From the Guidelines
Alcohol withdrawal can be life-threatening, Joanne, and it's crucial to seek medical help immediately if you're experiencing symptoms. The signs and symptoms of alcohol withdrawal typically begin within 6-24 hours after the last drink and may include:
- Anxiety
- Irritability
- Nausea
- Vomiting
- Tremors (shaky hands)
- Sweating
- Increased heart rate
- Trouble sleeping As withdrawal progresses, you might experience more severe symptoms like:
- Confusion
- Fever
- Hallucinations (seeing or hearing things that aren't there)
- Seizures The most serious form, delirium tremens (DTs), can develop 2-3 days after stopping drinking and includes severe confusion, agitation, fever, and potentially life-threatening seizures 1. Treatment typically involves medications like benzodiazepines, which are considered the 'gold standard' for reducing withdrawal symptoms and the risk of seizures and/or delirium tremens. Long-acting benzodiazepines (e.g. diazepam, chlordiazepoxide) provide more protection against seizures and delirium, but short and intermediate-acting benzodiazepines (e.g. lorazepam, oxazepam) are safer in elderly patients and those with hepatic dysfunction 1. It's essential to use a symptom-triggered regimen rather than a fixed dose schedule to prevent the accumulation of the drug and to avoid the potential risk of abuse associated with benzodiazepines 1. Other compounds, such as baclofen and topiramate, are being evaluated for their efficacy in treating alcohol use disorder (AUD) and may have a role in the treatment of alcohol withdrawal syndrome in the future 1. Medical supervision during withdrawal is crucial as it can be life-threatening in severe cases.
From the Research
Signs and Symptoms of Alcohol Withdrawal
The signs and symptoms of alcohol withdrawal syndrome can range from mild to severe and include:
- Tremors, insomnia, nausea and vomiting, hallucinations, anxiety, and agitation 2
- Delirium tremens, which is characterized by clouded consciousness, disorientation, disturbed circadian rhythms, thought processes and sensory disturbances 3
- Mild symptoms such as insomnia and tremulousness, as well as severe complications like withdrawal seizures and delirium tremens 4
- Irritability, anxiety, or agitation, with the most severe manifestations including delirium tremens, hallucinations, and seizures 5
- Mild agitation to withdrawal seizures and delirium tremens 6
Diagnosis and Assessment
Diagnosis and assessment of alcohol withdrawal syndrome can be done using various tools, including:
- The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale 2
- The Clinical Institute Withdrawal Assessment for Alcohol scoring system, which streamlines care, optimizes patient management, and is the best scale available for withdrawal assessment 6
- The three-question Alcohol Use Disorders Identification Test-Consumption and the Single Alcohol Screening Question instrument, which have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older 2
Treatment and Management
Treatment and management of alcohol withdrawal syndrome can include:
- Supportive care and pharmacotherapy, with benzodiazepines being first-line therapy for moderate to severe symptoms 2
- Carbamazepine or gabapentin for mild symptoms, and as potential adjunctive or alternative therapies for moderate to severe symptoms 2, 4
- High doses of benzodiazepines, especially lorazepam, diazepam and oxazepam, for symptomatic treatment of delirium tremens 3
- Symptom-triggered dosing of benzodiazepines, which is the preferred method for most patients in withdrawal 6