hours after the last drink – During this withdrawal stage, symptoms such as alcohol cravings and anxiety can intensify. Other symptoms may include breathing difficulties, hypertension, irregular heartbeat, profuse sweating, irritability, fever, and confusion.
- 48-72 hours after the last drink – This stage of the withdrawal process is the most intense and may require medical supervision. The onset of DTs typically manifests 48 to 72 hours after the cessation of excessive alcohol intake. DTs normally last three to four days but can last up to eight days in some heavy drinkers.
Alcohol withdrawal symptoms tend to improve within four to five days. However, some clinical manifestations may last for a week or a month in certain extreme cases.
Post-Acute Withdrawal Syndrome (PAWS)
In rare cases, detoxification from alcohol may induce chronic withdrawal symptoms, even after acute alcohol withdrawal symptoms have faded. This is known as post-acute withdrawal syndrome or protracted withdrawals. PAWS can last anywhere between a few months to a few years, depending on the severity of alcohol addiction.
Symptoms of PAWS include the following:
- Irritability and emotional outbursts
- Low energy
- Memory problems
- Stress sensitivity
- Problems with motor coordination
- Intense craving for alcohol
- Suicidal thoughts
Many people experience PAWS symptoms in cyclical waves. For example, they may feel fine one day but experience low energy and intense alcohol cravings the next. This unpredictability of PAWS makes it challenging to achieve and establish sobriety. However, with appropriate, individualized treatment, alcoholic patients can manage the symptoms and achieve long-term recovery.
An underlying mental disorder can exacerbate PAWS symptoms and vice versa. Dual-diagnosis treatment is indicated for those struggling with co-occurring disorders. This form of treatment for alcohol dependence can help address both substance use disorder and mental disorder simultaneously.
Assessment of Alcohol Withdrawal
Due to the complications associated with alcohol detoxification, it is essential to seek medical advice and care for the clinical management of alcohol withdrawal. Medical professionals will start their assessment by evaluating a patient’s condition. This evaluation often includes information on the average number of drinks consumed per day, frequency of heavy drinking, timeframe since the last drink, history of alcohol withdrawals, co-occurring medical or psychiatric conditions, and polysubstance abuse.
In addition, medical professionals may also perform a physical examination to assess possible complicating medical conditions, including cardiovascular diseases such as arrhythmias, congestive heart failure, coronary artery disease, gastrointestinal bleeding, infections, severe liver disease, nervous system impairment, and pancreatitis. Basic laboratory tests include a complete blood count, a urine drug test, liver function tests, and the determination of blood alcohol content (BAC) and electrolyte levels.
Once a diagnosis of alcohol withdrawal has been made, medical professionals will assess the severity of symptoms and the potential risk for alcohol withdrawal seizures and other complications. The best-validated tool for this assessment is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar). CIWA-Ar scores of eight points or fewer indicate mild withdrawal symptoms, scores of nine to 15 indicate moderate symptoms, and scores greater than 15 indicate severe withdrawal symptoms and an increased risk of seizures and delirium tremens.
Treatment for Alcohol Withdrawal
The physician will decide the most effective treatment option based on the patient’s CIWA-Ar score. For most patients, especially those with severe withdrawal symptoms, the benefits of medical detoxifications include improved symptoms, reduction of both DTs and seizure threshold, and encouragement to enter alcoholism treatment for relapse prevention.
Outpatient detoxification is regarded as safe and effective for people with mild-to-moderate alcohol withdrawal syndrome, and it costs less than inpatient treatment. However, most patients should be considered for inpatient care regardless of the severity of their symptoms. These include alcoholic patients with a history of severe withdrawal symptoms, such as alcohol withdrawal seizures or DTs, multiple alcohol detoxification attempts, concurrent medical or psychiatric conditions, pregnancy, and a lack of a strong support network.
Patients undergoing outpatient management typically attend a treatment facility multiple times weekly for alcohol detox. On the other hand, inpatient treatment necessitates that patients reside at the treatment center for the duration of treatment, where they will receive the round-the-clock medical supervision and care they need to manage the most severe symptoms.
Although medical detoxification is a crucial stage of alcohol withdrawal treatment, it doesn’t address the underlying causes of alcohol addiction needed to establish long-term abstinence. Hence, treatment of alcohol withdrawal should be followed by treatment of alcohol dependence.
Treatment of alcohol dependence includes a combination of counseling and behavioral therapies, such as cognitive-behavioral therapy (CBT) and family therapy, and physical therapy in an inpatient or outpatient setting. Some alcoholic patients also achieve remarkable results by joining 12-step groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).
Can Alcohol Withdrawal Be Prevented?
The risks and difficulties of alcohol detoxification can be mitigated or eliminated altogether if problematic drinking is recognized and treated early on. Alcohol withdrawal symptoms are unavoidable once a person develops a dependence on the substance. However, pharmacological and holistic interventions can help alleviate their intensity.
If you or a loved one has an alcohol addiction and requires alcohol detox treatment, Futures Recovery Healthcare is here to help. Our dedicated specialists and experts are committed to providing you with a comprehensive treatment program centered on individualized treatment to assist each patient in their recovery process.