Alcohol abuse is common in the United States. According to recent data from the National Institute on Alcohol Abuse and Alcoholism, 5.8 percent of adults in the United States have an alcohol use disorder, which is the term used to describe a diagnosable alcohol addiction.
One of the signs of an alcohol use disorder is experiencing withdrawal symptoms (alcohol withdrawal disorder) in the absence of alcohol, meaning that once a person stops drinking for a period, withdrawal will begin. Reports from American Family Physician suggest that each year, about 2 million Americans will experience some sort of alcohol withdrawal. This can range from mild symptoms to severe withdrawal conditions that require hospitalization.
Symptoms of Alcohol Withdrawal
What is alcohol withdrawal?
When a person with an alcohol addiction stops drinking, it is not unusual for withdrawal to occur, since the body may become dependent upon alcohol over time. In some cases, withdrawal is mild and may create symptoms like sleep disturbances and tremors. In more serious cases, a person may develop withdrawal-related seizures or a potentially life-threatening condition called Delirium Tremens (DTs).
According to addiction experts from the Medical University of South Carolina, the following symptoms are associated with alcohol withdrawal syndrome:
Common alcohol withdrawal symptoms
- Agitation and Irritability
- Sensitivity to Light and Noise
- Concentration Problems
- Nausea and Vomiting
Serious alcohol withdrawal symptoms
- Extreme agitation
- Extreme confusion
- Excessive sweating
- Hallucinations: tactile, auditory & visual
- High blood pressure
- Delirium tremens
Is fever a symptom of alcohol withdrawal?
According to a 1999 study conducted by researchers at the European Journal of Internal Medicine, fever is a common symptom in patients experiencing alcohol withdrawal. Roughly 65% of participants admitted for treatment of Alcohol Withdrawal Syndrome displayed low-grade fever while an additional 21% presented high-grade fever.
People with a more severe case of alcohol withdrawal syndrome may also experience hallucinations that come and go. Experts explain that these alcohol use disorder withdrawal symptoms of alcohol use can appear as soon as 6 hours but as long as two days after a person who drinks heavily has his or her last drink. The symptoms will reach a peak and then taper off over a period of a day or two.
According to scientists from SUNY Upstate Medical University, about half of people who abuse alcohol will undergo withdrawal syndrome when they stop or reduce their drinking, so the above symptoms, which can be considered mild to moderate, are fairly common. Only about 3 to 5 percent of people who experience withdrawal will progress to the most severe form of alcohol withdrawal syndrome, which is delirium tremens.
When withdrawal is severe, initial symptoms can quickly progress to seizures and hallucinations, which may be the first signs that a person is at risk for delirium tremens. In fact, untreated seizures can lead to delirium tremens, suggesting that withdrawal-related seizures should not be taken lightly.
Treatment Setting for Alcohol Withdrawal
Inpatient vs. outpatient treatment
Treatment of alcohol withdrawal syndrome will vary based upon symptom severity and each person’s history and needs. For example, some patients who have a history of heart problems, infectious diseases, liver problems, or pancreatitis may require more intensive care.
Mild alcohol withdrawal symptoms
For patients who are experiencing mild to moderate withdrawal, outpatient treatment is appropriate, especially for those who have no known medical problems that could complicate the withdrawal process. While engaged in outpatient withdrawal, best practices stipulate that patients should see a treatment provider daily during the withdrawal process to assess vital signs and ensure that treatment is effective.
Acute alcohol withdrawal symptoms
Those who experience more severe or acute withdrawal symptoms or who have a history of withdrawal-related seizures or delirium tremens may require inpatient withdrawal treatment. This level of care may also be necessary for those who have mental or physical health conditions that can complicate the withdrawal process.
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Withdrawal Treatment Protocol
Just as the setting for alcohol withdrawal syndrome treatment varies based upon withdrawal severity, the specific treatment that is provided will also be different based upon severity level. For example, mild cases of withdrawal can be managed at home by remaining in a quiet environment with low lighting and minimal social interaction. Proper nutrition and fluid intake are also necessary to support mild withdrawal.
On the other hand, those who experience severe withdrawal will likely require inpatient treatment, where they can receive frequent, ongoing monitoring from medical staff. Medications are commonly used to treat severe alcohol withdrawal syndrome, and benzodiazepines, a type of prescription drug use to treat anxiety, sleep disturbances, and seizures, are typically the first choice for alcohol withdrawal. In some cases, patients may receive hourly doses of a benzodiazepine until symptoms subside or they become heavily sedated. In this case, a patient will typically require only one to two days of medication. Other treatment providers prefer to provide lower doses of medication so that a patient does not become as heavily sedated.
Regardless of symptom severity, nutritional deficiencies are an important consideration in cases of alcohol withdrawal syndrome. For instance, alcohol abuse can lead to deficiencies in sodium and magnesium, which can cause life-threatening metabolic disturbances in severe cases. Magnesium supplements are often considered to be beneficial during the withdrawal treatment process, and according to experts, they may even prevent serious complications like seizures and delirium tremens.
Thiamin and folic acid may also be helpful for alcohol withdrawal syndrome. Experts recommend a folic acid supplement for patients who are being treated for alcohol-related withdrawal symptoms. Thiamin supplementation is also recommended, because it can prevent the development of a severe condition called Wernicke syndrome, which leads to confusion, and in severe cases, permanent dementia.
Beyond vitamin and mineral supplementation, some patients may require intravenous fluids during the course of alcohol withdrawal. For example, those who become dehydrated as a result of nausea and vomiting may require fluids to remain healthy.
Delirium Tremens Treatment
Mild to moderate withdrawal can often be treated in an outpatient setting, whereas moderate to severe alcohol withdrawal syndrome is likely to necessitate inpatient treatment. In cases of delirium tremens, emergency treatment in an inpatient setting is required, as the condition can cause respiratory failure and death when left untreated. According to alcohol treatment experts from the Catholic University of Rome, treatment for severe withdrawal syndrome like delirium tremens occurs in an inpatient setting, often with benzodiazepine medications. Some patients may benefit from other medications, such as barbiturates.
How alcohol withdrawal is diagnosed
Assessing Withdrawal Severity
When a patient presents for treatment of alcohol withdrawal syndrome, providers will likely use an assessment tool like the Clinical Institute Withdrawal Assessment for Alcohol to determine the withdrawal severity and assist with treatment planning.
Typical CIWA-Ar scoring model
Less than 8
Generally, patients who score less than 8 on this assessment are considered to be experiencing a mild case that does not require medication and can be treated on an outpatient basis.
Between 8 – 15
Those who score between 8 and 15 can often be treated on an outpatient basis, but medications may be necessary.
When patients score above a 15, their withdrawal is considered to be severe, meaning it requires inpatient treatment that includes the use of medications like benzodiazepines. Severe cases may require intravenous benzodiazepines, as well as other medications like barbiturates or beta blockers to calm the nervous system.
As with the specific treatment protocol used, the detox timeline varies based upon the severity of alcohol withdrawal. For example, experts report that mild to moderate cases typically pass within 2 to 7 days after alcohol cessation. On the other hand, severe withdrawal typically persists for 5 to 7 days. In some cases, which are referred to as protracted withdrawal, people may experience some symptoms for several weeks or months.
Regardless of the detox timeline or alcohol withdrawal syndrome duration, it is important to understand that alcohol withdrawal syndrome is a potentially life-threatening condition that requires monitoring from a medical professional. If you have been abusing alcohol and would like to stop, it is important to seek treatment from an addiction professional, regardless of whether or not you feel you are at risk for severe withdrawal.
While severe complications like delirium tremens are relatively uncommon, your withdrawal symptoms can quickly progress and become more serious. This is why it is vital that you work with a treatment provider to monitor your symptoms throughout the withdrawal process and ensure that you prevent life-threatening complications.
Another important consideration is the fact that withdrawal and detox are only the first steps toward a life that is free from the grips of alcohol addiction. Once you complete withdrawal treatment, it is important that you engage in ongoing recovery services to remain sober. This can involve attending support groups like Alcoholic Anonymous and receiving individual services, such as cognitive therapies that help you to develop coping strategies to prevent relapse.
Ongoing treatment may also involve meeting with a psychologist or psychiatrist to address any underlying issues like anxiety or depression that have contributed to alcohol abuse.
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