Alcohol Withdrawal Syndrome

DEFINITION

Alcohol Withdrawal Syndrome (AWS) refers to a spectrum of signs and symptoms that develop after a person, who has been drinking alcohol everyday, suddenly stops drinking. In these people, the central nervous system (CNS) has adjusted to the constant presence of alcohol in the body by compensating for alcohol’s depressive effects. Consequently, when alcohol levels suddenly drop, the brain remains in a hyperactive state, causing AWS. Many with AWS have multiple issues (withdrawal symptoms, polysubstance abuse, depression, and liver disease), which requires a multifaceted treatment approach, although careful evaluation and proper treatments should ensure a safe detoxification.

How Safe is Alcohol?

Alcohol consumption is socially acceptable and widely used, but that doesn’t mean it’s safe. In fact, alcohol is more physically destructive when misused than nearly all other recreational drugs combined. Alcohol-related health problems are among the most significant public health issues in the United States. 

Scientific Study (Isbell et al. 1955)

Participants were well fed, each consumed up to almost 30 standard drinks per day for up to 3 months. Upon abstaining from alcohol intake, these men invariably developed withdrawal symptoms. Moreover, the symptoms of alcohol withdrawal were dose dependent: The men who had consumed the largest amounts of alcohol developed the most severe manifestations of withdrawal.

Alcohol Withdrawal

Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal syndrome (AWS). Signs and symptoms of AWS can include, among others, mild to moderate tremors, irritability, anxiety, or agitation. The most severe manifestations of withdrawal include delirium tremens, hallucinations, and seizures. These manifestations result from alcohol-induced imbalances in the brain chemistry, which causes excessive neuronal activity when alcohol is withheld.

Mild alcohol withdrawal

Mild alcohol withdrawal generally consists of anxiety, irritability, difficulty sleeping, and decreased appetite. Mild alcohol withdrawal symptoms typically appear within 24-hours after discontinuation.

1. Light Sensitivity
2. Nausea
3. Headache
4. Dehydration
5. Irritability
6. Lack of Appetite

Moderate alcohol withdrawal

Moderate alcohol withdrawal symptoms usually occur 24-36 hours after discontinuation of alcohol consumption and include manifestations such as intense anxiety, tremors, insomnia, and excessive adrenergic symptoms.

1. Alcohol Craving
2. Nausea
3. Vomiting
4. Dehydration
5. Lethargy
6. Anorexia
7. Weakness
8. Incongruent Thoughts
9. Slight Tremors
10. Depression

Severe alcohol withdrawal

Severe alcohol withdrawal is characterized by trembling hands and arms, sweating, elevation of pulse (above 100) and blood pressure (greater than 140/90), nausea (with or without vomiting), and hypersensitivity to noises and light. Brief periods of hearing and seeing things that are not present also may occur. A fever greater than 101° F also may be seen. Seizures and true delirium tremens, represent the most extreme forms of severe alcohol withdrawal.

Physiological Symptoms

1. Profuse Sweating
2. Nausea
3. Vomiting
4. Anorexia
5. Diarrhea
6. Dehydration
7. Tremulousness
8. High Blood Pressure
9. Increased Heart Rate
10. Tonic-Clonic Seizures
11. Stroke
12. Death

Psychological Symptoms

1. Alcohol Craving
2. Fear
3. Anxiety
4. Paranoia
5. Disorientation
6. Confusion
7. Psychosis
8. Insomnia
9. Auditory Hallucinations
10. Visual Hallucinations
11. Tactile Hallucinations
12. Confabulation
13. Irritability
14. Screaming
15. Mumbling
16. Psychosis
17. Depression
18. Suicidal Thoughts

Alcohol Risks

Short-Term Health Risks

Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions. These are most often the result of binge drinking and include the following:

• Motor vehicle crash, injuries, falling, drowning and burning.
• Violence, including murder, suicide, sexual battery, and intimate partner violence.
• Alcohol poisoning, a medical emergency that results from high blood alcohol levels.
• Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.
• Miscarriage and stillbirth or fetal alcohol spectrum disorders (FASDs) among pregnant women.

Long-Term health risks

Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including:

• High blood pressure, stroke, liver disease, heart disease and digestive problems.
• Cancer of the liver, breast, mouth, throat, esophagus and colon.
• Memory and learning problems, including dementia and poor school performance.
• Mental health problems, including depression and anxiety.
• Social problems, including lost productivity, family problems, and unemployment.
• Alcohol dependence, or alcoholism.

History of Alcohol Withdrawal

Around 400 B.C. Hippocrates wrote the first clinical report on alcohol withdrawal. He wrote, that if the patient is in the prime of life and if from drinking he has trembling hands, it may well be the case that the patient is showing signs of alcohol withdrawal.