Alcohol Withdrawal

What is Alcohol Withdrawal?

Alcohol withdrawal is a potentially deadly condition experienced by regular heavy alcohol drinkers who decide to cut down on their consumption suddenly.

Unlike any other form of withdrawal from drugs, alcohol withdrawal can be much more problematic. Perhaps what makes it more deadly than other drugs’ withdrawals is its ability to cause death in cases of severe dependability of the victim on alcohol.

The symptoms of alcohol withdrawal have the potential to occur less than three hours after the last drink, and its symptoms can vary from mild to extreme depending on the levels of intake the body has become used to. Alcohol withdrawal can trigger lethal life complications which need medical attention.

Overview of alcohol withdrawal syndrome

According to research, at least 87% of the total adult population has had a drink of alcohol in their lifetime. The reason this figure is so high is that alcohol, unlike other drugs, is legal for people over a certain age, usually 21 in the US. Also, some studies even suggest that drinking in moderation each day may be good for health. These two reasons form the basis for why people tend to overindulge. Unfortunately for some, before they know it, they become alcoholics and often after a concerted effort to stop, alcohol withdrawal syndrome can inadvertently set in.

Research also shows that close to 17 million people in the US have experienced an alcohol consumption related problem. In fact, one in ten people has died from the effects of alcohol consumption. Alcohol claims close to ninety thousand lives yearly in the US and is the third leading cause of preventable death.

Consumption of alcohol leads to elevation of dopamine levels in the brain resulting in feelings of happiness and pleasant feelings. Alcohol can elevate moods, boost confidence and lower many inhibitions, which explains why people are so inclined to consume it more than any other drug, apart from it being a legal drug. When alcohol levels drop in the bloodstream, the dopamine levels dissipate, and the good feelings reduce.

Typically, the more a person drinks or physically elevates the dopamine levels, the more the body becomes tolerant to the alcohol, prompting them to take more to achieve the same levels of excitement. When the effects wear off, the drinker suffers from withdrawal effects which many may call “hangovers” which range in severity.

Alcohol withdrawal results in the sudden removal of alcohol from the body entirely, meaning the dopamine levels suddenly drop. This means the pleasant feelings suddenly get replaced with the exact opposite feelings due to the physical dependence of the body on alcohol for the perceived good feeling.

Alcohol withdrawal occurs in different time frames depending on the level of drinking the body gets used to. The effects may set in in less than 8 hours for heavy drinkers, 24 hours for mildly heavy drinkers and some days for others. The effects may lead to death if the patient does not seek medical attention. The effects peak during the second and third day, after which the effects start to slow down gradually, and after the seventh day, most of the physical effects have reduced. Only the psychological effects take weeks to dissipate completely.


Alcohol Withdrawal Symptoms

To understand the symptoms of alcohol withdrawal, you need first to understand the stages of the condition. It occurs in three major phases depending on the severity of alcohol consumption. The symptoms vary from physical to mental symptoms with the physical ones lasting during the first days of the alcohol withdrawal symptoms and the psychological ones lasting much longer.

Early stage (minor-level withdrawal)

Mildly heavy drinkers go through early stage withdrawal which can happen at least 8 hours after their last drink. The stage is characterized by body tremors that usually set in 10 hours after the last drink and can worsen if the victim becomes agitated. The symptoms in this stage vary but are mostly mild and last for three days or more depending on the person. They include headaches, nausea, sleeplessness, and depressed mental states.

Second stage withdrawal (mid-level withdrawal)

A good percentage of those undergoing detox is likely to go through this stage of withdrawal. Usually, one is likely to go through this second stage of symptoms if their drinking was prolonged and significantly heavy. Constant blood spikes accompanied by hallucinations characterize this stage. The hallucinations set in 12 to 14 hours after the last drink and may worsen over time. The patients in the second stage experience the symptoms from the first stage only worse in their case. In extreme circumstances, the patients go on to experience withdrawal-associated seizures characterized by muscle rigidity, teeth clenching or uncontrollable tongue biting.

Third stage withdrawal (major-level withdrawal)

This stage affects only 30% of alcoholics, and its symptoms occur three to four days after the last drink. Most of the people who experience this stage have been heavy drinkers over an extended period. The symptoms in the third stage may extend weeks after the last drink and are potentially deadly. One particular condition characterized by this stage is Delirium Tremens (DTs) which involves muscle tremors, seizures, a state of delirium, hallucinations, mood changes, deep sleep, and potentially fatal heart rhythms. This stage can kill in a short time if no medical attention comes forth.

The death rate resulting from DTs is an estimated 1-5% in cases where the patients did not seek medical attention. Also, DTs result in death in patients who have other underlying problems like lung or Cardiovascular Disease (heart diseases) or if there is a history of cases of seizures in the family.

Alcohol Withdrawal Causes

Usually, when one consumes alcohol in excess, the effects of the consumption lead to the neurotransmitter working overtime to counter the consequences of the alcohol and to keep the body at optimal functioning. This, in turn, leads to the body adapting to the condition of the transmitter, working harder and harder to overcoming the suppressing effects of alcohol as the new standard. When the alcohol intake suddenly gets cut down, the neurotransmitter still goes on to work in excess, as usual, irrespective of whether the alcohol is there or not. This condition is called ‘neurotransmitter rebound’.

The removal of alcohol from the body means the system gets left without a means to counter the hyperactivity caused by the neurotransmitter working in excess. Usually, alcohol consumption inhibits some neurotransmitters and makes you feel at ease through feelings of drunkenness. However, the absence of alcohol means the neurotransmitters have nothing to hinder them now and hence hyper-excitability sets in. This explains why the effects of alcohol withdrawal differ from those of alcohol consumption.

Here is a good example to explain the effects of alcohol withdrawal from the body of an alcoholic. Just imagine a tug of war between two people; if one person suddenly decides to let go of the rope, the other person is likely to fly off and tumble in the other direction. Alcohol and neurotransmitter act the same way, when both are in the body, there is a maintained balance. However, the sudden removal of alcohol from the body causes the neurotransmitter to fly off in the other direction suddenly.

Alcohol withdrawal usually results from the GABA neurotransmitter system. The effects of alcohol on that neurotransmitter system result in sleep, relaxation, calmness and, in other cases, soothing of pain. However, the sudden removal of alcohol from the system results in the rebound in the GABA system neurotransmitter leading to effects like insomnia, anxiety, panic attacks, muscle cramps, hallucinations and seizures in extreme cases.

Treatments for Alcohol Withdrawal

Before your doctor can begin your treatment, you will have to undergo some assessments to determine the severity of your symptoms to aid the doctor in knowing which treatment program to enlist you for.

Assessment of withdrawal symptoms

The assessment typically involves the doctor taking your complete medical history, asking you how much you drink, how often, and the last time you took a drink. The doctor also needs to know if you’ve had an experience with withdrawal effects or if you abuse other substances that cause similar withdrawal effects to alcohol. Also, information about any underlying psychiatric conditions or other medical condition is important here.

The doctor then takes you through a physical exam to identify the symptoms and medical complications resulting from the withdrawal. The results of the exam and medical history help the doctor decide if you’re suffering from alcohol withdrawal syndrome or if your level of severity needs medical attention.

Treatment of alcohol withdrawal

The main goals of treatment of alcohol withdrawal effects are:

  • To reduce withdrawal symptoms
  • To prevent complications resulting from alcohol usage
  • To take the patient through therapy to help them abstain from alcohol

Types of treatment

Inpatient and outpatient treatment

Depending on how severe the symptoms of an individual are, the doctor may recommend inpatient or outpatient treatment.

Inpatient treatment is recommended for those who don’t have a reliable social network and will need constant supervision to make sure they don’t relapse. Outpatient treatment applies for patients with a supportive social network and family. The benefits of outpatient treatment are its cost effectiveness compared to inpatient detoxification.

Medication treatment

This type involves doctors prescribing some medications to help patients cope with other aspects of alcohol recovery. The various medications help reduce the physical symptoms and psychological effects and counter the risks of seizures associated with alcohol withdrawal. The drugs include benzodiazepines such as valium and other anticonvulsant drugs, antipsychotic drugs, and others to curb the various effects of withdrawal.

Individual counseling

Rehabilitation centers have counselors who provide support to patients during their various mood changes caused by withdrawal effects. The counselor also tackles any underlying factors that may have pushed the patient to indulge in alcohol and address addiction issues.

Support groups

Sometimes patients need to identify with a group of people going through the same things to feel understood and to fully explore their experiences. Support groups provide that feeling and are instrumental in the whole treatment phase to aid in the full recovery of the patient. The groups tackle various goals and challenges each person faces during the recovery and the patients get to share experiences and learn from each other’s experiences. The support group acts as a source of motivation for many patients in their recovery phase.

Alcohol Withdrawal Prevention

The best approach to preventing future instances of alcohol withdrawal syndrome is to follow up with alcohol dependence treatment.

While outpatient treatment is as effective in the prevention of future occurrences, the best way to prevent future alcohol withdrawal symptoms is intensive therapy addressing the issues of alcohol dependence. The doctor or your rehabilitation supervisor may recommend various therapy groups to join or give you a comprehensive post treatment program that involves a combination of behavioral therapy, family therapy, and cognitive therapy.

The other alternative way a person can prevent future instances of alcohol withdrawal is to completely abstain from alcohol, i.e. “stay clean.” For that to happen, patients need to surround themselves with supportive friends and a conducive environment that will help them make it through their goals. Doctors can do follow ups on the patients for a period after the treatment phase is over to ensure the patient does not relapse. Various rehabilitation centers have post treatment follow ups for their patients to curb relapse. Family therapies give the patients’ families insights into how to take care of their loved ones and protect them from instances that would make them relapse.

Last Reviewed:
September 26, 2017
Last Updated:
April 10, 2018
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