Causes and Risks:

Alcohol withdrawal state usually occurs in adults, but it may happen in adolescents as well. It occurs when a person who uses alcohol excessively suddenly stops the alcohol use. The withdrawal usually occurs within 5-10 hours after the decrease in alcohol intake, but it may occur up to 7-10 days later.

Excessive alcohol use is generally considered the equivalent of 2-6 pints of beer (or 4 oz of "hard" alcohol) per day for one week or habitual use of alcohol that disrupts a person's life and routines.

The likelihood of developing alcohol withdrawal symptoms increases as the number and frequency of drinks increase. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Prevention: Minimize or avoid the use of alcohol. In persons with alcoholism, total abstinence from alcohol may be necessary.

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
• 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 delerium tremens
• Agitation
• Fever
• Convulsions
• "Black outs" -- when the person forgets what happened during the drinking episode

Signs and Tests: Examination of the neuromuscular system may show increased pulse, respiratory rate, or temperature. Abnormal eye movements, hand movement or general body tremelousness may be present. Healthcare providers may check for signs of abnormal heart rhythms, internal bleeding, liver failure or overdehydration.

A toxicology screen may be performed as well as other blood tests.

Treatment:

The goals of treatment are to treat the immediate withdrawal symptoms, to prevent complications, and to begin long-term preventive treatment.

Immediate treatment involves symptom relief, constant observation, and frequent monitoring of physical functions and condition. Hospitalization is often required. Heart function, respiratory function, and general physical condition are monitored by frequent measurements of vital signs (temperature, pulse, rate of breathing, blood pressure) and fluids and electrolytes (chemicals in the body such as sodium and potassium).

Symptoms may progress rapidly and become an emergency condition. Drugs that depress the central nervous system such as sedatives may be required, often in moderately large doses, to reduce symptoms.

Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete. A class of medications known as Benzodiazepine are often useful to reduce physiological symptoms (e.g., blood pressure), as well as psychological symptoms (e.g., anxiety).

A "drying out" period may be appropriate. No alcohol is allowed during this time.

Monitoring for signs of complicated alcohol abstinence is ongoing, and signs are treated as appropriate.

Hallucinations that occur without other symptoms of complications are uncommon. They are treated similarly to any acute psychotic episode, with hospitalization and antipsychotic medications as needed.

Testing and treatment for other medical problems associated with use of alcohol is necessary. This may include disorders such as alcoholic liver disease, blood clotting disorders, alcoholic neuropathy, heart disorders (such as alcoholic cardiomyopathy), chronic brain syndromes (such as Wernicke-Korsakoff syndrome), and malnutrition.

Rehabilitation for alcohol use or alcoholism is often recommended. This may include psychiatric interventions, social support such as AA (Alcoholics Anonymous), medications, and behavior modification.

Support Groups: The stress of illness can often be helped by joining a support group where members share common experiences and problems. See alcoholism - support group.

Prognosis:

Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin within 12 hours of the last drink. Acute symptoms peak in 48 to 72 hours and may persist for a week or more.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may persist for 3 to 12 months and may become chronic. If a person continues to drink excessively, they will develop many medical conditions such as liver and heart disease.

Complications:

For complications, see the symptoms section.

Call your health care provider or go the emergency room if symptoms indicate alcohol withdrawal state, especially in a person who has a history of habitual use of alcohol, or a history of stopping use of alcohol after a period of heavy alcohol consumption. Alcohol withdrawal is a serious condition that may rapidly develop to an emergency condition.

Call for an appointment with your health care provider if symptoms persist after treatment.

Go to the emergency room or call the local emergency number (such as 911) if emergency symptoms occur, including seizures, fever, delirium or severe confusion, hallucinations, and irregular heart beat.