12 Minutes

Edited & clinically reviewed by THE BALANCE Team
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Alcohol abuse is a major public health issue worldwide, ranking 7th among the top causes of morbidity and mortality. Around 15 percent of people in the Western world struggle with alcohol abuse disorder at some point in their lives. When individuals with alcohol use disorders cut back on their drinking, almost half of them will have withdrawal symptoms, with 4 percent experiencing severe symptoms. Up to 15 percent of those who have severe symptoms die. As a result, most medical professionals are required to deal with some of their patients’ difficulties. In the US alone, there are an approximated 8 million alcoholics, and roughly 500,000 bouts of withdrawal severe enough to necessitate pharmacologic therapy occur every year. To put it another way, between 2 and 7 percent of patients admitted for routine medical care and have a history of heavy alcohol use will experience severe alcohol withdrawal.

When you stop or drastically reduce your alcohol consumption after weeks, months, or years of heavy drinking, you may experience both physical and mental problems. That’s what is known as alcohol withdrawal. The signs and symptoms might range from minor to severe. Alcohol withdrawal syndrome (AWS) is a combination of symptoms that can develop due to a reduction in the consumption of alcohol after a long phase of excessive alcohol consumption.

If you just drink sometimes, you’re unlikely to experience symptoms of withdrawal once you quit. However, if you have experienced alcohol withdrawal before, you are more prone to undergo it again the next time you quit.

The central nervous system (CNS) is the primary site that is affected during alcohol withdrawal and the clinical symptoms emerge as a consequence of this. Withdrawal symptoms can range from minor to severe, including sleep difficulties and stress, to life-threatening symptoms including autonomic instability, delirium tremens, and alcoholic hallucinosis.

Withdrawal normally starts six to twenty-four hours after the last drink. It has the potential to last up to a week. At least 2 of the following symptoms must be present in order to be classed as an alcohol withdrawal syndrome: Increasing hand tremor, sleeplessness, vomiting or nausea, transitory hallucinations (tactile, visual, or auditory), psychomotor irritability, tonic-clonic seizures, autonomic instability, and anxiety.

The intensity of symptoms is determined by a variety of factors, the most significant of which are the amount of alcohol consumed, the duration of time spent drinking, and past experience with alcohol withdrawal. Symptoms are also categorized and grouped together:

Patients with alcohol hallucinosis exhibit brief auditory, visual, or tactile hallucinations but are generally normal.

Seizures associated with withdrawal begin within 2 days of avoiding alcohol and might take the form of a single widespread tonic-clonic seizure or a brief bout of several seizures.

Hyperadrenergic conditions, dizziness, tremors, excessive sweating, poor attention/consciousness, and aural or visual hallucinations are all symptoms of delirium tremens. This normally happens 2 to 3 days after you stop drinking. Delirium tremens is the most serious form of withdrawal, occurring in 5 percent to 20 percent of detoxification patients and 1/3 of those who experience withdrawal seizures.

Alcohol has a depressing effect on the body, according to physicians. It causes a reduction in the performance of the brain processes and alters the way nerves send and receive data.

The central nervous system adapts to consuming alcohol around all of the time. The body functions hard to keep your brain alert and your nerves communicating with one another.

When the amount of alcohol in your bloodstream lowers suddenly, your brain remains stressed. Withdrawal is the result of this.

AWS is a serious condition that affects individuals who have an alcohol dependency or who drink excessively on a routine basis and are unable to progressively reduce their consumption.

AWS is more frequent in adults, although it can also affect children and teens who drink heavily. If you have ever had symptoms of withdrawal or needed medical detoxification for a problem with alcohol, you are at risk for AWS.

Heavy drinking is defined as over 8 drinks a week for women and more than fifteen drinks a week for men, according to the Centers for Disease Control and Prevention. One drink is comparable to the following:

  • 1.5 oz. Distilled alcohol or liquor, such as whiskey, vodka, rum, or gin
  • A glass of wine (about five ounces)
  • A glass of wine (about five ounces) Beer (twelve ounces)
  • Malt liquor (eight ounces)

The most prevalent type of excessive drinking is binge drinking. It’s described as 4 or more drinks in just one session for ladies. It’s described as 5 or more drinks consumed in one session for men.

A recognized instrument for assessing the intensity of AWS is the Clinical Institute for Withdrawal Assessment for Alcohol—revised (CIWA-Ar) rating. This tool is intended to track withdrawal symptoms and signs and determine whether or not prescription medicines are required. The CIWA-Ar includes a list of ten withdrawal symptoms and signs that can be measured to determine the severity of the illness.

Vomiting, headaches, sensory abnormalities, paroxysmal sweating, restlessness, visual problems, tremor, nausea, disorienting and overshadowing of the sensorium, and anxiety are some of the symptoms. Nine of the ten symptoms and signs can be scored on a scale of 0 to 7, and one can be ranked on a scale of 0 to 4. The highest score attainable is 67. Minimal or very light withdrawal is indicated by a rating of 8; mild withdrawal is indicated by a score of 9 to 14; moderate withdrawal is indicated by a score of 15 to 20, and severe withdrawal is indicated by a score of >20.

The clinical approach to treat AWS is to control the clinical manifestations of alcohol withdrawal, avoid major medical consequences from developing, and link patients to rehabilitation for long-term recovery. Patients with minor symptoms may just require supportive care, whereas those with moderate-to-severe complaints may require therapeutic intervention.

Nutritional Assistance

Nutritional support, when appropriate, should be administered to patients with AWS due to the possibility of nutritional deficits. Folic acid and thiamine should be given on a regular basis as part of such support. A daily dose of 1 milligram of folic acid is suggested. Wernicke’s encephalopathy can be prevented by thiamine replacement, which should be given to all individuals at a dose of 100 milligrams per day. In Wernicke’s encephalopathy, high-potency vitamins containing 500 milligrams of thiamine should be administered Intravenously 3 times daily for 3 days.

Because serum magnesium concentrations have been demonstrated to be low in alcohol withdrawal, magnesium supplements have also been advocated. Magnesium levels, on the other hand, appear to be returning to normal as the AWS winds down. Due to this restoration of magnesium back to normal levels, magnesium supplementation has also been shown to be ineffective in some studies in the treatment of AWS.

Medications

Benzodiazepines. In individuals with AWS, benzodiazepines are favored and regarded as first-line medication. These medications help to avoid symptom development by reducing symptoms of withdrawal such as seizures. AWS is treated with benzodiazepines that have a long or intermediate duration of action. Chlordiazepoxide (half-life of active metabolites: 14 to 100 hours) and diazepam (30 to 100 hours) are examples of long-acting agents. Lorazepam (12-hour half-life), oxazepam (5 to 15 hours), and alprazolam (6 to 26 hours) are examples of intermediate-acting medications. There isn’t enough evidence to suggest that one medicine is better than the others for managing AWS. Long-acting benzodiazepines, on the other hand, are thought to have a gentler withdrawal impact than intermediate-acting benzodiazepines. Intermediate-acting medicines, which do not have active ingredients/forms, may be preferable for individuals with impaired hepatic function, such as the elderly. Furthermore, drowsiness and respiratory impairment are less likely with these medicines. Tailored dosages are needed to treat clinical symptoms, and in the event of refractory alcohol withdrawal, very high quantities may be required, albeit respiratory distress is a risk.

A symptom-triggered dosage schedule and fixed-dose schedule are the two most commonly utilized benzodiazepine administration regimes for AWS.  The fixed-dose regimen uses preset doses at periodic intervals, but it also provides for extra doses as required to control symptoms. Benzodiazepines are used in the symptom-triggered regimen only when the individual has substantial symptoms, as measured by a CIWA-Ar score of >9. The symptom-triggered regimen has been found in studies to decrease drug use and duration of treatment.

The average duration of treatment and dosage of oxazepam were 20 hrs vs. 62.7 hrs and 37.5 milligrams vs. 231.4 milligrams, respectively, in research by Daeppen et al contrasting symptom-triggered dosing to fixed-schedule dosing utilizing oxazepam to manage alcohol withdrawal, with no variation in patient comfortability. Only inpatient treatment was the focus of this research.

Other Drug Treatments.  Although there is nothing in the form of controlled trials data to back up their usage, neuroleptic medications such as haloperidol and phenothiazines may help patients with uncontrollable agitation. Furthermore, they are not as helpful in preventing seizures and delirium as benzodiazepines.

Anticonvulsants like oxcarbazepine, Divalproex, and carbamazepine may be beneficial in the treatment of alcoholism by lowering alcohol cravings and in the therapy of AWS due to their anti-kindling action, according to some evidence. Surprisingly, neither Delirium Tremens nor seizures were prevented by these medications. Gabapentin proved to be more effective than lorazepam in treating AWS in one trial. Furthermore, it appears to lessen alcohol cravings during abstinence. More randomized studies are needed, like with the other antiepileptic drugs.

In individuals with refractory Delirium Tremens, propofol and barbiturates have been recommended. Despite the fact that barbiturates are affordable, there has been little controlled research. Furthermore, when taken with alcohol, they raise the risk of respiratory distress. The usage of propofol is poorly documented. Its exorbitant cost, however, is a significant disadvantage. Baclofen, a skeletal muscle relaxant and structural counterpart of GABA, was studied as a therapy for AWS. Baclofen was found to be equally beneficial as diazepam in treating AWS, suggesting that it could be used as a therapeutic option.

Non-benzodiazepines’ success in the management of AWS and AUD, on the other hand, need more regulated clinical research. Benzodiazepines will continue to be the therapeutic option of choice until sufficient evidence is available to justify the use of alternative medicines over them.

Adjunctive therapy is a type of treatment that is used in conjunction with another treatment Based on the patient’s symptoms, adjunctive therapy may be needed in addition to benzodiazepine medication. Alpha-adrenergic agonist clonidine and Beta-blockers may be used to alleviate adrenergic symptoms such as heart rate or blood pressure reduction, as well as tremor reduction. Delirium and seizures are not prevented by them. Any of the previously mentioned agents could be used as a treatment option. The choice of agent is made based on the individual clinical symptoms being addressed. These supplementary agents should not be used alone to treat AWS.

Monitoring

The periodicity of screening and monitoring is determined by the intensity of the patient’s symptoms. Hospital patients may be watched and checked several times a day at first until they start to feel better. Once the patient has been stabilized, he or she should be checked on a daily basis until the symptoms have subsided and the medicine dosage has been reduced. Patients may need to be directed to a long-term intensive outpatient program, a medical professional who is a specialist in addiction, or an inpatient treatment facility after completing therapy.

Based on the intensity of the withdrawal, individuals with AWS can be managed in an outpatient or inpatient setting. Outpatient treatment for individuals with mild or moderate AWS can be safer and more successful than inpatient treatment, with lower expenses and a lower effect on the person’s daily life. Anomalous lab results, a lack of a support system, critical illness, a significant risk of Delirium Tremens, a background of withdrawal seizure activity, poorly controlled chronic health issues, severe mental conditions such as suicidal thoughts, serious alcohol withdrawal symptoms, or substance misuse are all contraindications to outpatient care.

A luxury upscale treatment center is more than just a relaxing resort; it is a healing environment where you can strive to overcome your physiological alcohol addiction.

A high-end alcohol withdrawal treatment center believes that healing is more than simply medical treatment. When the atmosphere is nice to the eye, recovery might be a more pleasant process. Unwanted irritation or distractions can be avoided by a relaxing environment of a premium rehab center. The more at ease you are, the more likely you are to relax and commit to the process of recovery. A luxury treatment center provides the ideal calm environment for your rehabilitation because you are accustomed to a higher standard of living.

A luxury residential rehab center is more than gorgeous architecture. It has a good reputation because it is quite effective. On staff will be only highly qualified alcohol withdrawal treatment experts. There will be lots of professionals on hand to make sure that you receive the best possible care.

While luxury treatment provides a comprehensive list of customized services, it also provides more concrete and obvious advantages. 5-start resort-style facilities are frequently located in scenic or quiet areas. Luxurious beds, greater personal space, and gourmet meals are all on the menu. On-site personnel will be accessible 24/7. Treatment can seem like a vacation or a trip to a luxurious spa. This isn’t to say that the rehabilitation process isn’t challenging and time-consuming. However, it does imply that you can do so in comfort.

The cost of admittance to one of these luxury inpatient treatment programs might be several thousand dollars each month. Because such a hefty price tag might be daunting for many people, an increasing number of premium and luxury rehabilitation institutions are now providing financing solutions to help clients and their families afford treatment.

Insurance coverage: Most insurance policies cover a term in a treatment facility in some capacity. Before deciding on a facility, it’s a good idea to speak with your health insurer. To find out what is and is not covered under your plan, contact the number on the backside of your insurance card.

Payment plan: If you’re interested in a particular high-end treatment facility, contact them to see what subscription plans they have available so that you can space out your treatment expenses over time and avoid the financial strain of a one-time lump sum amount.

Personal loan: Most banks provide health care or personal loans to help people afford treatment. Consult your bank to learn what loans are accessible to people in your position. Be sure that your finances will allow making the loan payments in a reasonable amount of time, and escape predatory loans with huge interest rates.

Crowdfunding: In today’s environment, social media may be a strong instrument to share your story of recovery and gain support from family and friends. When you start a fundraising drive, individuals who care about you and are committed to your rehabilitation can contribute to assist you to meet your financial objective. You might be amazed at how many people are eager to contribute to your treatment costs.

It may be frightening to consider taking out a loan or charging the entire expense of therapy on your credit card but bear in mind that there are always choices to help you get better. You can get innovative and put together several funding solutions to help you pay for treatment and obtain the help you need to live a happy and clean life.

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