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  Alcohol withdrawal

A syndrome which is a combination of a set of symptoms that people have when they suddenly stop drinking after using alcohol for a long period of time is known as alcohol withdrawal syndrome. The worst form of withdrawal is called delirium tremens (“DTs”). DTs can be very serious if not treated by a doctor. It is rare for people who just drink alcohol once in a while to develop alcohol withdrawal symptoms. Those who are at risk for the withdrawal symptoms include people who have been drinking heavily for weeks or months and then suddenly stop drinking. People who have gone through withdrawal before are also more likely to experience withdrawal symptoms every time they quit drinking.

Alcohol withdrawal
Alcohol withdrawal

The actual withdrawal itself can result in death of heavy alcoholics from the direct effects of the withdrawal if it is not properly managed. If untreated, mortality can be up to 35%, though if treated early, death rates may be as low as 5%. This is the reason why alcohol withdrawal is significantly different from opiates (a stimulant) withdrawal. The exact pharmacology of ethanol is not fully understood, however it is theorized that delirium tremens is caused by the effect of alcohol on the benzodiazepine-GABA-chloride receptor complex for the inhibitory neurotransmitter GABA. If a heavy drinker suddenly stops alcohol consumption, a condition where neither alcohol nor the gamma amino butyric acid (GABA) exists in the system in adequate quantities causes the detrimental effects to the body.

The GABA is a major inhibitory neurotransmitter and sudden down regulation of this neurochemical receptors may cause uncontrolled firing of the neural impulses along synapses because of the up-regulation in the production of excitatory neurotransmitters (epinephrine, norepinephrine, serotonin and dopamine) In short, there is unopposed sympathetic activation also known as “adrenergic storm". Manifestations include: hallucinations (primarily visual and tactile – a phenomenon known as formication), shakes or tremors, convulsions, seizures, possible heart failure and secondary symptoms such as anxiety, panic attacks and paranoia. These symptoms are collectively referred to as delirium tremens. Five percent of acute ethanol withdrawal cases progress to delirium tremens. Delirium tremens (colloquially, “the horrors”, “the shakes”, or “rum fits”) is an acute episode of delirium that can also appear after a withdrawal from benzodiazepine or barbiturates and typically manifests about 18 to 24 hours after discontinuation of alcohol consumption by heavy drinkers.

Therefore, it is important that your doctor know that you’re going through withdrawal symptoms to prevent more serious health problems and to provide emotional support. Without getting the proper treatment (barbiturates and benzodiazepines-to substitute alcohol) after you go through several withdrawal symptoms, it is possible that your symptoms may even get worse each time you had a withdrawal attack. So even if your withdrawal symptoms don't seem that bad, it's mandatory to see your doctor especially for people who have had a bad withdrawal before and people who have other health problems, such as infections, heart disease, lung disease or a history of seizures. Severe withdrawal symptoms might occur to people who quit using other drugs (such as tobacco, injected drugs or cocaine) at the same time they stop drinking alcohol. It is advisable that they should see a doctor before they quit. Family and friends’ support can also help people who are going through the withdrawal and find success. Some may need to join a group therapy (e.g. Alcoholics Anonymous) which is a program that can give emotional support to a person who is going through the difficulty of experiencing withdrawal symptoms. Hence, a multidisciplinary approach is required for the treatment of alcohol withdrawal syndrome. It is important that the determination to stop alcohol use should start from the drinker himself/herself supported by family, friends and the medical health care team.

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