When people drink heavily for extended periods of time and suddenly stop or cut down on their alcohol intake they may be affected by alcohol withdrawal syndrome which could potentially put their lives at risk.
Symptoms of alcohol withdrawal may start as soon as 2 hours subsequent to the final alcoholic drink was consumed. The symptoms can start with shakiness and anxiety to delirium tremens (DTs), seizures and even death. Many of these symptoms can continue for weeks after becoming sober. Delirium Tremens causes death in an estimated 1% up to 5% of people with this alcohol withdrawal symptom and is characterized by feverishness, accelerated heartbeat, and confusion.
Even if the symptoms appear mild, it is important to get treatment as soon as possible as the withdrawal symptoms may escalate rapidly and become severe in a short space of time. Medical personnel can administer treatments to lessen the severity of alcohol withdrawal and even prevent DTs and seizures. If you have had alcohol withdrawal in the past or suffer from respiratory or cardiac illnesses, have any infections or have experienced seizures in the past, it is important that you seek medical assistance as soon as possible.
Symptoms of alcohol withdrawal such as feverishness, hallucinations, confusion, irregular heartbeat, and seizures should be considered an emergency. The person suffering from alcohol withdrawal needs immediate medical attention and should be taken to the nearest emergency treatment facility or emergency personnel should be called to scene.
Neurotransmitters, chemicals responsible for transmission of messages in the brain, are disrupted by alcohol. Excessive drinking on a daily basis and prolonged heavy drinking cause suppression of these brain chemicals. Take the neurotransmitter GABA for instance. This is the neurotransmitter that makes us feel calm and relaxed. Excessive alcohol consumption suppresses this chemical to such a degree that larger and larger quantities of alcohol are needed to achieve the same feeling from the narcotic. This is known as tolerance. The neurotransmitter, glutamate, causes the feelings of excitability in our brains. The body produces a higher level of glutamate in heavy drinkers to compensate for the suppression effect of the alcohol in the bloodstream.
Chronic drinkers who suddenly drastically limit their alcohol intake or stop all together suddenly find themselves confronted with brain hyper-excitability. The body is still producing large amounts of neurotransmitters but they are not being suppressed by the alcohol anymore. This causes alcohol withdrawal symptoms such as agitation, anxiety, seizures, irritability and delirium tremens. These effects are the opposite of those associated with drinking alcohol.
The severity of the alcohol withdrawal symptoms is closely correlated with the period of time the person has been drinking and how much they drink. You can begin experiencing mild alcohol withdrawal symptoms anything from 6 to 12 hours subsequent to you having had your last alcoholic beverage. Your blood alcohol level may still be fairly high at this stage. Some of the mild symptoms you may experience include:
Shakiness of the hands
Anxiety, generally mild
Nausea and Vomiting
Insomnia (not being able to sleep or erratic sleep)
After a period of 12 to 24 hours following you having had your last drink, you may find that you experience hallucinations. These are usually visual but can also be tactile or auditory. Most hallucinations fade within a 48 hour period. This is referred to as alcoholic hallucinosis but should not be confused with hallucinations experienced when suffering from delirium tremens. Alcohol withdrawal sufferers are usually aware that these hallucinations are not real.
Within 24 to 48 hours subsequent to the last alcoholic beverage being consumed there is a risk of seizures, although these can actually begin within 2 hours after the person stops drinking. People who have gone through detoxification in the past or have had previous seizures are at a much higher risk. Delirium tremens can start anything from 48 to 72 hours after the person has stopped drinking. People who suffer from various medical illnesses, are elderly, have impaired liver function or who have had seizures during past withdrawals are at high risk of developing delirium tremens.
Some of the possible delirium tremens (DT) symptoms can include:
Confusion, disorientation, confusion, severe anxiety
Primarily visual hallucinations which appear real to the sufferer
Raised blood pressure
Erratic or rapid heartbeat
To assess whether you are suffering from alcohol withdrawal syndrome, your medical practitioner will have to obtain a full medical history including how long you have been a drinker and the quantity you generally imbibe. He will also need to know when your last drink was and if you’ve suffered from alcohol withdrawal in the past. You will also be questioned on your medical history and whether you are currently suffering from mental or physical health conditions. The doctor will also need to know if you abuse other substances.
Your physician will do a physical examination and check for withdrawal symptoms while also making sure you are not suffering from conditions that can complicate the alcohol withdrawal such as coronary artery disease, congestive heart disease, infections, irregular heartbeats, nervous system issues, gastrointestinal bleeding, liver disease or pancreatitis. Blood and urine tests will also be used to check blood alcohol levels, blood count to check for infection, liver function, electrolyte levels as well as additional drugs in your bloodstream or urine. The doctor can use these findings to determine whether or not you are suffering from alcohol withdrawal and how severe it is.
Your medical practitioner will decide based on the severity of your symptoms on whether to treat your case as an outpatient or an inpatient. Outpatient care is generally a lot cheaper and is preferable if you have a good support structure. If you do not have a good social support structure or are pregnant you may be required to be treated as an inpatient. You may also be booked into a facility for treatment if you have a previous history of:
Withdrawal symptoms on a severe level
DTs or withdrawal seizures
Specific psychiatric or medical illnesses
The aim of the treatments are to reduce complications and control the withdrawal symptoms as well as starting therapy to encourage abstinence from alcohol in the future.
Various drugs are used in the treatment including benzodiazepines such as chlordiazepoxide (Librium), oxazepam (Serax), diazepam (Valium) and lorazepam (Ativan) to control anxiety, confusion, and shakiness. These drugs also reduce the occurrence of delirium tremens and withdrawal seizures. Carbamazepine (Tegretol) is used in people with milder symptoms. This is an anticonvulsant which is not addictive or sedating and has low abuse potential. Your physician may also add extra drugs to your regimen to control withdrawal complications, such as:
Anti-psychotics to help with hallucinations and agitation
Beta-blockers to reduce high blood pressure and lower heart rate or reduce strain on the heart of coronary artery disease sufferers during alcohol withdrawal
Clonidine (Catapres) to control blood pressure
Phenytoin (Dilantin) to treat any underlying seizure disorders as this anticonvulsant is not effective for withdrawal seizures
Treating alcohol withdrawal syndrome does not treat the addiction, only the withdrawal symptoms. People should follow up with treatment and therapy for alcohol dependence or alcohol abuse to get to the root cause of the disease. While alcohol abuse may be curbed with therapy on an outpatient basis, people with an alcohol dependence may require more intense treatments. Your doctor could prescribe certain medication to help prevent you drinking after your detoxification. Attending groups such as Narcotics Anonymous and Alcoholics anonymous and taking part in their twelve step program may also be of some benefit. Your doctor may recommend a stay at a treatment facility for a period of time to take part in cognitive-behavioral therapy, family therapy and a twelve step program as a combined treatment.