Understanding Alcohol Withdrawal Syndrome: Causes, Symptoms, and Treatment

While it is very easy to become addicted to alcohol, leaving alcohol can be an entirely different story. Trying to quit alcohol can give rise to a wide variety of symptoms that are known as alcohol withdrawal syndrome. These symptoms usually develop when a heavy drinker suddenly stops drinking or tries to reduce their intake of alcohol. It has been observed that people who drink heavily experience certain changes in their brain chemistry over a period of time because of the continued exposure to the many chemicals present in alcohol. So when the person suddenly stops drinking or reduces the intake of alcohol, the brain has to readjust, which causes the symptoms associated with alcohol withdrawal syndrome. Read on to find out everything you need to know about alcohol withdrawal syndrome.

Alcohol withdrawal syndrome (AWS) is an umbrella term used to refer to the symptoms that develop when a heavy drinker dramatically reduces or suddenly stops drinking alcohol. ^(1,2) In the past, a person who was a heavy alcohol drinker was known to have an alcohol addiction or alcoholism, but now it is referred to as alcohol use disorder. When a person regularly starts to drink too much alcohol, their body quickly becomes dependent on alcohol. ⁽³⁾

It is important to know that alcohol is a depressant and drinking heavily can, over a period of extended time, alter the brain chemistry of a person because of the prolonged and regular exposure to the chemicals in the alcohol. Chronic alcohol use can lead to many complex changes in the brain. This may even include changes to the important neurotransmitters known as gamma-aminobutyric acid (GABA) and dopamine. This has an impact on the person’s sense of reward and excitement levels. The production of these neurotransmitters gets affected when the person suddenly stops or dramatically decreases the intake of alcohol. This means that the brain has to suddenly readjust, which is what leads to the withdrawal symptoms associated with AWS. ^(4,5)

When you have alcohol withdrawal syndrome, you are likely to experience a combination of both emotional and physical symptoms, which may include mild anxiety and weakness to nausea. If it gets extreme, AWS can even be life-threatening. ⁽⁶⁾

People with alcohol withdrawal syndrome may experience a wide range of symptoms, depending on the extent of withdrawal. The primary factor that determines the severity of symptoms is the amount of alcohol the individual drank, their gender, age, body type, and whether they have any other underlying medical conditions. Some of the common symptoms of alcohol withdrawal syndrome may include: ⁽⁷⁾

• Nausea and/or vomiting
• Agitation
• Fast heart rate
• Headache
• Sweating
• Insomnia
• Anxiety
• Nightmares

Though it is rare, some people can also develop severe symptoms of alcohol withdrawal. Severe symptoms of alcohol withdrawal syndrome are known as delirium tremens (DTs). Symptoms of delirium tremens may include: ^(8,9)

• High blood pressure
• Extreme disorientation
• Increased body temperature
• Severe tremors
• Visual hallucinations, meaning seeing things that are not actually there
• Tactile hallucinations – this includes feeling a burning or itching sensation or numbness that is not really happening.
• Auditory hallucinations, meaning hearing sounds that are not there
• Fast respirations
• Seizures

Delirium tremens can prove to be fatal in many cases. In some extreme cases of DTs, the brain can have trouble regulating circulation and breathing. Some people may also develop drastic changes in heart rate and blood pressure, which may even cause a heart attack or stroke. ^(10, 11)

The symptoms of alcohol withdrawal syndrome tend to worsen over a period of two to three days, though some of the milder symptoms can continue to persist for several weeks in some cases. These symptoms are usually more noticeable in the morning when you wake up and there is less amount of alcohol present in the blood.

If you are experiencing severe symptoms of alcohol withdrawal syndrome, you should consider it to be a medical emergency and call for immediate medical assistance.

Hallucinations, high fever, and heart disruptions are some of the signs that should alert you to seek immediate medical help.

Excessive drinking causes excitement and irritation to the nervous system. If you consume alcohol on a daily basis, over a period of time, the body becomes dependent on alcohol. When this happens, the central nervous system is no longer able to adapt as easily as it used to the lack of alcohol. If you suddenly cut down on the amount of alcohol you drink, or stop drinking completely if may cause alcohol withdrawal syndrome. ⁽¹²⁾

People who drink heavily on a regular or daily basis or those who already have an addiction to alcohol and are not able to cut down on their alcohol intake gradually, are at a high risk of alcohol withdrawal syndrome. Alcohol withdrawal syndrome is most commonly observed in adults, but teenagers and children who drink excessively at that age may also experience the symptoms of alcohol withdrawal syndrome. You are further at risk of developing alcohol withdrawal syndrome if you have previously experienced withdrawal symptoms or you have gone through a medical detox program to help deal with a drinking problem.

According to the US Centers for Disease Control and Prevention (CDC), heavy drinking is defined as drinking more than eight drinks per week for women and over 15 drinks in a week for men. This translates to mean the equivalent of one drink for the following: ⁽¹³⁾

• 5 ounces of wine
• 1.5 ounces of distilled liquor or spirits like vodka, rum, whiskey, and gin
• 12 ounces of beer
• 8 ounces of malt liquor

It is important to note that binge drinking is one of the most common types of heavy drinking. This can be defined as five or more drinks for men in one sitting, and four or more drinks for women in one sitting. ^(14,15)

To diagnose alcohol withdrawal syndrome, your doctor will first go over your medical history in detail, enquire about your symptoms, and also carry out a physical examination. Some of the signs and symptoms that your doctor will be looking out for include:

• An irregular heart rate
• Hand tremors
• A fever
• Signs of dehydration

Your doctor is also likely to order a toxicology screen, which is a test that measures how much alcohol is present in your body or bloodstream. One of the most common items used to diagnose alcohol withdrawal syndrome is the Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar), which is a series of questions or a questionnaire used for determining if a patient has AWS. ⁽¹⁶⁾ Doctors commonly use this test to diagnose alcohol withdrawal syndrome. It is also used to determine how severe your symptoms are on a scale that measures the following ten symptoms:

• Level of agitation
• Auditory disturbances
• Anxiety
• Headache
• Nausea and/or vomiting
• Inability to think clearly or clouding of sensorium (senses)
• Tactile disturbances
• Visual disturbances
• Sudden and uncontrollable sweating known as paroxysmal sweats
• Tremors

However, there is a lot of debate about the use of the Clinical Assessment mentioned above as many doctors consider the questionnaire to be unreliable due to it being subjective in nature. According to a study carried out in 2017, the use of the Objective Alcohol Withdrawal Scale (OAWS) was found to be more helpful in treatment since it could also be used as a framework, while doctors could also customize it to individual patients and cases. ⁽¹⁷⁾

The exact treatment for alcohol withdrawal syndrome depends on the severity level of your symptoms. While some people can easily be treated at home, others may need to be admitted to a hospital to receive more supervised care so that any potentially dangerous complications can be avoided, such as seizures.

The primary goal of treatment for alcohol withdrawal syndrome is to remain comfortable while managing the symptoms of the patient. Alcohol counseling forms an important part of the treatment. The overall goal of treating alcohol withdrawal syndrome is to help a patient stop drinking in the quickest and safest manner possible. ^(18,19)

If your symptoms are mild, they can usually be treated at home itself. However, it is necessary for someone, either a relative or friend, to stay with you in order to keep an eye on your condition. The job of whoever stays with you will be to ensure that your symptoms do not worsen. In case of any complications, they should get you to the nearest emergency center or hospital or call the emergency number of your area immediately, such as 911.

The symptoms of alcohol withdrawal syndrome are commonly treated with a class of sedative drugs known as benzodiazepines. The most commonly prescribed medication is chlordiazepoxide. Some of the other benzodiazepines that your doctor may prescribe include:

• Ativan (lorazepam)
• Xanax (alprazolam)

It is important to note that benzodiazepines have a risk of dependence. If you are prescribed a benzodiazepine drug, you must discuss the risks of taking these medications with your doctor and also take them exactly how your doctor has prescribed them. ⁽²⁰⁾

In addition to these medications, vitamin supplements may also be prescribed to replace the essential vitamins that get lost due to the regular alcohol use. Once your withdrawal process is complete, further medications and supplements may have to be continued in order to address any complications or nutritional deficiencies that develop due to prolonged alcohol use.

Most people with alcohol withdrawal syndrome usually recover completely. If you are in otherwise good health and are able to stop drinking while also seeking proper treatment, the outlook for alcohol withdrawal syndrome is usually good. However, irritability, fatigue, and sleep disruptions may continue for several months.

However, if your alcohol withdrawal syndrome advances to the level of delirium tremens, it can prove to be life-threatening. If you start experiencing the severe symptoms of alcohol withdrawal syndrome, it is important that you seek immediate medical help. Remember that the earlier you seek and start treatment, the better are your chances of developing any type of life-threatening complications from this condition.

The best way to prevent alcohol withdrawal syndrome is, of course, to avoid becoming a regular heavy drinker. If you already suffer from alcohol use disorder, it is important to seek counseling at the earliest possible and begin treatment if required. The goal of treatment in alcohol withdrawal syndrome is to gradually and safely cut down your addiction to alcohol so that you are able to get back to your normal life without alcohol.

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