Alcoholic withdawal 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
disease, 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.
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.
Treatment of Alcohol Withdrawal Syndrome
If you have mild to moderate withdrawal symptoms, your doctor may
prefer to treat you in an outpatient setting, especially if you have supportive
family and friends. Outpatient detoxification is safe, effective, and less
costly than inpatient detoxification at a hospital or other facility.
However, you may
require inpatient treatment if you don't have a reliable social network, are pregnant, or
have a history of any of the following:
- Severe withdrawal symptoms
- Withdrawal seizures or DTs
- Multiple previous detoxifications
- Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate
withdrawal symptoms, preventing complications, and beginning long-term therapy
to promote alcohol abstinence.
Surprising
Addictions
Prescription
drugs of choice include benzodiazepines, such as diazepam
(Valium),
chlordiazepoxide
(Librium),
lorazepam
(Ativan),
and oxazepam
(Serax).
Such medications can help control the shakiness, anxiety, and confusion
associated with alcohol withdrawal and reduce the risk of withdrawal seizures
and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine
(Tegretol)
may be an effective alternative to benzodiazepines, because it is not sedating
and has low potential for abuse.
To help manage withdrawal complications, your doctor may consider
adding other drugs to a benzodiazepine regimen. These may include:
- An antipsychotic drug, which can help relieve agitation and hallucinations
- A beta-blocker, which may help curb a fast heart rate and elevated blood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
- Clonidine (Catapres), another blood pressure drug
- Phenytoin (Dilantin), an anticonvulsant which doesn't treat withdrawal seizures but may be useful in people with an underlying seizure disorder
Preventing Future Alcohol Withdrawal Episodes
Because successful treatment of alcohol withdrawal syndrome
doesn't address the underlying disease of addiction, it should be followed by
treatment for alcohol
abuse or alcohol dependence.
Relatively brief outpatient interventions can be effective for
alcohol abuse, but more intensive therapy may be required for alcohol
dependence. If you have alcohol dependence, your doctor may prescribe other
medications to help you stop drinking. He or she also may recommend joining a
12-step group -- such as Alcoholics
Anonymous and Narcotics Anonymous -- or staying at a comprehensive
treatment facility that offers a combination of a 12-step model, cognitive-behavioral
therapy, and family therapy.
WebMD Medical Reference
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