alcohol withdrawal

Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption.

Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs -- which are characterized by confusion, rapid heartbeat, and fever -- is estimated to range from 1% to 5%.

Because alcohol withdrawal symptoms can rapidly worsen, it's important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs.

It's especially important to see a doctor if you've experienced previous alcohol withdrawal episodes or if you have other health conditions such as infections,  heart disease, lung diseases or a history of seizures.

Severe alcohol withdrawal symptoms are a medical emergency. If seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur, either take the patient to an emergency room or call 911.

Causes of Alcohol Withdrawal Syndrome

Heavy, prolonged drinking -- especially excessive daily drinking -- disrupts the brain's neurotransmitters, the brain chemicals that transmit messages.

For example, alcohol initially enhances the effect of GABA, the neurotransmitter which produces feelings of relaxation and calm. But chronic alcohol consumption eventually suppresses GABA activity so that more and more alcohol is required to produce the desired effects, a phenomenon known as tolerance.

Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter which produces feelings of excitability. To maintain equilibrium, the glutamate system responds by functioning at a far higher level than it does in moderate drinkers and nondrinkers.

When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability. So, the effects associated with alcohol withdrawal -- anxiety, irritability, agitation, tremors, seizures, and DTs -- are the opposite of those associated with alcohol consumption.  

Symptoms of Alcohol Withdrawal Syndrome

In general, the severity of alcohol withdrawal symptoms increases in tandem with the amount and duration of prior alcohol consumption.

Minor alcohol withdrawal symptoms often appear six to 12 hours after alcohol cessation, sometimes while patients still have a measurable blood alcohol level. These symptoms include:

• Shaky hands
• Sweating
• Mild anxiety
• Nausea and/or vomiting
• Headache
• Insomnia

Between 12 and 24 hours after alcohol cessation, some patients may experience visual, auditory, or tactile hallucinations which usually end within 48 hours. Although this condition is called alcoholic hallucinosis, it's not the same as the hallucinations associated with DTs. Most patients are aware that the unusual sensations aren't real.