Alcohol Withdrawal Symptoms

A person who suffers from alcohol use disorder (AUD) may find it hard to stop drinking. It is not because they do not want to stop drinking, rather there are mental and physical consequences that could result from the immediate stop of heavy drinking. This is called alcohol withdrawal syndrome (AWS).

What Is Alcohol Use Disorder?

Alcohol Use Disorder (AUD) is defined as problematic drinking behaviour or patterns that include heavy drinking and/or binge drinking over prolonged periods. When these drinking behaviours are stopped or significantly decreased, individuals experience symptoms associated with Alcohol Withdrawal Syndrome (AWS).

How Is Heavy Drinking Defined?

If you drink heavily and regularly and abruptly stop drinking, you are at risk of experiencing alcohol withdrawal syndrome. According to The National Health Service (NHS), heavy drinking is defined as consuming 35 units of alcohol per week for women and consuming 50 units or more per week for men.

Who Does AWS affect?

According to research studies, around 50% of people who stop drinking will experience symptoms that range from mild to severe, from alcohol withdrawal.

Individuals who have experienced withdrawal symptoms from alcohol in the past and those that have been drinking heavily for a long time are at a higher risk than others to experience withdrawal. AWS does not discriminate, although adults are more likely to be diagnosed with AWS, young people are known to be at risk as well.

How Is AWS Diagnosed?

There are a few different things that are looked at when diagnosing alcohol withdrawal syndrome. You should be honest with your GP to receive an accurate diagnosis for AWS. All medical issues incurred by alcohol misuse needs to be addressed.

Methods of diagnosis including the following:

• Blood tests: this is used to rule out medical conditions that can mimic withdrawal signs
• Physical exam: this includes an assessment of the physical signs and symptoms that you are experiencing
• Medical history: the length of time that you have been drinking, the number of units you drink, and how often you drink
• Miscellaneous tests: this includes a toxicology screening to measure the amount of alcohol that is in your body and assessments which asks a series of questions relating to your symptoms

Clinical Institute Withdrawal Assessment of Alcohol(CIWA-Ar)

Oftentimes, medical professionals will administer a 5-minute 10 item survey-style assessment that helps determine the severity of the withdrawal symptoms that a person is experiencing. The total score is 67 points.

The following symptoms are assessed:

• Nausea and vomiting
• Anxiety
• Tremors
• Sweating
• Auditory disturbances- hearing things that are not there
• Visual disturbances- seeing things that are not there
• Tactile disturbances- unusual feeling in, on, or under the skin. I.e. the feeling of bugs crawling under the skin.
• Headache
• Agitation
• Clouding of sensorium- unable to think clearly or concentrate

Your doctor will ask questions related to the above symptoms. Questions 1-9 are given 0-7 points, and the last question is given 0-4 points. If you score 15 or greater, you are given medication immediately and monitored for DTs.

Physical vs Psychological Symptoms

Withdrawal symptoms are not only broken down by severity, but they are categorised according to physical and psychological symptoms.

Physical withdrawal symptoms occur when a person who is dependent on alcohol stops drinking. These symptoms are your body’s way of trying to adjust to functioning without the use of alcohol. Psychological symptoms involve the mental effects of alcohol withdrawal.

These symptoms include:

• Depression
• Anxiety
• Confusion
• Mood swings
• Irritability and agitation
• Difficulty concentrating
• Insomnia

Triggers can be considered a psychological withdrawal when your mind and body has acclimated to consuming alcohol at a specific time of day, specific place, or doing certain activities. These triggers can place you at risk for relapse if they are not properly managed.

What Is The Timeline Of Experiencing Symptoms?

Early withdrawal may produce mild withdrawal symptoms. These symptoms are typically felt within 6-12 hours after an individual’s last drink. After 24 hours without a drink, these symptoms may increase, this is usually when the symptoms begin to peak.

Within 24-72 hours, most symptoms will have peaked and they will begin to taper down. However, in some cases, individuals may experience symptoms for a longer period. Within 4-5 days most of your physical withdrawal symptoms should subside.

There are times when the symptoms can last for a few months, this usually refers to difficulty sleeping, fatigue, mood swings, and irritability.

What Causes Alcohol Withdrawal?

Heavy, excessive, and daily drinking causes the body to build a tolerance to and become dependent on alcohol. Without the alcohol, your body is unable to function and begins to crave the alcohol to adapt to the normality that your body has become accustomed to. This leads to symptoms of withdrawal.

These withdrawals are caused by the binding effect alcohol has on the Gamma-Aminobutyric Acid (GABA) neurotransmitters located in your brain.

These neurotransmitters provide a calming effect when they attach to GABA receptors. When you drink alcohol, it increases the production of GABA, As you continue to misuse alcohol and drink heavily, your GABA receptors become desensitised.

This causes you to drink more to continue producing the same calming effect. When you stop drinking your body goes through withdrawals from the inability to regulate GABA.

How Do You Treat Alcohol Withdrawal?

The treatment of withdrawal symptoms is known as detoxification, which is the removal of harmful substances from the body. This can be done with or without medication depending on the severity of the withdrawal symptoms.

No matter what method(s) of treatment is used, the common goal is to get through the withdrawals and to stop drinking.

Home Or Outpatient Detox

For mild symptoms, most of the care and treatment of the withdrawals can be done at home, under the supervision and care of regular visits to your GP or other healthcare professional. In some cases, withdrawals are known to move rapidly from mild to moderate to severe within the first 48 hrs. If this happens you need to seek immediate medical attention.

Medical Detox (Inpatient)

An inpatient detox centre differs from a hospital or acute care detox setting because the setting is not as intense. The concept is still the same, you are given 24-hour medical supervision but this will be in a freestanding centre.

This type of setting is for individuals experiencing moderate to severe withdrawal symptoms. If your symptoms continue to progressively worsen, you will need to move to an acute care detox centre or get hospitalised.

Acute Care Detox

For individuals experiencing moderate to severe withdrawal symptoms, hospitalisation may be inevitable. With moderate to severe symptoms, there is a high risk for dehydration and possible organ failure, therefore your vital signs would need to be closely monitored as a precautionary method.

Whilst you are hospitalised, you will receive an IV with medication and fluids to help you with managing the withdrawals and preventing the possibility of dehydration.

Medications Used For Withdrawals

When an individual is experiencing withdrawal symptoms and undergoing detox, their GP may prescribe medication to help manage the withdrawals. When these medications are prescribed, some people may require a hospital stay to monitor and manage your medication and withdrawal symptoms.

Your GP may prescribe benzodiazepines to help with the physical and psychological withdrawal symptoms from alcohol, These medications are considered sedatives that help with sleep disturbances, irritability, and fatigue.

Other medications can be prescribed to help with triggers, cravings, and relapse prevention.

These medications include the following:

• Lorazepam also is known as Ativan
• Diazepam is also known as Valium
• Naltrexone (Revia, Vivitrol)
• Antabuse
• Acamprosate (Campral)
• Nalmefene

When managing acute alcohol withdrawal symptoms through medical detox, an individual may be given anti-seizure medication. These medications are sometimes administered along with benzodiazepines for severe withdrawal.

Unlike benzodiazepines, anticonvulsants do not prevent seizures, however, they do aid with managing acute withdrawal symptoms.

These medications include the following:

• Gabapentin (Neurontin)
• Valproic Acid(Depakene)
• Oxcarbazepine (Trileptal)
• Carbamazepine (Tegretol)

Some other commonly prescribed medications include the following;

• Chlordiazepoxide (Librium)
• Clorazepate (Tranxene)

Vitamin supplements can help you replenish any nutrients that you have lost during your period of alcohol misuse. If you feel dehydrated, make sure to drink plenty of fluids such as water or fruit juice.

After you have completed detox, your GP may decide to continue prescribing you benzodiazepines to help manage any anxiety that you may continue to have.

What Happens After Detox?

A detox programme can last between 3-7 days. However, this is only the beginning of your road to recovery. After detox, you have to decide on what programmes and steps you will take for your long-term recovery. The purpose of detox is to get you through the withdrawals, once you are through with the physical withdrawals, you can move forward with your recovery.

However keep in mind, you can still feel the psychological withdrawals for months after detoxing. You can attend meetings, counselling, an inpatient or outpatient rehabilitation programme, to continue with your recovery.

In addition to these programmes, other forms of therapy can be recommended to help you with your recovery after detox. This includes cognitive behaviour therapy and 12-step facilitation therapy, where you meet one-on-one with a therapist or counsellor.

Withdrawal Prevention

After you have completed detox, you should avoid heavy drinking or drinking altogether.

If you have recognised that you are suffering from alcohol use disorder or alcohol dependency, you should seek help right away.