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Alcohol Withdrawal

Alcohol withdrawal is a cluster of symptoms observed in persons who stop drinking alcohol following continuous and heavy consumption. Milder forms of withdrawal symptoms include tremulousness, seizures, and hallucinations, typically occurring within 6-48 hours after the last drink. Approximately 95 percent of people who quit drinking alcohol experience mild to moderate withdrawal symptoms and can usually be treated by addiction treatment professionals. However, five percent experience severe withdrawal symptoms and must be treated in a hospital or a facility that specializes in detoxification.

Alcohol withdrawal symptoms often include but are not limited to:

  • Anxiety
  • Grand Mal Seizures
  • Illusions
  • Increased Hand Tremor
  • Insomnia
  • Nausea or Vomiting
  • Physical Agitation
  • Sweating or Rapid Pulse
  • Transient Visual, Tactile or Auditory Hallucinations

A more serious alcohol withdrawal syndrome, delirium tremens (DTs), involves profound confusion, hallucinations, and severe autonomic nervous system over activity, typically beginning between 48 and 96 hours after the last drink.

When Alcohol is Withdrawn

Alcohol has a slowing effect (also called a sedating effect or depressant effect) on the brain. In a heavy, long-term drinker, the brain is almost continually exposed to the depressant effect of alcohol. Over time, the brain adjusts its own chemistry to compensate for the effect of the alcohol. It does this by producing naturally stimulating chemicals (such as serotonin or norepinephrine, which is a relative of adrenaline) in larger quantities than normal. If the alcohol is withdrawn suddenly, the brain is like an accelerated vehicle that has lost its brakes. Not surprisingly, most symptoms of alcohol withdrawal are symptoms that occur when the brain is over-stimulated.

In a classic study that has shaped our understanding of alcohol withdrawal for many years, Isbell et al. (1955) found that alcohol-related seizures occur only after stopping heavy drinking. In a recent study that looked primarily at seizures, challenged Isbell's concept and reported that the risk of first seizure is related to current alcohol use rather than to withdrawal. They concluded, based on self-reports given retrospectively by seizure patients, that the relationship of alcohol use to seizures is causal and dose-dependent. However, emerging neurophysiological findings lend support to Isbell's interpretation of alcohol withdrawal.

In the central nervous system, ethanol (in concentrations high enough to intoxicate humans) interferes with the processes that tell certain nerve cells to activate or become excited. It also enhances those processes that tell certain nerve cells to be restrained. Thus, ethanol acts as a nonspecific biochemical inhibitor of activity in the central nervous system. During alcohol withdrawal, a person's central nervous system experiences a reversal of this effect: Excitatory processes are enhanced while inhibitory processes are reduced. Such changes can result in over activation of the central nervous system when alcohol is withdrawn.

Clinical researchers have measured this over activation in patients. Even patients with moderately severe alcohol withdrawal can experience sympathetic nervous system over activity and increased production of the adrenal hormones cortisol and norepinephrine. Both of these hormones can be toxic to nerve cells. Moreover, cortisol can specifically damage neurons in the hippocampus --a part of the brain that is thought to be particularly important for memory and control of affective states. Thus, repeated untreated alcohol withdrawals may lead to direct damage to the hippocampus. Ballenger and Post (1978) did a retrospective chart review that led them to postulate that repeated inadequately treated alcohol withdrawal could produce future withdrawals of increased severity.

Alcohol Withdrawal: Getting Treatment

The good news for those who are extremely alcohol dependent and who wish to quit drinking, all of these symptoms can be alleviated and even eliminated with proper medical treatment. Typically, for those who are mildly dependent doses of vitamins (Thiamin) and a proper diet will prevent most of the mild withdrawal symptoms from occurring. For the severely dependent, medication can be administered, but only by a physician. If you are a heavy drinker and want to quit, consult a trained medical professional or a facility that specializes in alcohol and drug treatment, and be honest about your usual alcohol intake. The psychological withdrawal is enough to deal with, without also having to fight the physical symptoms. You don't have to do it "on your own" to prove anything to anyone. Help is available, take advantage of it.

Alcohol Withdrawal: Inpatient Detox is More Effective than Outpatient

A study by Hayashida (1989) compared outpatient with inpatient alcohol withdrawal and detoxification. The research concluded that outpatient medical detoxification is "an effective, safe, and low-cost treatment for patients with mild-to-moderate symptoms of alcohol withdrawal."

However, the data from this study indicate that inpatient detoxification was more effective than outpatient detoxification. At the 6-month follow up those treated as inpatients reported significantly greater improvement in their drinking behavior, despite having been measured as more impaired than the outpatient group at the time of admission. Whereas outpatient detoxification may be cheaper for some alcoholics, it is not clear to what extent other serious health problems may be undetected outside a hospital setting and may lead to more severe and expensive problems later.

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