A Guide to Alcohol Withdrawl

If your alcohol intake has been going on for months or years and you suddenly stop drinking or drastically cut back, it will lead to physical and mental problems. Excessive consumption of alcohol leads to dependence that, in turn, poses the risk of developing an alcohol use disorder (AUD). People that reach this AUD state are bound to have alcohol withdrawal syndrome (AWS) when they suddenly stop or reduce drinking.

Alcohol consumption causes a depressive effect on your system that slows down brain functions. This effect changes the way nerves relay messages back and forth, and with consistent use of alcohol, the pattern adjusts to accommodate your intoxicated mental state. The central nervous system adapts to the constant intoxication while the body works hard to keep the brain awake enough for the nerves to communicate. When alcohol is suddenly eliminated or reduced from your system, the brain is left in this setting, leading to withdrawal symptoms.

Alcohol Withdrawal Symptoms

AWS comes with a host of withdrawal symptoms that are a combination of emotional and physical effects such as nausea, fatigue, and anxiety. These symptoms can be mild or as severe as seizures and hallucinations. In extreme cases, withdrawal symptoms can be life-threatening, but doctors can contain them with an early and proper diagnosis. Other symptoms of AWS include:

• Vomiting
• Nausea
• Headache
• Anxiety
• Increased heart rate
• Tremors
• Nightmares
• Sweating
• Insomnia
• Irritability
• High blood pressure
• Confusion
• Fatigue
• Gastrointestinal disturbances
• Hyperthermia
• Seizures
• Rapid abnormal breathing
• Palpitations

Mild symptoms can begin as soon as six hours from the last drink, while serious ones like seizures and hallucinations can set in after 12 to 48 hours. Some people experience severe symptoms like delirium tremens and high blood pressure after 48 to 72 hours. The nature and severity of these symptoms depend on the amount of alcohol taken and for how long. AWS can be extremely uncomfortable and distressing, making a return to drinking likely, which is why people in withdrawal need help.

Causes of Withdrawal Symptoms

Excessive intake of alcohol irritates and excites the nervous system, so, if you drink daily, your body becomes dependent on alcohol. When this happens over time, the central nervous system can no longer adapt easily without alcohol.

The effects of alcohol on your body are complex, as prolonged and excessive use causes various changes in brain activity leading to complicated neurochemical reactions. The reactions and the associated symptoms are the brain’s way of compensating for previous distributions in both inhibitory and excitatory neurotransmitter activity. The balance between the two neurotransmitter activities is distorted from prolonged alcohol use, leading to AWS when trying to recover.

Gamma-aminobutyric acid (GABA) is the brain’s main inhibitory chemical, while glutamate is the brain’s main excitatory chemical. When you drink alcohol, the functioning of both the GABA and glutamate receptors changes, resulting in a slowdown in brain function leading to reduced anxiety and sedation. The brain reacts by reducing the release of GABA and increasing glutamate signals to compensate for the levels altered by alcohol. When the brain does this constantly, you develop alcohol tolerance.

When you stop drinking alcohol suddenly, it causes a hyper-aroused state due to the abrupt disruption of your brain’s activity. This disruption leads to a series of withdrawal symptoms that start within a few hours after your last drink. Roughly 80% of people with AUD experience withdrawal symptoms, and the severity varies greatly from one person to another. The symptoms worsen over two to three days, and milder symptoms might persist for weeks.

Diagnosis of Withdrawal Symptoms

Diagnosis of withdrawal symptoms requires your doctor to take an adequate history of the frequency and amount of alcohol intake. The physician can also conduct a physical exam for signs like hand tremors, irregular heart rate, dehydration, and fever. These two examination methods establish the severity of the symptoms to help determine the best course of action to take. The history should consist of:

• Quantity of alcohol intake
• Duration of alcohol use
• Time since last drink
• Any other agents abused
• Concurrent medical conditions
• Psychiatric conditions

When conducting the physical examination, your doctor will also establish the presence of other possibly complicating medical conditions. Basic laboratory tests such as a complete blood count, a urine drug test, a liver function test, electrolyte levels, and determination of blood alcohol levels need to be carried out. The tests will help to determine whether you are suffering from conditions like:

• Congestive heart failure
• Arrhythmias
• Coronary artery disease
• Gastrointestinal bleeding
• Liver disease
• Infections
• Pancreatitis
• Nervous system impairment

The other method used for diagnosis is the Clinical Institute Assessment for Alcohol (CIWA-Ar) scale. Clinicians can use this validated 10-item assessment tool to measure the severity of AWS and monitor and medicate people undergoing withdrawal. It includes 10 common symptoms of AWS:

• Anxiety
• Agitation
• Auditory disturbances
• Headache
• Inability to think clearly
• Nausea and vomiting
• Tremors
• Uncontrollable sweating
• Visual disturbances
• Tactile disturbances

If the scores on the CIWA-Ar are fewer than eight points, this signifies a mild withdrawal. Scores between nine and 15 suggest a moderate withdrawal. Those exceeding 15 points indicate that you have severe withdrawal symptoms and a higher risk of seizures or delirium tremens. Your physician must consider a clinical perspective while using CIWA-Ar since some psychiatric and medical conditions can imitate the withdrawal symptoms of alcohol.

It is also worth noting that the assessment might be unreliable since it is subjective in nature, and certain medications such as beta-blockers might inhibit the manifestation of the symptoms. Another significant factor that makes a proper diagnosis of AWS important is that other conditions such as anticholinergic drug poisoning, thyrotoxicosis, and amphetamine use can be confused with AWS. Withdrawal from hard drugs or sedative-hypnotic agents causes similar symptoms to those of AWS.

Alcohol Withdrawal Timeline

A variety of factors will determine what happens to your body when you decide to quit alcohol. These factors will depend on the level of alcohol dependence, and the withdrawal will vary from one person to another. Withdrawal symptoms range from mild to severe depending on how much you drank and for how long. There are three stages that a person undergoing withdrawal may experience:

• Stage 1: The first six hours after your last drink are when you might start to experience withdrawal symptoms. They are still mild at this stage, such as headache, anxiety, sweating, nausea, insomnia, hand tremors, heart palpitations, vomiting, and gastrointestinal disturbances.
• Stage 2: The symptoms that occur at this stage are moderate to severe. Between 12 to 48 hours after taking your last drink, you might still have stage 1 symptoms along with confusion, increased heart rate or blood pressure, rapid abnormal breathing, and mild hyperthermia.
• Stage 3: At this stage, you will still have stage 2 symptoms as well as hallucinations, fever, disorientation, delusions, seizures, and impaired attention. These symptoms occur 48 to 72 hours after your last drink. This is also the stage where delirium tremens might begin.

Delirium tremens is a severe withdrawal symptom, and it occurs within three days to a week after the last drink. This condition causes rapid heartbeat, dehydration, and high blood pressure. Less blood flow to the brain leads to confusion, irritability, nervousness, soaking sweats, hallucinations, and disturbed sleep. Clients with this condition often require treatment in an intensive care unit. Only about 5% of people develop delirium tremens when withdrawing from alcohol, but it claims the lives of one in 20 victims who develop it.

AWS tends to improve and go away on its own about five days after your last drink. However, some people have symptoms that linger for weeks. In rare cases of persistent withdrawal, symptoms such as fatigue, sleep disorders, and mood swings might last for months.

Prevention, Coping, and Treatment of Withdrawal Symptoms

Alcohol detox is the first step of treatment. It helps you navigate through the challenging process of AWS, although it does not address the patterns of behavior and thought that contribute to alcohol consumption. There are various approaches to the treatment and settings that can help provide and sustain the constant support needed to achieve long-term sobriety after detox. The treatment depends on how severe your withdrawal symptoms are.

While some people can be treated at home if their condition is not severe, others might require supervised care in a medical facility to avoid potentially hazardous complications such as seizures. The priority of the treatment is to provide a conducive environment and make you comfortable by managing your symptoms. Your detox doctor’s goal is to help you stop drinking as swiftly and safely as possible. Part of the detox program involves alcohol counseling, which is crucial to attaining sobriety.

The course of alcohol detox is highly variable and can be unpredictable, as there are no screening or assessment tools to predict or verify the outcome. If you have mild withdrawal symptoms, you can benefit from the advice of a physician trained to assess and treat AWS. If the symptoms are moderate to severe, monitoring and treatment in a hospital or detox-equipped facility will be required.

Detox treatment can be done in two ways.

Inpatient

This kind of treatment is also known as residential treatment, which involves staying at a facility such as a rehab center for the entire treatment period. In this case, you will receive intensive therapy and round-the-clock care/support individually or in group sessions. At these facilities, clinicians might put you on intravenous injections to prevent dehydration and give you medications that will help ease your symptoms.

Most of the AWS symptoms are treated with sedatives known as benzodiazepines. The most common benzodiazepine prescribed is chlordiazepoxide, but other varieties such as lorazepam (Ativan) and alprazolam (Xanax) are also on the market. These drugs pose the risk of dependence, so it is always advisable to follow your doctor’s instructions while taking them.

Clients with delirium tremens are treated with diazepam administered intravenously to keep them calm and allow them to sleep. Doctors may use other medications to manage AWS, including antipsychotics, anticonvulsants, alpha-adrenergic agonists, and beta-blockers.

Outpatient

In this scenario, you can live at home and regularly attend individual or group therapy sessions. This arrangement allows you to practice what you learn in detox treatment in real-life situations while coping with stressors.

Some people experiencing mild symptoms of AWS can be treated at home, where a friend or family member can stay with them to monitor their condition. The person who takes care of you will make sure you attend counseling sessions and keep doctor’s appointments for any routine examinations required. This home setting can only be practical in detox if it supports your sobriety. If this is not the case, your doctor can connect you with rehab centers that accommodate people combating alcohol addiction.

If you or a person you care about is struggling with the condition described above, you need to take the necessary steps to seek proper treatment and care. The American Addiction Centers (AAC) can help you complete a detox and withdrawal program within 90 days. With nationwide coverage from the East Coast to the West Coast, AAC provides addiction treatment and mental healthcare to help you achieve long-term sobriety goals. Contact us anytime, day or night, to start your treatment.