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Acute withdrawal may develop in people who have developed physical dependence to certain substances (such as alcohol) and then suddenly quit or cut down on the amount of the substance regularly used.
Physical dependence develops as a result of certain types of substance use. Neurochemical changes accompany the consistent presence of alcohol and certain other drugs in a manner that could leave a person feeling sick or unwell when this previously steady supply of substances stops. People with significant physiological dependence essentially come to “require” the substance in question to feel and/or function normally.
Chronic drinkers will inevitably develop some level of alcohol dependence. Alcohol dependence and its associated risks can be quite serious—individuals commonly require close monitoring and medical intervention to keep them safe during the withdrawal management period.
The character and severity of the acute alcohol withdrawal syndrome will be influenced by the amount of alcohol that was regularly used, the frequency of such use, whether drinking took place in addition to other chronic or compulsive drug use, the presence of any other co-occurring psychological disorders like anxiety and depression, as well as individual differences in terms of physical and emotional health.
Depending on the magnitude of alcohol dependence, some individuals will potentially experience severe withdrawal symptoms and others will not. However, in many instances of early treatment for alcohol use disorders, medical detoxification and pharmaceutical withdrawal management will be the standard of care to mitigate the likelihood of a complicated and potentially lethal withdrawal.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes alcohol withdrawal syndrome as one of several substance-related issues. Such a withdrawal syndrome—the diagnosis of which is made based on the presence of several criteria such as autonomic hyperactivity, anxiety, and nausea/vomiting—develops as a result of an individual with a prolonged history of alcohol use either suddenly not drinking anymore or significantly cutting down on the amount of alcohol consumed. In very heavy users, or when physiological dependence is otherwise quite pronounced, an unpleasant withdrawal syndrome may appear relatively shortly after drinking stops. Many individuals at risk of experiencing acute alcohol withdrawal will continue to drink to avoid an onslaught of unpleasant symptoms.
In some cases of significant physical alcohol dependence, the associated withdrawal syndrome can be markedly severe. Severe withdrawal may be accompanied by potentially dangerous complications such as seizures and the development of delirium tremens.
Other features of acute alcohol withdrawal include:
More severe presentations of the acute alcohol withdrawal syndrome may include the following:
Delirium tremens may include marked disorientation, confusion, delusions, vivid hallucinations, fever, sweating, tachycardia and, potentially, psychomotor agitation. If someone is going to develop delirium tremens, this will most often occur about 72 hours after the appearance of other alcohol withdrawal symptoms. Delirium tremens is a severe, potentially fatal syndrome that requires immediate medical attention.
Because of the risk of severe or complicated withdrawal, people with alcohol use disorders or who are otherwise contemplating sobriety after a period of consistent and/or excessive use would benefit from consultation with a physician before attempting to totally quit drinking. This cannot be stressed strong enough. Even though the majority of individuals who undergo the detox process associated with alcohol abuse will not experience potentially severe seizures or delirium tremens, it is far better to be cautious and err on the side of safety than to risk potentially serious medical complications.
Though not all individuals will experience life-threatening withdrawal complications, medications are often used to assist with the withdrawal process for several reasons, including:
Several medications may be used for medical detoxification. Though medically managed withdrawal protocols may vary, these may include:
In addition to detox medications, additional supportive measures may be taken to help people to better negotiate the withdrawal process as well as promote their post-withdrawal recovery. These include: