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Alcohol Withdrawal Syndrome (AWS)

Alcohol withdrawal occurs when a person who drinks heavily stops drinking. It is the period before their bodies are “clean,” but they are not consuming any more alcohol. The body tends to crave alcohol during this time, which makes it difficult to resist the urge to drink.

This phase of recovery is one of the most difficult and there is a high risk for relapse. Other health risks also occur during this time. People with an alcohol use disorder (AUD) are at risk for withdrawal symptoms.

Alcohol withdrawal syndrome (AWS), on the other hand, is the medical term for the symptoms that occur when a heavy drinker stops drinking. Withdrawal symptoms occur when alcohol intake is suddenly stopped or reduced. Symptoms are both physical and emotional and can be severe.

In some cases, AWS is life-threatening.

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What Causes Alcohol Withdrawal Syndrome (AWS)?

Excessive drinking affects the nervous system. Long-term excessive drinkers can develop a physical dependence on alcohol, which damages the nervous system. It expects alcohol and has trouble functioning without it.

Symptoms of AWS occur when the nervous system fails to get what it “thinks” it needs. Your body works hard to keep your brain in a more awake state and to keep your nerves talking to one another. When the alcohol level suddenly drops, your brain stays in this keyed-up state. That’s what causes withdrawal.

Symptoms of Alcohol Withdrawal Syndrome (AWS)

Heavy drinkers who suddenly stop or reduce alcohol intake are likely to experience mild symptoms of AWS within six hours of their last drink. Symptoms can continue for up to seven days.

Symptoms can be severe in the first few hours of withdrawal. They gradually become milder in the days and weeks that follow. Although, they tend to be the most intense after first waking.

Symptoms might include any combination of the following:

  • Tremors
  • Anxiety
  • Nausea and vomiting
  • Headache
  • Elevated heart rate and/or blood pressure
  • Sweating
  • Irritability and confusion
  • Insomnia and nightmares
  • Hallucinations that can be tactile, auditory, or visual

Delirium tremens (DT) might be a symptom in severe cases. DTs usually start 48 to 72 hours after a person’s last drink. Its symptoms include:

  • Extreme confusion or agitation
  • Fever
  • Seizures
  • Hallucinations, including tactile, auditory, or visual
  • Racing heart
  • High blood pressure
  • Heavy sweating

If you or a loved one experiences any of these symptoms, it is necessary to seek medical attention immediately.

Alcohol Withdrawal Timeline

Symptoms of alcohol withdrawal tend to peak about 24 to 72 hours after a person’s last drink. Typically, symptoms fade and are gone within a week.

Alcohol withdrawal occurs in three phases:

Alcohol Withdrawal Timeline

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What are Alcohol Withdrawal Seizures? 

Abruptly reducing or stopping alcohol intake after extended heavy drinking might trigger alcohol seizures. Generalized tonic-clonic (formerly known as Grand Mal) seizures are the most dangerous component of alcohol withdrawal syndrome.

Tonic-clonic seizures include both tonic and clonic activity:

  • Tonic activity includes loss of consciousness, strong muscle spasms, the potential for impaired breathing, gasping and gurgling sounds, and saliva or foam from the mouth.
  • Clonic activity includes intense and rapid jerking movements of the face, arms, and legs that eventually relax as seizure activity concludes.

People often remain unconscious for several minutes following the seizure as the brain recovers.

Neuronal networks in the brainstem trigger tonic-clonic withdrawal seizures. Long-term heavy drinkers experience more intense withdrawal symptoms, and over time, multiple detoxification episodes increase their risk for seizures. Researchers postulate that alcohol withdrawal permanently alters the brain in a way that heightens seizure risk.

Treatment for Alcohol Withdrawal 

Doctors treat alcohol withdrawal based on the severity of a person’s symptoms. Severe cases often require hospitalization and temporary round-the-clock monitoring.

The initial step in treatment is to keep the patient safe and comfortable by managing the most severe symptoms. In some severe cases, treatment of symptoms of AWS include benzodiazepines such as Ativan, Klonopin, Xanax, and Valium.

Treatment includes detoxification from alcohol and then counseling. The goal is to help the person stop drinking as quickly and safely as possible.

At-home treatment is possible in less severe cases of AWS. This requires monitoring symptoms to ensure they don’t worsen and follow-up efforts for counseling and medical evaluations. Heavy drinking can cause long-term health problems. In many cases, it’s necessary to treat these issues before or concurrently with treating alcohol addiction.

Alcohol withdrawal syndrome and the associated symptoms are avoidable if you do not drink. If you’ve already developed a dependence on alcohol, seek ongoing counseling and medical care to manage your addiction and avoid relapse. Avoiding alcohol, either immediately or through a gradual reduction in consumption, is the only way to avoid alcohol withdrawal symptoms.

Treatment Options for Alcohol Abuse & Addiction

  • Inpatient Programs — Inpatient treatment is the most intensive and effective option for alcohol addiction treatment. These programs usually last 30, 60, or 90 days, however they may be longer in certain cases. Throughout the duration of an inpatient program you will live on site in a safe, substance-free environment. You will go through medically supervised detoxification first, then behavioral therapy and other services will be added to your regimen. Many of these treatment programs will assist you with an aftercare program afterwards.
  • Partial Hospitalization Programs (PHPs) PHPs are the second most intensive alcohol addiction programs. They are sometimes referred to as intensive outpatient programs (IOPs). Partial hospitalization programs provide comparable services to inpatient programs. These may include detoxification, medical services, behavioral therapy, support groups, and other holistic or custom treatments. The main difference between PHPs and inpatient programs is that in a partial hospitalization program, you return home and sleep at your house. Some PHPs provide food and transportation, but this varies by program. PHPs are ideal for new patients, as well as patients who have completed an inpatient program and still require intensive treatment.
  • Outpatient Programs Outpatient programs are less intensive than inpatient programs and PHPs. They are best for people who are highly motivated to achieve sobriety and have responsibilities at work, home, or school. Outpatient treatment programs customize your treatment sessions around your personal schedule. Outpatient programs can help new patients achieve success. They may also be a part of aftercare programs once a patient completes an inpatient program or PHP.
  • Medication-Assisted Therapy (MAT) Certain patients will qualify for medication-assisted therapy. Some medications can assist you throughout detoxification and withdrawal. Others can reduce cravings and normalize your bodily functions. Disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia and Vivitrol) are the most common medications used to treat Alcohol Use Disorder. MAT can help prevent relapse and increase your chance of recovery if combined with other therapies.
  • Support Groups Support groups are peer-led organizations made of people dedicated to helping each other stay sober. They can be a first step towards sobriety or a component of an aftercare plan. Many of these programs follow the 12-step approach.

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Resources

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Rogawski, Michael A. “Update on the Neurobiology of Alcohol Withdrawal Seizures.” Epilepsy Currents, vol. 5, no. 6, Nov. 2005, pp. 225–230, www.ncbi.nlm.nih.gov/pmc/articles/PMC1312739/, 10.1111/j.1535-7511.2005.00071.x.

“Tonic-Clonic (Grand Mal) Seizures.” Johns Hopkins Medicine, 2020, www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/tonic-clonic-grand-mal-seizures.

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