Dangers Of Alcohol Withdrawal
June 18, 2019
Alcohol addiction can ruin lives and yet many people keep on drinking because they fear what will happen if they stop; so the question is, can alcohol withdrawal be dangerous?
We’ll be exploring this crucial question below. Roughly half of all heavy drinkers experience withdrawal symptoms when detoxing during the first stage of rehabilitation and managing those early symptoms is key to a successful recovery.
What Is Alcohol Withdrawal Syndrome (AWS)?
Alcohol withdrawal syndrome (AWS), refers to the symptoms a heavy drinker experiences when they suddenly stop or dramatically reduce their intake of alcohol.
These symptoms can be both physical and emotional.
At the milder end of the spectrum, the patient might feel nauseous, anxious or heavily fatigued. And on the severe end, symptoms of AWS can extend to hallucinations, seizures, or even fatality.
With such extreme symptoms, it begs the question, why does the body react this way?
What Causes It?
Drinking to excess causes significant changes in the central nervous system.
Since alcohol has a sedating impact on the brain, heavy and long-term drinkers become exposed to this depressant effect almost continually. The brain fights back and tweaks its chemistry by producing chemicals to counteract the depressant induced by alcohol.
While still actively drinking, the presence of serotonin and norepinephrine in greater quantities than normal are balanced by the depressant effect of alcohol. Remove alcohol from the equation, and the brain is left overstimulated.
With the brain in overdrive and the central nervous system struggling to adapt to the absence of alcohol, AWS can develop. The symptoms manifest when neural signaling caused by alcohol dependence becomes excitable but there’s no longer any alcohol to balance things out.
How Long Does It Last?
Fifty percent of all heavy drinkers experience some degree of alcohol withdrawal symptoms that develop 6 to 24 hours after decrease or discontinuation of alcohol consumption.
Mild to moderate symptoms can often be self-managed and disappear within 2 to 7 days.
However, with more severe cases of AWS, medical treatment is often required and symptoms can linger slightly longer. More severe effects tend to occur anywhere from 2 to 4 days after abstinence.
How Is Alcohol Withdrawal Diagnosed?
If you’re alcohol dependent, it’s always wise to consult a doctor before abruptly stopping drinking.
The doctor can take a close look at your medical history and also conduct a physical examination. Depending on the amount of alcohol in your body, the doctor might also perform a toxicology screen.
AWS is measured using a series of questions from the CIWA-Ar (Clinical institute Withdrawal Assessment of Alcohol).
This scale takes 10 symptoms into account:
- Auditory disturbances
- Visual disturbances
- Tactile disturbances
- Inability to think clearly
- Nausea and vomiting
Your doctor might accompany this assessment with some simple questions to establish whether you’re thinking lucidly.
Broad symptoms your doctor will be looking for include an irregular heart rate, dehydration, fever and hand tremors.
While it can be difficult to be honest with your healthcare provider, transparency is paramount. Your doctor might also speak with you about your diet since poor nutrition is commonplace in anyone who’s alcohol dependent.
With a diagnosis in place, what can you expect by the way of alcohol withdrawal symptoms?
3 Stages of AWS Symptoms
The symptoms of alcohol withdrawal can be broadly split into 3 stages:
- Stage 1: Mild
- Stage 2: Moderate
- Stage 3: Severe (Delirium Tremens)
Stage 1: Mild
Minor issues such as headaches, anxiety and tremors come about at the milder end of AWS.
Insomnia is common as are gastrointestinal disturbances and abdominal pain. At the same time, you might experience a loss of appetite and vomiting.
A feeling of depression can descend even with mild withdrawal.
Stage 2: Moderate
Alongside the symptoms above, moderate withdrawal symptoms can also include elevated body temperature (hyperthermia) and a rapid heartbeat (tachycardia).
Sweating and shallow breathing regularly occur along with a rise in systolic blood pressure.
With moderate AWS symptoms, a general sense of confusion often accompanies these physical symptoms. Irritability and mood swings are to be expected.
Stage 3: Severe (Delirium Tremens)
With severe withdrawal symptoms, disorientation and hallucinations can become dangerous if you’re not in the correct environment.
In the worst scenario, severe AWS can provoke seizures.
Many factors influence the degree of severity of these symptoms including:
- How long you’ve been drinking
- The amount you’ve been drinking
- Your stress levels
- Your medical history
- A family history of addiction
- Any co-occurring mental disorders
While not all symptoms develop in all patients, alcohol withdrawal tends to follow a pretty predictable pattern once alcohol is no longer in your system.
Timeline and Dangers of Alcohol Withdrawal
Although there’s no fixed timeline, the NLM (National Library of Medicine) breaks down how the first week after eliminating alcohol from your system will look:
- 8 hours after last drink: Initial stage of alcohol withdrawal can begin at any stage from this point forth
- 24 to 72 hours after last drink: This is normally where symptoms peak. During the first 3 days, stage 2 and stage 3 symptoms can occur
- 5 to 7 days after last drink: You can expect symptoms to start diminishing and becoming less intense
- 7 days and later after last drink: In most cases, physical withdrawal symptoms will be gone after a week, but some psychological effects can continue for several weeks if not properly treated
With that rough guideline of time frame in place, what can you expect to happen specifically?
We’ll categorize common symptoms now along with the time they usually occur. Many of these symptoms are at the more severe stages of withdrawal but they indicate the possible dangers of alcohol withdrawal if it’s not carefully managed.
- Tremors: Starting some 5 to 10 hours after the last drink, shaking and tremors will usually taper off within the first couple of days. Shaking is routinely accompanied by an increased pulse and blood pressure. Breathing becomes rapid and you’ll be prone to sweating profusely. Nausea and vomiting are also common. Psychological effects include anxiety, hyper-alertness, vivid dreams or nightmares and insomnia
- Hallucinations: At some point during the 24 hours following your last drink, hallucinations can start and might last for 48 hours. These can be detailed visions or the physical feeling of crawling insects on the skin. It’s vital that you’re adequately supervised if you start hallucinating
- Seizures: The risk of seizures peaks 24 hours after the last drink but there’s still a danger during the initial 48 hours of withdrawal. This is one of the primary hazards of severe withdrawal
- Delirium Tremens: Delirium tremens (DTs) can begin any time during the first week of withdrawal but most frequently occur after 2 to 3 days. The New England Journal of Medicine states that DTs happen in 3-5% of cases. Close medical supervision is essential. You could experience dangerous shifts in breathing, dramatic spikes in blood pressure and a racing heart. Circulation and temperature regulation can go haywire. DTs can even reduce blood flow to the brain. Symptoms indicating DTs are wide. Confusion and disorientation along with angry behavior bordering on the irrational, hallucinations and loss of consciousness suggest the need for medical supervision
With all these concerning symptoms and side effects of withdrawal, what is the best form of treatment?
Treatment: Alcohol Detox
Alcohol withdrawal is a serious and potentially life-threatening problem that chronic alcohol users usually experience. While many believe they can detox in their own home, a medically supervised detox program is the safest and most advisable method.
Supervised care in a hospital or inpatient program is sometimes the best course of action. The most appropriate type of treatment will work to minimize the dangers of alcohol withdrawal and detox. It is the first valuable stage on the path to lifelong recovery.
If your blood pressure, pulse or temperature rise radically, there’s a good chance your doctor will recommend medically supervised withdrawal. If there’s any chance of seizures or delirium tremens, you should be treated in a hospital, sometimes even in the Intensive Care Unit. This will allow for close monitoring of heart rate, breathing and blood pressure since seizures can occur.
If you’re hospitalized for alcohol withdrawal, you’ll also be able to get fluid into your veins to ensure you’re sufficiently hydrated at all times.
Medication can be used to mitigate anxiety and insomnia. Benzodiazepines like Librium and Ativan can reduce acute AWS symptoms to a more manageable level. You may also be administered anti-seizure drugs or antipsychotics.
Who Is At Risk From Alcohol Withdrawal?
Anyone drinking heavily on a regular basis and anyone dependent on alcohol is at a high risk of AWS.
This begs the question, what constitutes heavy drinking?
According to the Centers for Disease Control and Prevention, women consuming more than 8 drinks per week and men taking more than 15 drinks weekly are considered heavy drinkers. The definition of one drink is:
- 12oz beer
- 5oz wine
- 1.5oz spirits
This risk of alcohol withdrawal is heightened if you have previously tried detoxing from alcohol and experienced withdrawal symptoms.
Is It Possible to Avoid Alcohol Withdrawal?
It might seem obvious but the easiest way to prevent alcohol withdrawal is to avoid regular heavy drinking and binge drinking in the first place.
If you’re already dependent on alcohol, gradually reducing your dependence by tapering off your consumption could lessen the symptoms of AWS when you stop completely.
While alcohol withdrawal is relatively common, the more severe delirium tremens only occurs in 5% of cases. That said, anywhere from 5 to 15% of patients that develop those symptoms die.
It’s primarily for this reason, along with the chance of severe seizures occurring, that medically supervised detox is vital in cases of alcohol dependence.
If you’ve attempted to stop drinking at home and notice any symptoms of delirium tremens, seek medical attention immediately. This will mitigate the chance of any potentially life-threatening complications.
The vast majority of people with AWS recover. Remaining sober will keep most symptoms at bay after the first week. Sleep disturbances, irritability and fatigue can continue for months, though.
As long as you take all sensible precautions, alcohol withdrawal is far more likely to be uncomfortable than outright dangerous.
However, any alcoholic who continues drinking can expect a reduction in life expectancy of up to 15 years. Is a drink really worth that much?
Remember that withdrawal is only the first stage in a lifelong journey to sobriety. There’s no catch-all solution but you should consider that only around 20% of alcoholics abstain from drinking permanently without engaging in any treatment or self-help programs at all.
With programs like AA, almost half of all members who stay sober for a year remain sober for another year. After attending AA for 5 years and remaining abstinent throughout, this figure rises to an impressive 91%.
The symptoms that patients may deal with when it comes to alcohol withdrawal can be dangerous and even life-threatening, but for the bulk of people withdrawal is just the first uncomfortable step on the way to a fruitful recovery.