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alcohol Withdrawal Symptoms

Alcohol withdrawal syndrome and the symptoms that come along with it

They say that the first step to getting over an alcohol addiction is accepting that you have a problem. Acknowledging the problem is part of the lengthy recovery process that is to follow. Remember, this might just be one of the hardest things you have ever done. Getting over an addiction, be it alcohol or anything else, is a Herculean task that must not be taken lightly. This journey that you are about to take on is one that requires immense patience, vigilance and resilience. Unless you have will power to light the way, you aren’t going to get anywhere anytime soon. The emotional and physically taxing journey that recovery is can only be overcome if you have a clear knowledge of what is going on – how is your body reacting to the recovery process? What is going on inside you? Why are you feeling the way that you are?

As any recovering alcoholic will tell you, the withdrawal takes the maximum toll on you. The dictionary defines withdrawal as “the action of withdrawing from something”. In simple terms, during the recovery process and after, you will not be able to consume alcohol in any form. Think about it. All these days, your body has been used to a certain product being consumed every day and has altered its functionality accordingly. One fine day, you decide to opt for abstinence, without preparing your body for it. Don’t you think it would react adversely? That is probably the simplest way of explaining withdrawal symptoms before we delve into the details.

Alcohol withdrawal symptoms

We all know that alcohol consumption, especially to the extent that it hampers your personal and social life is bad and looked down upon. But deciding to quit alcohol one fine day on an impulse is equally dangerous and may even kill you. Yes, you heard that right. Extreme withdrawal symptoms may even lead to death. When you decide to quit alcohol, you will be encountering what is commonly known as AWS or Alcohol Withdrawal Symptom. After all, there’s a reason why rehab is a long procedure; under medical supervision, you will be made to quit alcohol gradually and the prescribed pace. Not out of the blue!  So, what exactly is this withdrawal symptom?

Basically, people who have been consuming alcohol regularly for a long duration of time are subject to withdrawal symptoms when they first decide to quit. The decision to quit affects you both mentally and physically. Yes, withdrawal isn’t just a disorder of the mind. It takes a menacing toll on your health, overall. Imagine craving for your favourite drink and being deprived of it – that is precisely what leads to withdrawal symptoms. Depending on the person and the nature of the addiction, the extent of the withdrawal symptom varies from fatigue to nausea to anxiety or eating disorders to severe hallucinations and even seizures. In some extreme cases, it may even result in delirium tremens and rapid heartbeat. Such extreme cases may prove to be fatal as well.

If statistics are anything to go by, more than 2 million people are affected by alcohol withdrawal symptom every year. The duration of withdrawal may vary from person to person. For some, it lasts for a couple of hours while for some, it may persist for a few weeks. Symptoms of withdrawal, as have been discussed in detail below, usually worsen with time and might compel you to seek medical attention as well. This is precisely why it is always recommended to undergo recovery under medical supervision. We would advise you to seek help as soon as you decide to quit, so that you can go for check-ups and keep a tab on the symptoms which are an integral part of the rehab procedure.

Who is prone to alcohol withdrawal syndrome?

Technically speaking, anyone who is subject to heavy drinking is bound to experience alcohol withdrawal symptom once they quit, regardless of age. Anyone who drinks more than the prescribed limit is going to experience withdrawal syndrome.

So what’s the prescribed limit we keep talking about? How much alcohol is too much? After what point, would it be considered over drinking? Let’s take a look. According to the Centre for Disease Control and Prevention, the following may be considered heavy drinking:

  • 5 oz. wine
  • 5 oz. distilled spirits/liquor, including rum, vodka, gin & whiskey
  • 8 oz. malt liquor
  • 12 oz. beer

Binge drinking is pretty common nowadays. Basically, people who drink in enormous quantities in one sitting are binge drinking. You might claim to drink only at social occasions, and that’s perfectly fine, right? NO! Getting intoxicated within a short period of time is never okay. It is even worse than chronic drinking. Can you imagine what the withdrawal symptoms would be like when you decide to quit suddenly?

The different phases of alcohol withdrawal syndrome

It would be rather easy to list a number of common symptoms that alcohol withdrawal symptom can bring along. If you look it up online, you’ll find the symptoms in abundance. But it’s much more serious than it seems. Alcohol withdrawal symptoms come in three stages, and each stage is equally important. Each stage progresses into the next one and each recovering alcoholic must undergo each of the three stages to get over his or her addiction.

The first stage

For people who are heavy drinkers, the first stage of alcohol withdrawal occurs immediately after they stop drinking. This stage usually thus lasts for approximately eight hours. You will be able to feel the tremors that define this particular stage for about 12 hours. You are bound to feel things more deeply during this stage and bouts of agitation aren’t unexpected either. However, these symptoms usually wane out after about twenty four hours or so. The symptoms that you encounter during this stage are mild, compared to the others. These symptoms would be lasting for one to three days. However, in some cases they might last longer. They are as follows:

  • Nervousness
  • Anxiety
  • Depression
  • Restlessness
  • Irritation
  • Mood swings that come and go without explanation
  • Unable to think clearly
  • Dilated pupils
  • Nightmares and mild seizures
  • Severe fatigue
  • Palpitations
  • Severe headache
  • Loss of appetite
  • Sleeplessness
  • Nausea
  • Trembling limbs
  • Unusually excessive sweating
  • Clammy skin

The second stage

As part of your alcohol recovery process, you will be made to undergo a detox phase. In medical terms, detoxification is medicinal or physiological removal of any kind of toxic substance from your body. In this case, it is alcohol that is the toxic substance. The detoxification procedure would be removing all traces of alcohol from your bloodstream. Yet, that doesn’t come without its own set of side effects. During this stage, you are going to experience a different set of withdrawal symptoms that are even more severe than the ones experienced in the first stage. Let’s say you have been a heavy drinker for years and you decide to quit out of the blue. Once you kick start the recovery process, these are the withdrawal symptoms you’ll have to encounter. Similarly, if this is your second attempt at giving up alcohol, you would be finding yourself in this predicament.

During this stage, you might experience severe fluctuations in blood pressure which can be alarming at times. Although most of the symptoms during this stage resemble that of the previous stage, they are much more dangerous and severe in this stage. This stage is also characterised by terrifying hallucinations which seem to get worse with time – these hallucinations last for twelve to twenty fours post alcohol consumption.

In medical terms, a hallucination is when someone begins to feel and experience or see and hear things that aren’t really happening. Hallucinations can be frightening, both for those facing it and for those around you. They bring on paranoia, nervousness, anxiety, panic attacks and fear. Thus, it is always better to be around people who love you and those whom you trust. That makes you feel safer and gives you a sense of belonging, something that can help you recover faster. Here are some other symptoms that you might be facing during this stage:

  • Loss of bladder and bowel control
  • Muscle rigidity in whole body
  • Disruptions or difficulties in breathing
  • Teeth or jaw clenching
  • Uncontrolled bites on tongue

The third stage

At least thirty per cent of the people recovering from alcohol addiction may be experiencing the third stage of alcohol withdrawal symptoms. These symptoms usually start three to four days after you stop drinking and may last for over two weeks. In extreme cases, these symptoms lead to DTs or delirium tremens which could prove to be life threatening. Below is a list of DTs indicators:

  • Muscle tremors in full body
  • Delirious mental condition
  • Grand mal seizures
  • A confused or disoriented mental state
  • Sound or sight-based hallucinations
  • Rapid and Drastic mood changes
  • Unusual sensitivity to light, sound or touch
  • Fearful or excited mental state
  • Fatal alterations in the heart rhythm
  • Deep slumber extending for full 24 hours and even more

Additionally, it is important to mention that those who are suffering from delirium tremens might end up hurting themselves or those around them – either intentionally or accidentally. Remember, they are delirious. In a fit of rage, which is most often unexplainable, they might act out of rage and impulse. Medical attention and supervision is of the utmost importance during this stage. These instances are more common if the person has been a heavy drinker for years or has tried to quit before and has experienced withdrawal symptoms before. Such instances are aggravated when the person is already suffering from liver or other ailments. People who are middle aged are more prone to such symptoms. Also, keep in mind, these symptoms are erratic. They might stop a day or two after they start; but that’s not the end of it. They might resurface a few days later and reach their peak in about five days.

Apart from delirium tremens, some other symptoms are also found during this stage. Some symptoms might be persisting from the previous stages, although they are much more severe. Some of them are as follows:

  • A state of confusion and inattention
  • Hallucination
  • Rapid heartbeat
  • Dilated pupils
  • Excessive sweating
  • Fever

It is important to remember that this stage is the most crucial of the three. Although the symptoms of the earlier two stages are severe and equally dangerous, most of them aren’t life threatening. Statistics show that if these symptoms go untreated, they might end up being fatal in fifteen per cent of cases. In most cases, these lead to cardiovascular or respiratory collapse, which eventually leads to death.

Protracted withdrawal symptoms

You cannot speak of alcohol withdrawal syndrome without speaking of protracted withdrawal. This is usually found in people who have been heavy drinkers for a long period of time and have finally decided to give up alcohol. This term refers to the prolonged symptoms that crop up even after the three stages of alcohol withdrawal are over. However, these symptoms are much less severe and usually wane out with time. If the symptoms of alcohol withdrawal linger for more than a year, it may be called a case of protracted withdrawal. Here are some of the characteristics of protracted withdrawal:

  • Craving for liquor
  • Clouded sensorium
  • Anhedonia – this is experienced when you are unable to derive pleasure from what made you happy earlier on
  • Nausea
  • Disorientation
  • Headache
  • Vomiting tendencies
  • Insomnia

The science behind alcohol withdrawal syndrome

Alcohol and every other similar substance usually has an effect on our brain, the neurotransmitters specifically. So what causes alcohol withdrawal syndrome? Is it simply you craving for a taste of alcohol? Or is it something more, like your body NEEDING alcohol?

When you consume alcohol, the ethanol seeps into the epithelial cells of your body through the bloodstream, and causes the happy high that you enjoy. The alcohol is metabolized to a certain extent in the body; the rest of it is excreted in the form of urine or sweat. One part of the alcohol that isn’t broken down is further absorbed by the brain. The strange sense of euphoria (what is commonly referred to as the “buzz”) is thus generated. While limited quantity of alcohol would induce a “feel good factor”, more than the prescribed amount would trigger drunkenness – where you are unable to function properly; it is characterized by memory lapses, blurred speech and difficulty in walking. Alcohol toils with the neurotransmitters and hampers their working. Consequently, we are cut off from a sense of reality and sink into a world of our own. Although we are swept into feeling or euphoria, the brain starts craving for more and more alcohol in order to feel the same feeling over and over again.

When you suddenly quit alcohol, your brain isn’t aware of what’s going on. All it craves for is the feeling of euphoria that was once regularly experienced. When you deny your body the alcohol and your brain of the feeling, the withdrawal symptoms arise. That is your body’s way of telling you that it needs alcohol; most people, unable to bear the withdrawal symptoms, give in to the cravings. This is why a very few percentage of people succeed in getting over their addiction at one go. It usually takes at least two attempts for you to be completely cured. Yet remember, getting over alcohol addiction is a lifelong procedure and doesn’t stop with time; it is something you will have to keep at for the rest of your life.

Alcohol & GABA & Glutamate

When you consume alcohol, it triggers the neurotransmitter called GABA and heightens its effects. This neurotransmitter is responsible for causing the feeling of relaxation and calmness. Well, that isn’t all that bad, isn’t it? However, the thing is, chronic consumption and stimulation of the GABA neurotransmitter will suppress its normal functioning and will lead to cravings for alcohol and eventually withdrawal tendencies. These cravings, as you have seen, may be staggering and are likely to take a toll on you.

Regular consumption of alcohol would also suppress the activities of a neurotransmitter called glutamate, which is usually responsible for you feeling excited. More than nondrinkers or light drinkers, glutamate would be all the more active in heavy drinkers and the effects are quite evident. The violence and jerky reactions that come along with withdrawal symptoms are usually associated with this particular neurotransmitter.

What happens when you suddenly quit alcohol?

So what really happens when you decide to quit drinking one fine day? All these neurotransmitters that had been suppressed all this while are triggered, and they become hyper active. This leads to a rebound which causes “hyperexcitability” – which is exactly what the term suggests. Consequently, what you feel is the exact opposite of what you felt while you drank. Instead of calmness and relaxation, you would be feeling charged up, anxious and overactive and this might even lead to tremors, violence, agitation and seizures.

Why is alcohol withdrawal dangerous?

We have talked about what goes on in your body when you consume alcohol and how it affects you. Now let’s take a look at what happens to your body once you quit drinking. We have already mentioned how your brain craves for alcohol when you stop drinking. For people who indulged in heavy drinking on a regular basis, the body would compensate for the alcohol by enhancing the production of several hormones and brain chemicals. Some of these are serotonin, dopamine and epinephrine. When you stop drinking, it triggers excessive production of these chemicals. This takes a massive toll on your nervous system causing arrhythmia, tremors, shakes, palpitations, hallucinations and other symptoms.

Diagnosis of alcohol withdrawal syndrome

It isn’t too tough to diagnose alcohol withdrawal syndrome since a large number of people experience it on a regular basis. We have talked about the symptoms and the science behind alcohol withdrawal syndrome. So what’s next? What can you do to help? Well, for firsts, you would be required to visit a doctor. It could be your general physician or a specialist. A doctor would be able to guide you in the right direction.

Getting medical attention

If you have stopped drinking suddenly, then you are bound to face some of the prior mentioned symptoms. When you do, you need to consult with a doctor. It would be like any other checkup really. The doctor would be asking you about your medical history, ailments, symptoms experienced and examine you physically. The physical examination is carried out to determine if you are suffering from any of these – coronary heart issues, congestive heart failure, gastrointestinal bleeding, liver diseases, infections, pancreatitis or impairment of the nervous system. Yes, all of these are possibilities when you quit drinking abruptly. Your doctor would be checking you for –

  • Irregular and abnormal heart rate
  • Hand tremors
  • Fever
  • Dehydration

Of course, a physical examination would be incomplete without a toxicology test. This test is performed to determine exactly how much alcohol is there in your body. A toxicology test involves blood count, liver functioning tests of LFTs, urine drug screening and testing the level of alcohol and electrolyte in your blood.

With a clear knowledge of your medical history and with a hands on physical examination to serve as evidence, the doctor would then be diagnosing the problem and the extent of it. But before that, your doctor would be asking you for the following information –

  • History of quantity of liquor consumption
  • Time since the patient had his last drink
  • Duration of liquor consumption
  • Previous case of alcohol withdrawal, if any
  • Any concurrent medical or psychological issues
  • Abuse or addiction to other agents

Clinical institute withdrawal assessment for alcohol, revised (CIWA-Ar)

The most effective and commonly opted for tool when it comes to determining the extent and severity of one’s alcohol withdrawal syndrome, is the CIWA-Ar. It comes in the form of a survey containing ten questions which are asked by the doctor. The best part about this survey is that it takes a maximum of five minutes and thus hastens the process. Based on your answers, you will be scored. The ten aspects covered in the Clinical institute withdrawal assessment for alcohol are as follows:

  • Anxiety
  • Agitation
  • Auditory disturbances
  • Clouded sensorium
  • Nausea/vomiting
  • Visual disturbances
  • Tactile disturbances
  • Paroxysmal sweating
  • Tremor
  • Headache

 

What do the results say

Depending on the severity of the symptoms experienced by the person, each parameter as mentioned above would be scored between 0 to 7. However, the symptom of clouded sensorium would be scored between 0 and 4. Based on that, your final score would be calculated.

People with scores more than fifteen, can be declared as suffering from medium to severe alcohol withdrawal. These patients are to be prescribed medication and more importantly, they are to be kept under medical supervision to watch out for signs of delirium tremens. People with a score between eight to fifteen are safer and are suffering from mild forms of alcohol withdrawal syndrome. These patients are also prescribed medication and their treatment must be monitored closely for optimum results. This scale has proved to be immensely helpful in determining the extent of the alcohol withdrawal symptoms of a person. Usually, detoxification units, medical centers and psychiatry units are authorized to carry out this assessment.

Seeking treatment for alcohol withdrawal syndrome

It’s okay to accept that you have a genuine problem and seek help for it. Remember, alcohol withdrawal syndrome is very much treatable and you are bound to get through it with the right care and treatment. It doesn’t matter how severe your symptoms are; as long as you are under medical supervision, it can be controlled and taken care of. Keep in mind, the symptoms of alcohol withdrawal syndrome are pretty erratic and you never know what may lead to what – if you or a loved one starts showing any of the symptoms mentioned above, rush them to a medical centre immediately.

What is hoped to achieve through the treatment procedure?

The American Society of Addiction Medicine has listed three goals that are to be kept in mind while providing treatment for alcohol withdrawal syndrome. They are:

·       Providing a safe and sound withdrawal from alcohol thus preparing the patient for an alcohol free and happy life.
·       The provision of withdrawal should be humane and would uphold the dignity of the patient.
·       Preparing the patient for the lengthy rehab procedure and on-going treatment.

To put it simply, during treatment, the abnormalities in your electrolyte and fluid levels caused by alcohol would be treated. Intravenous fluids are usually administered for patients exhibiting severe symptoms since fluid loss through sweat, vomiting and hyperthermia is a possibility. However, for patients showing mild symptoms, intravenous fluids aren’t required since that might lead to over hydration.

Treatment options

Basically, there are three treatment options when it comes to alcohol withdrawal syndrome, namely – home care, in patient rehab and outpatient rehab.

  • Home care – For patients showing mild symptoms of alcohol withdrawal symptoms, home care would suffice. They would be prescribed medicines and would have to come in for regular checkups to keep a tab on their progress.
  • In patient rehab – For patients who are suffering from severe alcohol withdrawal syndrome and are at risk for delirium tremens would be admitted and kept under observation. They would be closely monitored by specialists till it can be considered safe to send them home.
  • Outpatient rehab – This is for people who are suffering from mild to moderate alcohol withdrawal syndrome. They wouldn’t have to remain under constant medical supervision; occasional visits to the physician would do just fine. Medicines would be prescribed to them and lifestyle modification is a must.

Counselling

It would be impossible to get over your alcohol addiction without the help of a seasoned counsellor. Remember, recovering from addiction is taxing both physically and mentally. You might have loving friends and family who support you and care for you; but they don’t really know what’s going on inside your mind and body. Only your counsellor can help with that. They know exactly what you are feeling and how to help you. During this journey that you’ve taken on, you need someone to talk to, someone who would understand you and listen to you.

More often than not, recovering alcoholics relapse. This is pretty common; but having a counsellor by your side can significantly reduce the chances of a relapse. Remember, this is a struggle for a lifetime – you are never really done with recovery. You just have to take it one day at a time, and this is where a counsellor comes in handy.

Tips to avoid alcohol withdrawal syndrome

Well for one, do not stop drinking abruptly. If you have taken the decision to quit alcohol, then that’s a major step taken. Your next step should be to seek medical help. There are two reasons why you shouldn’t stop drinking abruptly. One, it puts you at greater risk for alcohol withdrawal syndrome and two; you’re not going to be able to keep it up. Instead, why not seek help and reduce alcohol consumption gradually, giving your body sufficient time to get used to it?

By now, you have a fair idea of what alcohol withdrawal syndrome is; the science behind it and why it happens, the three stages of the syndrome and the symptoms associated with each symptom and the treatment options available for you. If you feel that you have a drinking problem or maybe you know someone who does, it is probably time to stop procrastinating and get help.

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