Alcohol withdrawal

Definition

Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.

Causes

Alcohol withdrawal usually occurs in adults, but it may happen in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol. The withdrawal usually occurs within 5 - 10 hours after the last drink, but it may occur up to 7 - 10 days later.

Excessive alcohol use is generally considered the equivalent of 2 - 6 pints of beer (or 4 oz. of "hard" alcohol) per day for 1 week, or habitual use of alcohol that disrupts a person's life and routines.

The more heavily a person had been drinking every day, the more likely that person will develop alcohol withdrawal symptoms when they stop. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Symptoms

Mild-to-moderate psychological symptoms:

• Jumpiness or nervousness
• Shakiness
• Anxiety
• Irritability or easy excitability
• Rapid emotional changes
• Depression
• Fatigue
• Difficulty thinking clearly
• Bad dreams

Mild-to-moderate physical symptoms:

• Headache -- general, pulsating
• Sweating -- especially the palms of the hands or the face
• Nausea and vomiting
• Loss of appetite
• Insomnia (sleeping difficulty)
• Pallor
• Rapid heart rate
• Eye pupils enlarged(dilated pupils)
• Clammy skin
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:

• Delirium tremens -- a state of confusion and visual hallucinations
• Agitation
• Fever
• Convulsions
• Black outs -- when the person forgets what happened during the drinking episode

Exams and Tests

The health care provider will check for:

• Rapid heartbeat (tachycardia)
• Rapid breathing (tachypnea)
• Elevated temperature
• Abnormal eye movements
• Shaky hands
• General body shaking
• Abnormal heart rhythms
• Internal bleeding
• Liver failure
• Dehydration

A toxicology screen may be performed as well as other blood tests.

Treatment

The goals are to treat the immediate withdrawal symptoms, prevent complications, and begin long-term preventative therapy.

The person will probably have to stay at the hospital for constant observation. Heart rate, breathing, body temperature, and blood pressure are monitored, as well as fluids and electrolytes (chemicals in the body such as sodium and potassium).

The patient's symptoms may progress rapidly and may quickly become life-threatening. Drugs that depress the central nervous system (such as sedatives) may be required to reduce symptoms, often in moderately large doses.

Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete. A class of medications known as the benzodiazepines are often useful in reducing a range of symptoms.

A drying-out period may be appropriate. No alcohol is allowed during this time.

The health care provider will watch closely for signs of delirium tremens.

Hallucinations that occur without other symptoms or complications are uncommon. They are treated with hospitalization and antipsychotic medications as needed.

Testing and treatment for other medical problems associated with use of alcohol is necessary. This may include disorders such as alcoholic liver disease, blood clotting disorders, alcoholic neuropathy, heart disorders (such as alcoholic cardiomyopathy), chronic brain syndromes (such as Wernicke-Korsakoff syndrome), and malnutrition.

Rehabilitation for alcoholism is often recommended. This may include social support such as Alcoholics Anonymous, medications, and behavior therapy.

Support Groups

For additional resources, see alcoholism support group.

Outlook (Prognosis)

Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin within 12 hours of the last drink. The symptoms peak in 48 - 72 hours and may persist for a week or more.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for 3 - 12 months or more. If a person continues to drink excessively, they may develop many medical conditions such as liver and heart disease.

When to Contact a Medical Professional

Call your health care provider or go the emergency room if symptoms indicate alcohol withdrawal, especially in a person who has a history of habitual use of alcohol, or a history of stopping use of alcohol after a period of heavy alcohol consumption. Alcohol withdrawal is a serious condition that may rapidly become life-threatening.

Call for an appointment with your health care provider if symptoms persist after treatment.

Go to the emergency room or call the local emergency number (such as 911) if potentially lethal symptoms occur, including seizures, fever, delirium

Prevention

Minimize or avoid the use of alcohol. In people with alcoholism, total abstinence from alcohol may be necessary.