What is alcohol withdrawal?

Alcohol withdrawal refers to the physical problems and emotions you have if you are dependent on alcohol and then suddenly stop drinking, or if you drink much less than you are used to drinking. The problems usually occur 1 to 7 days after your last drink.

The effects of alcohol withdrawal vary greatly. You may have just a hangover with a headache, nausea, and dizziness. Most people dependent on alcohol experience mild to moderate effects of alcohol withdrawal such as tremors, nausea, vomiting, restlessness, and small increases in heart rate or blood pressure. However, a few alcoholics experience delirium tremens, a life-threatening effect of withdrawal that is a medical emergency. It is characterized by sweating, shaking, confusion, hallucinations, seizures, agitation, and disturbances of memory.

How does it occur?

If you are an alcoholic, you may enter withdrawal in these situations:

• You decide to stop drinking.

• You are hospitalized for an illness or trauma and may begin to have symptoms of withdrawal because alcohol is not available.

• You are arrested or incarcerated.

• You are referred for therapeutic withdrawal and treatment for alcoholism by your workplace, the courts, or your family.

What are the symptoms?

Symptoms of alcohol withdrawal may include:

• headache

• dizziness

• rapid heart rate

• high blood pressure

• fever

• sweating

• shaking

• restlessness

• nausea and vomiting

• difficulty sleeping or concentrating

• seizures

• strong desire to drink to relieve the symptoms of withdrawal

• delirium tremens, which may include confusion, hallucinations, agitation, seizures, disturbances of memory, and very high heart rate, blood pressure, and temperature.

How is it diagnosed?

To diagnose alcohol withdrawal, the doctor will review your symptoms, examine you, and take your medical history.

The doctor may also order these tests:

• urine and blood tests to check if other drugs are being used with the alcohol

• blood alcohol level (BAL)

• chest x-ray if pneumonia is suspected

• blood chemistries (electrolytes), blood glucose and blood count, and liver function tests

• x-rays if a fracture is suspected, such as from a fall with a seizure.

How are alcoholism and withdrawal treated?

If you are an alcoholic, you must acknowledge the problem and take responsibility for it before you can begin treatment. Some people know they have an alcohol problem but deny that they need help to stop drinking. When you can take responsibility for your problem and admit you need help, call your doctor.

Many alcoholics cannot, while still drinking, acknowledge their disease. Loved ones, employers, or others may then have the painful task of forcing a crisis and committing the alcoholic to treatment. This is very tough but necessary. To say the alcoholic can't be helped until he or she wants help is untrue and a cop-out.

Detoxification:
Depending on how much and how long you have been drinking, you may need a hospital stay to 'dry out' (detoxification). Withdrawal symptoms may require medical attention, including tranquilizers, vitamin supplements, and intravenous (IV) fluids. Acute withdrawal is often treated with medications such as Librium.

Long-Term Treatment:
Detoxification, which may take 3 to 4 days, must be followed by long-term treatment including social, physical, and psychological therapy.

• Social treatment involves family members and focuses on problems in the home and at work.

• Physical treatment may consist of medication therapy. If you are afraid you will begin drinking again, the doctor may give a medication that causes unpleasant reactions to alcohol.

• Psychological therapy usually involves group therapy sessions to understand the illness, why you drink, and what situations trigger your drinking.

• Support groups such as Alcoholics Anonymous (AA) are strongly recommended. AA is a self-help organization that provides opportunities to meet other alcoholics, share experiences, and receive encouragement.

  There are local chapters of AA. There is no membership fee and meetings are open to anyone who has a drinking problem and wants to become and stay sober. Phone numbers are usually listed in the white and yellow pages for AA (for alcoholics) and Al-Anon (for families of alcoholics). The family of a yet untreated alcoholic still in denial may well want to start going to Al-Anon meetings to gain understanding and build strength before forcing their loved one into treatment. It's very hard to continually deny your alcohol problem if your family is attending Al-Anon.

How long will the effects last?

The symptoms of a hangover may last 24 hours. The shakes and hallucinations of delirium tremens may last 1 to 5 days.

How can I take care of myself?

To help take care of yourself, take the full course of treatment your doctor prescribes. In addition, the most important thing you can do for yourself is to come to terms with the problem and ask for help. You must also follow your doctor's advice for treatment of any other medical problems.

If you are a long-time, heavy user of alcohol and suddenly stop or find yourself in a situation in which you cannot drink (such as in a hospital), ask for medical help. You may not need to be hospitalized for withdrawal symptoms, but you should not be alone.

You need to eat regular meals and take vitamins and, if possible, avoid drinking coffee and smoking. In addition, get enough sleep, stay as active as possible during the day, and attend AA meetings frequently.

If you are suffering from a hangover, drink lots of fluids and eat foods high in carbohydrates such as breads, cereals, vegetables, and fruits. If you have a headache, take one or two doses of buffered aspirin or acetaminophen. Nonbuffered aspirin may further irritate your stomach lining. If you are a chronic drinker, do not take more than 2 grams of acetaminophen a day because it can harm your liver. Do not take acetaminophen at all if you know you have a liver disease. Do not drink alcohol to cure your hangover.

What can be done to help prevent alcohol withdrawal?

If you are an alcoholic, you cannot prevent alcohol withdrawal but you should know this condition can be treated so that you can withdraw safely and with much less discomfort. If you are physically dependent on alcohol, you will experience withdrawal symptoms when you quit drinking. Most people can manage these symptoms without hospitalization. However, you will need support and help to manage each symptom as it occurs.