DefinitionAlcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.
Alternative NamesDetoxification - alcohol; Detox - alcohol
Causes, incidence, and risk factorsAlcohol withdrawal occurs most often in adults, but it may occur in teenagers or children.The more you drink every day, the more likely you are to develop alcohol withdrawal symptoms when you stop drinking.You may have more severe withdrawal symptoms if you have certain other medical problems.
SymptomsAlcohol withdrawal symptoms usually occur within 5 - 10 hours after the last drink, but can occur days later. Symptoms get worse in 48 - 72 hours, and may persist for weeks.Common symptoms include:Anxiety or nervousnessDepressionNot thinking clearlyFatigueIrritabilityJumpiness or shakinessMood swingsNightmares Other symptoms may include:Clammy skinEnlarged (dilated) pupilsHeadache
Insomnia (sleeping difficulty)Loss of appetiteNausea and vomitingPallorRapid heart rateSweatingTremor of the hands or other body parts A severe form of alcohol withdrawal called delirium tremens can cause:AgitationSevere confusionSeeing or feeling things that aren't there (hallucinations)FeverSeizuresFor more information on this severe form of alcohol withdrawal, see: Delirium tremens.
Signs and testsYour health care provider will perform a physical exam. This may reveal:Abnormal eye movementsAbnormal heart rhythmsNot enough fluids in the body (dehydration)FeverRapid breathingRapid heart rateShaky handsBlood and urine tests, including a toxicology screen, may be done.
TreatmentThe goal of treatment includes:Reducing withdrawal symptomsPrevent complications,Therapy to get you to stop drinking (abstinence)INPATIENT TREATMENTPeople with moderate-to-severe symptoms of alcohol withdrawal may need inpatient treatment at a hospital or other facility that treats alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens.Treatment may include:Monitoring of blood pressure, body temperature, heart rate, and blood levels of different chemicals in the bodyFluids or medications through a vein (by IV)Sedation using medication called benzodiazepines until withdrawal is completeOUTPATIENT TREATMENTIf you have mild-to-moderate alcohol withdrawal symptoms, you can often be treated in an outpatient setting. You will need someone to commit to staying with you during this process,k and who can keep an eye on you. Daily visits to your health care provider are needed until you are stable.Treatment usually includes:Sedative drugs to help ease withdrawal symptomsRoutine blood testsPatient and family counseling to discuss the long-term issue of alcoholism. See: AlcoholismTesting and treatment for other medical problems linked to alcohol useIt is important that the patient goes to a living situation that helps support them in staying sober. Some areas have housing options that provide a supportive environment for those trying to stay sober.Permanent and life-long abstinence from alcohol is the best treatment for those who have gone through withdrawal.
Support GroupsSee: Alcoholism support group
Expectations (prognosis)How well a person does depends on the amount of organ damage and whether the person can stop drinking completely. Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition.Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for months. People who continue to drink a lot may develop health problems such as liver and heart disease.Most people who go through alcohol withdrawal make a full recovery. However, death is possible, especially if delirium tremens occurs.
Calling your health care providerAlcohol withdrawal is a serious condition that may rapidly become life threatening.Call your health care provider or go the emergency room if you think you might be in alcohol withdrawal, especially if you were using alcohol often and recently stopped. 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 seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur.
PreventionReduce or avoid alcohol. If you have alcoholism, you should stop drinking completely.
ReferencesO’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.In the clinic. Alcohol use. Ann Intern Med. 2009 Mar 3;150(5).Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501.