ALCOHOL WITHDRAWAL SYNDROME

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Depending on which study you choose to believe, the incidence of alcohol use disorders are over 20% of the population while alcoholism represents about half to two-thirds of these.  The withdrawal from alcohol is well known and seen frequently by health professionals.  There are widespread manifestations and potentially fatal complications.  For this reason, no one should attempt withdrawal without medical supervision.

The first symptoms will usually begin 6-12 hours after a person’s last drink.  This timeframe is why patients may awake with mild withdrawal and why people may drink upon awakening.  Tremors, anxiety and agitation develop as well as a significant craving for more alcohol.  As time goes by, the tremors and agitation worsen.  Many signs of brain and nervous system excitability begin to develop.  The blood pressure and heart rate can increase.  A fever can develop in severe cases.  The person often appears flushed.  As more time passes, hallucinations develop. Hallucinations involving the sense of touch are commonly seen.  A person will often describe a crawling feeling and be deluded into thinking bugs are crawling on them.  In addition, both visual and auditory (what we hear) hallucinations also occur.   

Hallucinations are worrisome because they often predict the appearance of DELIRIUM TREMENS or DTs.  This is a syndrome that is considered the most severe type of withdrawal and can be fatal, if untreated, up to 10% of the time.  I consider DTs to be occurring when two elements are present.  First, there is a significant increase in the pulse and/or blood pressure AND second, the patient is confused or delirious.  The person may not know where he is.  He may not understand what is happening to him. He may not recognize familiar people. This symtoms will often not be seen until the second day of withdrawal.  Many persons tell me they have experienced DTs; however, in actuality they have only experienced shakiness and agitation.  When DTs occur, I place the person into an intensive care unit, both to administer frequent medication as well as to give the person the attention and support they need.

Another serious complication of withdrawal is seizures.  Again, this is an occurrence that people are often confused about.  Shakes, even when severe, are not seizures nor do they predict whether seizures will occur.  The type of seizure mostly seen is called a Grand Mal seizure.  During this occurrence, a person will often black out suddenly and be unconscious.  There will then be alternating contractions and then relaxations of the body’s muscles that often lasts less than a minute.  A person may bite their tongue and/or lose control of their bladders and/or bowels. They will eventually come around; but there will be a period of confusion that will last for several minutes to several hours.  Because the person is unconscious, he will not remember the event; when a person tells me they remember being awake during a seizure, I know that it was probably not a seizure.  The time frame for seizures is classically within 48 hours after a person stops drinking; but, it can occur up to 5 or 6 days after the last drink.  If a seizure occurred after that time, I would be suspicious that there may be another problem responsible for the seizure.  Also, seizures can occur without warning, even in the absence of any other symptoms of withdrawal.  It can even occur while the person is drinking if there has been a decrease in the amount taken in.

By two or three days after the last drink, the severity of withdrawal begins to reverse and is mainly gone by the fourth or fifth day.  Confusion caused by DTs can take a week or more to resolve.  There may be other problems that take longer to resolve.  Depression, which can be caused by the usage of alcohol and unmasked during withdrawal, may take up to two weeks to resolve.  There is also ATAXIA.  This is a problem of poor coordination and a feeling that the legs are weak.  This is caused by the alcohols effect in certain areas of the brain.   It may be made worse by the sedatives used for treatment of withdrawal.  Ataxia can also take up to two weeks to resolve but may be permanent if the relevant parts of the brain have been seriously and permanently damaged.

There is increasing evidence that there is a persistent hyperactivity in the brain that contributes to a chronic irritability and increase in cravings.  This is likely related to over-activity of the glutamate receptor.  New medication is available which are effective in treating this.  

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