Alcohol Withdrawal

An alcoholic man with delirium[1]

Alcohol withdrawal syndrome is characterized by onset of symptoms that occurs in individuals who suddenly stop drinking alcohol. It essentially occurs in the alcohol drinking population who all of a sudden either decreases their alcohol intake or stops its consumption.

The disease originates from the following process: Poison.


Symptoms of alcohol withdrawal usually develop within 8 hours after the last drink. However, in many instances, symptoms may occur after many days. Symptoms include depression, anxiety, nervousness, mood swings, nightmares, irritability, fatigue, headache, enlarged pupils, pallor, sweating and rapid heart rate. In more severe forms of alcohol withdrawal, delirium tremens may set in. Individuals experience fever, hallucinations, seizures, confusion and agitation [7]. Symptoms continue for several weeks and peak within 24 to 72 hours after the onset of preliminary signs [8].


A preliminary physical exam to evaluate the signs and symptoms of the condition would be carried out. Physical examination would show signs of tremors, fever, dehydration, abnormal movements of eye and arrhythmia.

In addition to physical examination, blood and urine tests would also be carried out to assess the amount of alcohol in body. A toxicology screen is also required to confirm the diagnosis.


The type of treatment involved depends on the severity of the symptoms experienced. Some patients with mild to moderate symptoms can be treated at home; while others may require hospitalization to avoid onset of unnecessary complications such as delirium. Treatment of alcohol withdrawal is aimed at relieving symptoms, preventing onset of complications and achieving permanent abstinence from alcohol [9].

Outpatient treatment: In this, the individual gets treated for alcohol withdrawal symptoms, through medications and regular visits to the doctor. It is required that the patient is constantly monitored by a caregiver to look for adverse symptoms of the condition. The individuals are put on sedatives to ease the symptoms and are regularly screened through blood tests. In addition, they are also screened for other medical problems which can worsen the existing condition.

Inpatient treatment: Individuals experiencing severe symptoms may require a hospital stay to be monitored closely for onset of complications. All the vital parameters of the individual such as blood pressure, heart rate, body temperature, and blood levels of chemicals will be tested. In case of dehydration, the individual will be given IV fluids to correct the condition. Administration of sedatives such as benzodiazepines will be employed, until the withdrawal process is completed. Patients are also given nutritional supplements to correct nutritional deficiencies that have occurred due to long term alcohol abuse [10].


The prognosis of the condition is usually favorable when individuals are given prompt treatment. Individuals however, tend to suffer from insomnia, fatigue and irritability for several months. It is necessary that alcohol withdrawal symptoms are treated with appropriate medications and therapies. This is so because, if the patients begin experiencing delirium, it can turn life threatening [6].


Sudden cessation of alcohol consumption or significantly reducing the alcohol intake can cause development of alcohol withdrawal symptoms. It is more common in individuals who drink regularly and are unable to gradually decrease the consumption. Individuals who are suffering from certain underlying disease conditions are also at risk of developing alcohol withdrawal symptoms when they suddenly stop its consumption. In addition to adults, even teenagers and children who drink excessive alcohol are also susceptible to develop alcohol withdrawal symptoms [2].


Alcohol withdrawal is a common phenomenon. It has been estimated that about 500,000 episodes of alcohol withdrawal symptoms occur each year in the US. About 5% of these individuals are known to fall prey to delirium tremens. The symptoms are so severe that they require pharmacologic intervention [3]. It has also been reported that about 50% patients who drink alcohol develop clinically relevant symptoms. In addition, less than 1 in 20 individuals who drink alcohol are also at risk of developing grand mal seizures or delirium tremens. Another statistical report revealed that mortality rate was as high as 20% in drinker’s population who suffered from delirium tremens [4].

Sex distribution
Age distribution


Drinking excessive alcohol on regular basis is known to gradually excite the nervous system. Over time when such a phenomenon continues, the body is unable to tolerate sudden cessation of alcohol. This means, the nervous system cannot easily adapt to sudden change in the alcohol consumption pattern causing various symptoms such as delirium, insomnia and anxiety to name a few [5].


Individuals are advised to gradually and slowly decrease their dependence of alcohol. This can be achieved by making conscious efforts by decreasing alcohol intake steadily. Such a practice will help prevent symptoms of alcohol withdrawal from setting in. It is also advised that individuals who wish to completely quit alcohol should seek medical advice to ensure a healthy withdrawal.


Alcoholism is a common occurrence with an estimated 140 million people throughout the world which suffer from alcohol dependence. The practice of drinking alcohol is certainly not good for the human system and has debilitating effects on the nervous system and other body organs. Alcohol withdrawal can produce various physical and emotional symptoms, which if not managed appropriately can get life threatening. Such a kind of phenomenon is common in adults; however teenagers and children can also often fall prey to it [1].

Patient Information


Alcohol withdrawal is a condition wherein individuals experience a group of symptoms when they suddenly stop drinking alcohol. An estimated 15.2 million Americans are alcoholic. Of these 1.2 million of hospital admissions occur due to alcohol withdrawal. Symptoms of alcohol withdrawal should be promptly treated to avoid onset of complications.


Sudden cessation of alcohol or significant decrease in alcohol intake causes alcohol withdrawal symptoms to set in. Individuals with certain underlying disease conditions experience more severe forms of alcohol withdrawal symptoms as compared to the normal population.


Symptoms of alcohol withdrawal include headache, anxiety, nervousness, mood swings, depression, irritability, enlarged pupil, sweating, arrhythmia, loss of appetite and insomnia. In more severe cases, individuals experience fever, agitation, seizures and severe confusion which occur due to development of delirium tremens.


Diagnosis of alcohol withdrawal symptoms is done through a preliminary physical examination to categorize the signs and symptoms. In addition, blood and urine tests are also carried out to assess the level of alcohol in the system.


Mild form of the condition is treated through medications and patients are allowed to stay at home. In severe cases, hospitalization is also required to manage the symptoms of the conditions. Medications such as benzodiazepines are recommended for patients with alcohol withdrawal.



  1. VICTOR M, ADAMS RD. The effect of alcohol on the nervous system. Res Publ Assoc Res Nerv Ment Dis 1953; 32:526.
  2. Hack JB, Hoffmann RS, Nelson LS. Resistant alcohol withdrawal: does an unexpectedly large sedative requirement identify these patients early?. J Med Toxicol. Jun 2006;2(2):55-60.
  3. Kosten TR, O'Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003; 348:1786.
  4. Monte R, Rabunal R, Casariego E, Lopez-Agreda H, Mateos A, Pertega S. Analysis of the factors determining survival of alcoholic withdrawal syndrome patients in a general hospital. Alcohol Alcohol. Mar-Apr 2010;45(2):151-8.
  5. Bayard M, McIntyre J, Hill KR, et al. Alcohol withdrawal syndrome. Am Fam Physician. Mar 15 2004;69(6):1443-50.
  6. ISBELL H, FRASER HF, WIKLER A, et al. An experimental study of the etiology of rum fits and delirium tremens. Q J Stud Alcohol 1955; 16:1.
  7. Abraham E, Shoemaker WC, McCartney SF. Cardiorespiratory patterns in severe delirium tremens. Arch Intern Med 1985; 145:1057
  8. Turner RC, Lichstein PR, Peden JG Jr, et al. Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation, and treatment. J Gen Intern Med 1989; 4:432.
  9. Mayo-Smith MF, Beecher LH, Fischer TL, et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med. Jul 12 2004;164(13):1405-12.
  10. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2010; :CD005063.

  • Acute alcohol withdrawal syndrome in a newborn - MM Nichols - Archives of Pediatrics & Adolescent Medicine, 1967 - Am Med Assoc
  • A pilot open randomized trial of valproate and phenobarbital in the treatment of acute alcohol withdrawal - RN Rosenthal, C Perkel, P Singh - American Journal on , 1998 - Wiley Online Library
  • Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis - ME Brown, RF Anton, R Malcolm, JC Ballenger - Biological psychiatry, 1988 - Elsevier
  • Alcohol and public health - R Room, T Babor, J Rehm - The lancet, 2005 - Elsevier
  • A model for predicting alcohol withdrawal delirium - T Palmstierna - Psychiatric Services, 2001 - Am Psychiatric Assoc
  • Characterization of DSM-III-R criteria for uncomplicated alcohol withdrawal provides an empirical basis for DSM-IV - EM Sellers, JT Sullivan, G Somer - Archives of general , 1991 - Am Med Assoc
  • A possible role of central noradrenergic neurons in withdrawal states from alcohol - DJ Reis - Annals of the New York Academy of Sciences, 1973 - Wiley Online Library
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • Alcohol withdrawal syndromes - RC Turner, PR Lichstein, JG Peden, JT Busher - Journal of general , 1989 - Springer
  • Animal models of alcohol withdrawal - HC Becker - Alcohol Research and Health, 2000 -
  • Blueprints Clinical Cases in Neurology - K Sheth, OA Harris, TA Cho, AB Caughey - 2006 -
  • A double‐blind comparison of carbamazepine and clomethiazole in the treatment of alcohol withdrawal syndrome - E Ritola, L Malinen - Acta Psychiatrica Scandinavica, 2007 - Wiley Online Library
  • Benzodiazepine withdrawal syndrome: a literature review and evaluation - GL MacKinnon, WA Parker - journal of drug and alcohol , 1982 -
  • An investigation of withdrawal symptoms shown by opiate addicts during and subsequent to a 21-day in-patient methadone detoxification procedure - M Gossop, B Bradley, GT Phillips - Addictive behaviors, 1987 - Elsevier
  • Alcohol and marijuana: effects on epilepsy and use by patients with epilepsy - E Gordon, O Devinsky - Epilepsia, 2001 - Wiley Online Library
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • A comparison of calcium antagonists and diazepam in reducing ethanol withdrawal tremors - GHA Bone, E Majchrowicz, PR Martin, M Linnoila - , 1989 - Springer
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • Alcohol withdrawal in the elderly - BI Liskow, C Rinck, J Campbell, C DeSouza - of Studies on Alcohol and , 1989 -
  • Cerebrospinal fluid 3-methoxy-4-hydroxyphenylglycol and norepinephrine levels in alcohol withdrawal: correlations with clinical signs - RJ Hawley, LF Major, EA Schulman - Archives of general , 1985 - Am Med Assoc
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • Alcohol intoxication and withdrawal - J Koch-Weser, EM Sellers - New England Journal of , 1976 - Mass Medical Soc
  • Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression - BF Grant, DA Dawson, FS Stinson, PS Chou - Drug and alcohol , 2003 - Elsevier
  • Alcohol dependence and anxiety disorders: what is the relationship? - MA Schuckit, V Hesselbrock - American Journal of Psychiatry, 1994 -
  • Alcohol withdrawal in mice: electroencephalographic and behavioral correlates - DW Walker, SF Zornetzer - Electroencephalography and clinical , 1974 - Elsevier

Media References

  1. An alcoholic man with delirium, CC BY 4.0