Alcohol withdrawal

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**Alcohol withdrawal** (also called **alcohol withdrawal syndrome**) is medical problem. It is a set of symptoms that can happen when a person who has drunk alcohol for a long time stops drinking. It can also happen when a person starts drinking less than they used to.

Alcohol withdrawal can be very dangerous. In the worst cases, it can even kill a person. This is why it is dangerous for people who drink a lot to stop drinking without talking to a doctor first.

## Why does withdrawal happen?
Alcohol is a central nervous system depressant. This means that alcohol slows down the activity in some parts of the brain. This can create good feelings, like feeling relaxed and happy.

If a person drinks a lot of alcohol, eventually their body will get used to the alcohol. After a while, the person will need to drink more and more alcohol to feel drunk and to slow down parts of their brain. This is called *tolerance*.

Once the body is used to having alcohol (and having parts of the brain slowed down), suddenly taking away the alcohol will cause withdrawal symptoms. The central nervous system is used to being slowed down by alcohol. So without alcohol, the central nervous system gets very excited and over-active.

A person who gets tolerant to alcohol, and gets withdrawal symptoms when they stop drinking, is *physically dependent* on alcohol. This is also called *physical addiction.*

## Who gets alcohol withdrawal?
Not everybody who drinks a lot of alcohol gets withdrawal symptoms when they stop. No one knows why some people get withdrawal symptoms and others do not.

About half of people with alcoholism will get withdrawal symptoms if they drink less than usual.

Everybody has a different set of withdrawal symptoms. Some people have only mild symptoms, like being unable to sleep or feeling anxious. Other people have very bad, life-threatening symptoms, like delirium, hallucinations, very high blood pressures, and very high fevers.

Withdrawal usually begins 6 to 24 hours after a person takes their last drink. Acute withdrawal can last for up to one week.

### Diagnosis
To be diagnosed with alcohol withdrawal syndrome, patients must have at least two of these symptoms:.
* Tremors in the hands
* Insomnia (trouble sleeping)
* Nausea or vomiting
* Hallucinations (seeing, hearing, or feeling things that are not really there)
* Anxiety
* Being agitated (unable to sit still)
* Tonic-clonic seizures (seizures where the person is not awake and jerks around)
* Autonomic instability (quickly changing symptoms related to the autonomic nervous system, like high blood pressure and high fevers

### How bad are the symptoms?
Many things affect how bad alcohol withdrawal symptoms can be. The most important things are: 
**Delirium tremens*: This is the worst form of alcohol withdrawal, and can kill a person. It usually happens 24 to 72 hours after the person stops drinking alcohol.
* Shaking (tremor)
* Headache
* Sweating
* Anxiety
* Nausea or vomiting
* Insomnia

*Twelve to 24 hours after the last drink:*
* Confusion
* Hallucinations
* Cravings for alcohol (wanting alcohol very, very badly)
* Anhedonia (not being able to enjoy things that a person normally likes)
* Not seeing, hearing, tasting, hearing, or smelling things as well as usual
* Feeling disoriented (meaning a person does not know who they are, where they are, or what is going on)
* Nausea and vomiting
* Headaches

Insomnia is also a common symptom of PAWS. It often keeps happening after acute (immediate) alcohol withdrawal. Research has showed that people with insomnia are more likely to relapse (start using alcohol again). Studies have found that magnesium or trazodone can help treat insomnia in recovering alcoholics.

For some people, the acute phase of alcohol withdrawal can last longer than usual. Protracted (longer than usual) delirium tremens has been reported in medical research, but is not common.

## Treatment
People with bad alcohol withdrawal symptoms often need to go into a hospital to make sure they are safe while they are withdrawing from alcohol.

The most commonly used benzodiazepines are long-acting (medications whose effects last a long time), like chlordiazepoxide and diazepam (Valium). These seem to be the best medicines for treating delirium, and do not have to be given as often. Also, both alcohol and benzodiazepines are depressants. If a person takes both at the same time, they are more likely to get depression or become suicidal.

### Vitamins
Alcoholics often do not have enough of certain vitamins in their bodies. One of these important vitamins is thiamine. If a person does not have enough thiamine in their body, they can get serious health problems and even brain damage.

When a person is going through alcohol withdrawal, the most important vitamins are thiamine and folic acid. If an alcoholic who stops drinking does not have enough of these vitamins, they can get Wernicke syndrome, a very serious brain problem. To keep this from happening, people who have stopped drinking alcohol are often given thiamine and folic acid intravenously (through a needle placed into a vein). They may also be given other vitamins. This can help prevent Wernicke syndrome.

### Anticonvulsants
Sometimes, anticonvulsant (anti-seizure) medicines are given to try to prevent seizures.

Some evidence says that topiramate (Topamax), carbamazepine (Tegretol), and other anticonvulsants are helpful in treating alcohol withdrawal; however, research is limited.

Other studies have shown that benzodiazepines work just as well as anticonvulsants.

### Other medicines
Clonidine may be used along with benzodiazepines to help some of the symptoms of alcohol withdrawal.

## Prognosis
If alcohol withdrawal is not treated correctly, people can die or have permanent brain damage.

Alcoholics often cannot stop drinking alcohol after their withdrawal symptoms are over. Often, they need support for months or years after withdrawal is over.

## Related pages
* Alcoholism
* Delirium tremens

## References