You are on page 1of 18


When, the desire to drink alcohol starts controlling people the body, the thoughts and the feelings strive for alcohol. The first step in recovering from alcoholism after acknowledging the problem and resolving to get help
alcohol abuse, which is not the same as alcoholism, the patient has not yet become physically addicting can detox with fewer side effects. Alcoholics, on the other hand, have developed dependence and may suffer severe withdrawal symptoms.

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%.

Severe alcohol withdrawal symptoms are a medical emergency

Causes of Alcohol Withdrawal Syndrome

Heavy, prolonged drinking -- especially excessive daily drinking -- disrupts thebrain'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.

Withdrawal Symptoms
Mild to moderate psychological symptoms:
Feeling of jumpiness or nervousness Feeling of shakiness Anxiety Irritability or easily excited Emotional volatility, rapid emotional changes Depression Fatigue Difficulty with thinking clearly Bad dreams

Mild to moderate physical symptoms

Headache - general, pulsating Sweating, especially the palms of the hands or the face Nausea and Vomiting Loss of appetite Insomnia, sleeping difficulty Paleness Rapid heart rate (palpitations) Eyes, pupils different size (enlarged, dilated pupils) Skin, clammy Abnormal movements Tremor of the hands Involuntary, abnormal movements of the eyelids

Severe symptoms:
A state of confusion and hallucinations (visual) -known as delirium tremens (DT) Agitation Fever Convulsions "Black outs" -- when the person forgets what happened during the drinking episode

DT (delirium tremens )
- 48 and 72 hours after alcohol cessation, although they can appear as early as two hours after cessation. Risk factors for DTs include a history of withdrawal seizures or DTs,
acute medical illness, abnormal liver function, and older age.

usually peak at five days, include:

Disorientation, confusion, and severe anxiety Hallucinations (primarily visual) which cannot be distinguished from reality Profuse sweating Seizures High blood pressure Racing and irregular heartbeat Severe tremors Low-grade fever

Alcohol Detoxification
The immediate goal of treatment is to calm the patient as quickly as possible.
About 95 percent of people have mild to moderate withdrawal symptoms, including agitation, trembling, disturbed sleep, and lack of appetite.

In 15 percent to 20 percent of people with moderate symptoms, brief seizures and hallucinations may occur, but they do not progress to full-blown delirium tremens. Such patients can nearly always be treated as outpatients.

Alcohol Detoxification

Outpatient treatment
Mild to moderate Withdrawal
After being examined and observed, the patient is usually sent home with a four-day supply of anti-anxiety medication, scheduled for follow-up and rehabilitation, and advised to return to the emergency room if withdrawal symptoms become severe. If possible, a family member or friend should support the patient through the next few days of withdrawal.

Patients are usually given one of the anti-anxiety drugs known as benzodiazepines (tranquilizers such as Valium), which inhibit nerve-cell excitability in the brain. They are used to relieve withdrawal symptoms, help prevent progression to delirium tremens, and reduce the risk for seizures.

moderate to severe dependence is demonstrated so that medical management is likely previous complicated withdrawal (eg. seizures or DTs) may have signs of withdrawal as judged clinically and/or supported by a rating scale concomitant physical or psychiatric illness, injury or recent surgery no reliable carer is available and has no stable home environment* alcohol or drug use in pregnancy or in mothers with babies who have no supportive environment may have had repeated unsuccessful attempts to detoxify at home *particularly relevant for admission to a specialist detoxification unit, less so for a general hospital

Diazepam has a longer duration of action thanlorazepam or midazolam.
Typically, the physician may give the patient an initial (or loading) intravenous dose of diazepam with additional doses given every one to two hours thereafter over the period of withdrawal. This regimen can cause very heavy sedation.

Symptomatic Relief when the patient can take oral medication: Metoclopramide an antacid Paracetamol Supplements: Thiamine, (Magnesium, Phosphate, Folate, Zinc, Vitamins A, D, E, C & B group) Thiamine (Vitamin B1) deficiency is especially common, and may lead to acute Wernickes encephalopathy if not corrected. Thiamine is given routinely to all patients undergoing alcohol detoxification, indeed all alcohol dependent inpatients. Supportive Environment: Nurse in a well-lit single room or in a quiet area of the ward; reassurances and explanations of procedures by the focal nurse; restrict visitors to a minimum

Other medications
Beta-blockers. Beta blockers, such as propranolol(Inderal) and atenolol (Tenormin), slow heart rate and reduce tremor. They are sometimes used in combination with benzodiazepines.

Anti-Seizure Medications. Anti-seizure agents, such as carbamazepine (Tegretol) or divalproex sodium (Depakote) may be useful for reducing the requirements of a benzodiazepine. When used by themselves, however, they do not appear to be effective in reducing seizures or delirium.
Psychosis. For hallucinations or extremely aggressive behavior, antipsychotic drugs, particularly haloperidol (Haldol), may be administered.
Korsakoff's psychosis (Wernicke-Korsakoff-Syndrome) is very difficult to treat. It is caused by severe vitamin B1 (thiamine) deficiencies, which cannot be replaced orally. Rapid and immediate injection of the B vitamin thiamin is necessary.

Other medications
Specific Treatment for Severe Symptoms Treating Delirium Tremens. People with symptoms of delirium tremens must be treated immediately. Untreated delirium tremens has a fatality rate that can be as high as 20 percent. Restraints may be necessary to prevent injury to themselves or others. Treating Seizures. Seizures are usually self-limited and treated with a benzodiazepine. Intravenous phenytoin (Dilantin) along with a benzodiazepine may be used in patients who have a history of seizures, who have epilepsy, or in those whose seizures cannot be controlled. Psychosis. For hallucinations or extremely aggressive behavior, antipsychotic drugs, particularly haloperidol (Haldol), may be administered. Korsakoff's psychosis (Wernicke-Korsakoff-Syndrome) is very difficult to treat. It is caused by severe vitamin B1 (thiamine) deficiencies, which cannot be replaced orally. Rapid and immediate injection of the B vitamin thiamin is necessary.

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.
joining a 12-step group -- such as Alcoholics Anonymous and Narcotics Anonymous staying at a comprehensive treatment facility that offers a combination of a 12-step model, cognitive-behavioral therapy, and family therapy