Alcohol Withdrawal Syndrome- Stages and Treatment

What is alcohol withdrawal? 

Alcohol withdrawal symptoms usually commence when someone quits drinking or cuts back on their usage over a prolonged period. Mild symptoms start to appear a few hours after the last drink.

When a person quickly stops drinking after abusing alcohol heavily, they may experience alcohol withdrawal syndrome, which can result in fatal health issues. 

Alcohol withdrawal is one of the most apparent indications of alcohol dependence. Alcohol withdrawal refers to the physiological changes that occur when a person abruptly quits drinking after engaging in heavy and frequent alcohol use. 

The body and the brain eventually get dependent on drinking habits and frequency. When the person stops drinking suddenly, the body becomes addicted to the effects of alcohol and needs some time to get used to life without it. Sleeplessness, nausea, tremors and anxiety are some of the unpleasant withdrawal symptoms noticeable.

Alcohol withdrawal symptoms (Timeline) 

Depending on an individual’s situation, they may experience withdrawal symptoms at different times and for varying lengths of time. Most people get over their symptoms in a week. Many people go through three phases of withdrawal.

First stage – Starts in six hours and lasts up to seven days.

Stage two – Begins during the first 48 hours and lasts up to a week.

Third stage – Begins after 48 hours and lasts for two to three days.

First stage

The first stage shows only mild symptoms. Withdrawal symptoms from alcohol can start as soon as six hours after the last drink. The initial symptoms are unpleasant but not severe. They may include,

• Nausea 
• Anxiety
• Tremors or shakes
• Changes in the blood pressure 
• Insomnia and other sleep-related issues.

Most individuals who experience these symptoms of alcohol withdrawal will eventually recover. The first stage of alcohol withdrawal might last up to seven days.

Second stage

Most sufferers experience severe symptoms, including seizures, during the first 48 hours following their last drink. The number of people who develop seizures during this stage of alcohol withdrawal without receiving treatment is around 5%. 

It’s likely that they’ll only experience minor symptoms if, after 48 hours, no major symptoms have appeared. However, there’s still a chance a person could eventually get them, in that case medical attention is mandatory.

The second stage of alcohol withdrawal symptoms often peaks 24 to 72 hours after a person has had their last drink.

Third stage

The third stage involves the onset of delirium tremens (DT). About 50% of individuals who experience withdrawal seizures will later develop DTs. This may happen 48 to 72 hours after quitting drinking. As a result, the most important part of the withdrawal period is the first few days after quitting drinking. 

It’s important to get medical attention during this stage. The third stage of alcohol withdrawal symptoms usually lasts for two to three days, although they can prolong for as long as a week.

Fourth stage – post-acute withdrawal

After stopping drinking, some persons who go through alcohol withdrawal may continue to experience symptoms for weeks or even months. It is termed post-acute withdrawal syndrome or PAWS. PAWS symptoms include persistent sleep issues and emotional issues.

The fourth stage of alcohol withdrawal may persist between six months and two years.

What causes alcohol withdrawal symptoms? 

Alcohol consumed by long-term users is primarily ethanol, which is a central nervous system (CNS) depressant. Therefore, the body grows dependent on it as the use of alcohol continues.

This occurs by decreasing the inhibitory (GABA receptors) and increasing the excitatory (glutamate receptors) sections of the central nervous system (CNS). Since the depressant removes the inhibition, stopping it causes the central nervous system to become overexcited. 

The outcome is an overflow of excitatory signals in the body, which causes withdrawal symptoms.

The effects of heavy drinking on the brain lead to withdrawal symptoms. 

Alcohol has an impact on the part of the brain that controls our ability to “fight or flight,” which helps our brains respond to danger by preparing us to either react or move away. The brain and nervous system’s “fight or flight” reaction is suppressed on drinking alcohol since it is a depressive.

The central nervous system adjusts to the alcohol’s suppressive effects over time on consistently consuming large amounts of alcohol. Thus, the brain is affected when the blood alcohol level unexpectedly drops. When alcohol leaves the system, a person may enter “fight or flight” mode, even if there is no danger.

Diagnosis of alcohol withdrawal symptoms

Diagnosis of alcohol withdrawal is made in a hospital or rehab facility where people go to detoxify or when their withdrawal symptoms have developed into an emergency medical situation. 

The Clinical Institute Withdrawal Assessment of Alcohol Scale, often known as the CIWA-Ar, is frequently used by healthcare professionals to determine how severe a patient’s withdrawal symptoms are. The scale evaluates various symptoms, including anxiety, hallucinations and nausea.

A doctor may also perform a physical examination to determine the severity of the withdrawal symptoms. They might also look for symptoms of fever, a fast or irregular heartbeat and signs of dehydration.

How to relieve Alcohol withdrawal symptoms? 

When a person experiences withdrawal symptoms, they’ll need medical assistance to cut back and eventually stop drinking. With support, an individual can choose the best approach to stop drinking. 

When a person stops drinking, the following will help relieve the symptoms.

• Try to eat consistently.
• Make sure to consume enough non-alcoholic beverages to stay hydrated (but avoid caffeine).
• Look for ways to unwind, such as reading, taking a stroll or listening to music.
• Seek out friends and family for support and company.
• Take prescription medication as instructed.

Quitting drinking brings about insomnia in some people, which can be difficult. It’s essential to fight the impulse to restart drinking to assist a person in falling asleep.

Giving up alcohol is an excellent method to boost the quality of sleep. It’s important to remember that as the brain heals from withdrawal, the sleep patterns may return to normal.

Patients should be kept in a calm atmosphere to reduce the risks of progression from moderate symptoms to hallucinations.

The following patients need hospital admission.

• Suicidal thoughts
• Misuse of other drugs
• Associated mental issues
• Lack of support structures
• Abnormal laboratory results
• The risk of delirium tremens is high
• Withdrawal seizures in the past

The most common treatment for withdrawal seizures is benzodiazepines. However, they may also need to be used in combination with phenytoin, barbiturates, intubation, or sedation with propofol or ketamine. In the most severe cases, dexmedetomidine is used.

Oxazepam and chlordiazepoxide are frequently prescribed in oral form to treat withdrawal symptoms. In addition to these, neuroleptics and anticonvulsants such as carbamazepine and valproic acid are used to treat symptoms.

Baclofen helps treat muscle spasms, and propofol treats delirium tremens, which has not responded to other treatments.

Doctor’s consultation and prescription is necessary before taking any medications or drugs. They can prescribe specific medicines and modify the dosage as needed.

Treatment methods

Since there is no one-size-fits-all method for treating alcohol abuse. Rehabilitation programmes usually include,

• Hospital treatment

Patients dealing with alcohol addiction can find a safe, supervised environment in inpatient recovery centres. This is the most intensive treatment, requiring 24-hour care, and often involves 30, 60 or 90-day regimens.

• Outpatient Care

Patients can manage their everyday activities while recovering with outpatient rehab. This approach best suits those with less severe forms of alcohol abuse.

• Medication-Assisted Therapy

Medication-assisted therapy is a common feature of treatment programmes to help ease unpleasant withdrawal symptoms. Alcohol withdrawal can be treated with specific prescription drugs, helping patients to concentrate on other parts of recovery.

• Counselling

Counsellors offer support throughout the highs and lows of alcohol withdrawal. Additionally, counsellors examine any potential underlying causes of alcoholism and offer patients advice on handling different issues.

• Support Groups 

Recovery continues even after rehabilitation. Support organisations provide a forum for persons in alcohol recovery to talk about their treatment goals and difficulties. This will motivate a person to maintain sobriety due to this.

One will move on to additional treatment techniques, activities and programmes after the alcohol withdrawal stage. These will provide them with the skills and resources required to stay in treatment, avoid triggers and lead a healthy life after rehab.

Complications 

Alcohol withdrawal syndrome can come with several complications, including

• Anxiety 
• Seizures
• Depression
• Hallucinations
• Delirium tremens
• Disturbances in sleep
• Cardiovascular problems
• Wernicke-Korsakoff Syndrome. 

Can alcohol withdrawal symptoms be fatal? 

The condition can be fatal when dealing with alcohol withdrawal on one’s own.

The following alcohol withdrawal-related illnesses are potentially fatal while being very uncommon. It’s important to get medical attention immediately when there are any signs of these diseases.

• Seizures
• Delirium tremens
• Heart failures.

Conclusion 

Alcohol withdrawal symptoms usually develop when a person abstains from drinking or drastically cuts back after prolonged usage. The symptoms of alcohol withdrawal can be fatal in certain cases. 

An interprofessional team manages alcohol withdrawal management in every situation to achieve positive outcomes.

Both inpatient and outpatient treatment options for alcohol withdrawal are available. Close observation is necessary for every situation since the symptoms can start at any time. 

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