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What is alcohol withdrawal and what does it feel like?
Alcohol withdrawal
is a condition that follows a reduction in alcohol consumption or when an alcohol dependent individual stops drinking abruptly. In addition to a high level of distress, alcohol withdrawal is also associated with impairment in social, occupational, and other areas of an individual’s functioning. Relatively uncomplicated cases of alcohol withdrawal are usually characterized by signs and symptoms of autonomic hyperactivity, and could possibly include increased heart rate, increased blood pressure, hyperthermia, tremor, nausea, vomiting, insomnia and frequently anxiety.
Uncomplicated Alcohol Withdrawal
Usually occur between 4 and 12 hours after an individual has had his last drink of alcohol. The severity of symptoms tend to peak around the second day, usually subsiding by about the fourth or fifth day of abstinence. After this period of time, less anxiety, insomnia and other autonomic symptoms may continue for the next few weeks, with some individuals experiencing prolonged alcohol withdrawal symptoms for up to five or six months after they quit drinking.
A minority, but significant number of alcohol dependent individuals (10%) can experience complicated alcohol withdrawal episodes, an alcohol withdrawal delirium also referred to as delirium tremens can occur in approximately 5% of the cases, usually between 36 and 72 hours following alcohol cessation. This condition may be characterized by delusions, auditory, visual or tactile hallucinations, psychomotor agitation, fluctuating cloudiness of consciousness and disorientation. Grand mal seizures are also associated with alcohol withdrawal in between 3% and 5% of the cases, usually within the first 48 hours following the reduction or cessation of alcohol consumption. In both instances of complicated alcohol withdrawal, either the lack or delay of instituting treatment is associated with increased mortality rate. Prior history of delirium tremens and/or alcohol withdrawal seizures, older age, poor nutritional status, comorbid medical conditions and a history of high tolerance to alcohol are predictors of increased severity of alcohol withdrawal.
Alcohol Withdrawal Criteria:
The following criteria define alcohol withdrawal:
(A) Cessation or reduction of alcohol use that has been heavy and prolonged.
(B) Two or more the following, developing within several hours to a few days after criteria A above:
autonomic hyperactivity (sweating or pulse rate greater than 100)
increased hand tremor
insomnia
nausea or vomiting
transient visual, tactile, or auditory hallucinations or illusions
psychomotor agitation
anxiety
grand mal seizures
(C) The symptoms of criteria B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(D) The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Alcohol withdrawal:
The management of alcohol withdrawal through detoxification is an incredibly important initial intervention for a significant number of alcohol dependent individuals. The objective of alcohol withdrawal is maintaining some comfort as the alcoholic goes through the early stages of treatment, the prevention of treatment complications, and preparing the individual for alcohol rehabilitation. The successful management of alcohol withdrawal is an important aspect of preparing an individual for subsequent efforts at alcohol rehabilitation.
Medical screening for concurrent medical problems is also an important aspect of treatment at this stage of the attempted alcohol rehabilitation, in addition to the management of alcohol withdrawal symptoms. Frequently, doctors will administer thiamine (50-100 mg by mouth or I M) and multivitamins, for a low cost, low risk intervention, for the prophylaxis and treatment of alcohol related neurological disturbances. In addition to good supportive care and the treatment of concurrent illness, this stage will also include fluid and electrolyte repletion.
Social detoxification which involves the non-pharmacological treatment of alcohol withdrawal has also been shown to be effective. This involves frequent reassurance, reality orientation, personal attention, monitoring of vital signs and general nursing care. Social detoxification is most appropriate for individuals with mild to moderate alcohol withdrawal symptoms. Many individuals have significant medical problems associated with alcoholism which substantially complicate therapy, so it is absolutely essential that therapists refer those individuals whose conditions require medical management.
