Alcohol Withdrawal Syndrome

Alcohol withdrawal syndrome (AWS) is the name for the symptoms that occur when a heavy drinker suddenly stops or significantly reduces their alcohol intake. With AWS, you may experience a combination of physical and emotional symptoms, from mild anxiety and fatigue to nausea. Some symptoms of AWS are as severe as hallucinations and seizures. At its most extreme, AWS can be life-threatening.

Excessive drinking excites the nervous system. If you drink daily, over time your body becomes dependent on alcohol. When this happens, your central nervous system can no longer adapt easily to the lack of alcohol. If you suddenly stop drinking, or significantly reduce the amount of alcohol you drink, it can cause a number of symptoms. These include anxiety, insomnia, heart rate changes, increased blood pressure, and delirium.

People who are addicted to alcohol, or who drink heavily on a regular basis and cannot gradually cut down, are at high risk for AWS. AWS is more common in adults, but children and teenagers who drink excessively may also experience the symptoms. You are also at risk for AWS if you have previously had withdrawal symptoms or needed medical detox for a drinking problem. 

Symptoms of AWS may appear anywhere from six hours to a few days after your last drink. These usually include at least two of the following:

• tremors
• anxiety
• nausea and/or vomiting
• headache
• increased heart rate
• sweating
• irritability
• confusion
• insomnia
• nightmares

Symptoms may worsen over two to three days and persist for weeks. They may be more noticeable when you wake up with less alcohol in your blood.

The most severe type of withdrawal syndrome is known as delirium tremens. Its symptoms include:

• extreme confusion and agitation
• fever
• seizures
• tactile hallucinations (e.g., itching, burning, and numbness)
• auditory hallucinations (e.g., hearing non-existent sounds)
• visual hallucinations (e.g., seeing non-existent images)

If you have severe AWS symptoms, it is a medical emergency. Call for help or go to the emergency room. A high fever, hallucinations, and heart disturbances are all reasons to seek immediate help.

Your doctor will review your medical history, ask about your symptoms, and conduct a physical exam. Some signs your doctor will look for include:

• hand tremors
• an irregular heart rate
• dehydration
• fever

Your doctor may also perform a toxicology screen. This tests how much alcohol is in your body.

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is a series of questions used to measure AWS. Your doctor may use this test to diagnose AWS. It can also be used to determine the severity of your symptoms.

Treatment for AWS depends on how severe your symptoms are. Some people can be treated at home, but others may need supervised care in a hospital setting to avoid potentially dangerous complications.

The first goal of treatment is to keep you comfortable by managing your symptoms. Alcohol counseling is another important treatment goal. Your doctor will want you to stop drinking as quickly and safely as possible.

Home Care

Mild symptoms of AWS can often be treated at home. A relative or friend must stay with you to monitor your condition. Their job is to make sure you go to counseling and visit the doctor regularly for routine blood tests. You may also need tests for alcohol-related medical problems.

If your home environment is not helpful for staying sober, talk to your doctor. He may be able to help you find a place to stay until you recover.

Hospitalization

If your symptoms are more severe, you may need hospitalization. This is so a doctor can monitor your condition and manage any complications. You may require IV fluids to prevent dehydration and medications to help ease your symptoms.

Medication

Symptoms of AWS are often treated with sedatives (benzodiazepines). Once withdrawal is complete, additional medications and supplements may be needed to address complications and nutritional deficiences that occur as a result of chronic alcohol use. 

Most people with AWS recover fully. If you stop drinking, get treatment, and are otherwise healthy, the outlook is usually good. However, sleep disturbances, irritability, and fatigue may continue for months.

If AWS has advanced to delirium tremens, it can be fatal. If you begin experiencing severe symptoms of AWS, it is important to seek immediate medical attention. The faster you begin treatment, the better your chances are of avoiding life-threatening complications. 

The best way to prevent AWS is to avoid regular heavy drinking. If you are already dependent on alcohol, seek counseling and medical care. The goal is to safely and gradually lessen your dependence on alcohol so that you can resume a healthy life.