Introduction to alcohol withdrawal

Abstract

Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal (AW). Signs and symptoms of AW can include, among others, mild to moderate tremors, irritability, anxiety, or agitation. The most severe manifestations of withdrawal include delirium tremens, hallucinations, and seizures. These manifestations result from alcohol-induced imbalances in the brain chemistry that cause excessive neuronal activity if the alcohol is withheld. Management of AW includes thorough assessment of the severity of the patient's symptoms and of any complicating conditions as well as treatment of the withdrawal symptoms with pharmacological and nonpharmacological approaches. Treatment can occur in both inpatient and outpatient settings. Recognition and treatment of withdrawal can represent a first step in the patient's recovery process.

Figure 1

The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA–Ar) (Sullivan et al. 1989; Foy et al. 1988). This instrument rates 10 withdrawal features, takes only a few minutes to administer, and can be repeated easily when necessary. A total score of 15 or more points indicates that the patient is at increased risk for severe withdrawal effects, such as confusion and seizures.

Figure 2

Administration period and median amount of the benzodiazepine chlordiazepoxide administered over the course of alcohol withdrawal to patients undergoing a symptom-triggered or fixed-schedule dosing regimen. The results demonstrate that compared with patients on a fixed-schedule regimen, patients on a symptom-triggered regimen required much less medication for a shorter period of time and were therefore at lower risk for unwanted side effects from the medication. SOURCE: Saitz et al. 1994.