Withdrawal or a withdrawal syndrome (also referred to as a discontinuation syndrome) is a result of the development of a physical dependence on a specific type of substance or substances. The withdrawal syndrome occurs when the individual abruptly stops using the drug or significantly cuts the dosage. The symptoms of both tolerance and withdrawal represent the development of physical dependence on the drug.
Tolerance refers to the notion that individuals need to take more of the drug, or take it more often than they did when they first started using the drug, to achieve the same effects that were once achieved at lower doses. Tolerance is a rapidly developing and ongoing phenomenon that results in many individuals using large amounts of drugs or alcohol that would physically harm other individuals who have not developed tolerance.
Withdrawal occurs as a result of an individual’s system becoming habituated to the presence of the drug and only operating in a normal fashion when the drug is in the system.
The person’s system adjusts to the present of the drug, and when the levels of the drug in the tissues decrease suddenly, the person’s system loses a sense of balance. This results in a number of physical and psychological symptoms that are not pleasant.
Factors Affecting the Process of Withdrawal from Alcohol
The withdraw process associated with alcohol is particularly serious. A number of potentially dangerous situations can occur when an individual who has chronically abused alcohol for years suddenly stops taking the substance.
Withdrawal from any drug, including alcohol, is dependent on the number of different factors. Individuals will experience a general overall pattern of withdrawal as well as individual variations in this overall pattern. According to the American Society of Addiction Medicine, the intensity of the withdrawal symptoms and the length of withdrawal process from alcohol will also vary depending on several factors.
The first important factor is
the length of time the person used alcohol and the amount of alcohol that the individual was using at the time use was discontinued.
Individuals who have consumed large amounts of alcohol, over regular intervals, for lengthy periods of time will experience more intense and lengthy withdrawal syndromes.
The second important factor is the method of discontinuation. Individuals who immediately stop using alcohol will begin to experience severe withdrawal effects that may be longer in duration. Individuals who slowly cut down on alcohol use and taper drinking over a period of time will not experience as intense withdrawal. However, this method is not recommended to be attempted by individuals without close medical supervision. Attempting this method without the supervision of a physician can be extremely dangerous. Of course, individuals who negotiate the withdrawal process with the assistance of medically assisted treatment, such as specific drugs, will also experience less intense withdrawal symptoms.
Finally, individual differences in both physiology and psychological makeup will play a part in the intensity and length of withdrawal from alcohol.
Potential Symptoms That Can Occur during Withdrawal from Alcohol
Symptoms will vary from individual to individual, depending on the above factors. According to a much cited article that was published in the journal The American Family Physician, the most common array of signs and symptoms associated with alcohol during withdrawal include:
- Elevations in blood pressure
- Elevations in body temperature
- Jitteriness or tremors (especially tremors in the hands)
- Dilated pupils
- Hyperarousal (being extremely sensitive to changes in the environment)
- Seizures (grand mal seizures)
- Paranoid thinking
The specific symptom profile is associated with the severity of the withdrawal syndrome and individual differences.
Timelines for Withdrawal from Alcohol
Remember that certain variations from case to case will affect the withdrawal process and the intensity of symptoms of withdrawal. Many online sources report general withdrawal timelines for alcohol; however, there is simply not a standardized timeline for withdrawal from alcohol due to the many variations.
The withdrawal process depends on the severity of the individual’s alcohol use disorder. The severity of one’s alcohol use disorder can be estimated during the formal diagnostic process by a trained and licensed mental health professional. Moreover, individuals in the early stages of recovery from an alcohol use disorder should have direct access to emergency medical care in case of complications and should remain with someone during the early stages of withdrawal regardless of the estimated severity of their disorder.
At its basic level, it is important to discuss alcohol withdrawal by the severity of the syndrome. This information can be found in the book Guidelines for the Treatment of Alcohol Problems.
Individuals experiencing less severe withdrawal from alcohol, or what is termed a minor withdrawal syndrome, will experience the following:
- The beginning of symptoms occur around six hours after one discontinues alcohol use.
- The average length of the withdrawal syndrome is 24-48 hours but may extend 72 hours or longer.
- Symptoms peak between 12 and 24 hours.
- The major symptoms include sweating, upset stomach (with potential vomiting), shakiness or minor tremors, tachycardia (faster than normal heartbeat at rest), headache, and anxiety.
- The individual typically suffers no serious issues with cognition or experiences no hallucinations. There are typically no psychotic features, and there are no seizures.
Individuals experiencing moderate to severe alcohol withdrawal as a result of more chronic and stronger alcoholic use disorders will experience the same symptoms above but also potentially more dangerous symptoms.
- In these individuals, the onset of the withdrawal can begin relatively quickly following discontinuation. Symptoms may begin 2-8 hours after the last drink.
- Hallucinations in moderate to severe alcohol withdrawal typically will begin to appear around 18 hours after discontinuation and may continue for up to 7 days following discontinuation.
- Symptoms will generally last between 24 hours to 6-7 days. However, symptoms of delirium tremens and hallucinations may continue up to 30 days, and in some rare cases even longer. Despite the length of the overall withdrawal syndrome in these individuals, the more severe symptoms will not be observable six months following discontinuing use. If symptoms, such as hallucinations or memory issues, persist after this period, the individual most likely has some other psychological disorder or medical condition in addition to the alcohol use disorder.
- The potential to develop seizures exists in moderate and severe alcohol withdrawal. This potential is present about 6 hours after discontinuation and will typically peak between 12 and 18 hours. Seizure potential can continue as long as several days following discontinuation of use.
- Delirium tremens (commonly referred to as DTs) is a clinical syndrome that occurs when individuals who have severe alcohol use disorders experience a sudden drop of the alcohol levels in their system. DTs represents the most severe manifestation of alcohol withdrawal. The symptoms include severe disorientation, agitation, hallucinations, the potential to develop seizures, and all the other associated symptoms of alcohol withdrawal. If present, this syndrome will most likely begin to appear 48-72 hours after discontinuation and may continue or potentially appear for up to 14 days following discontinuation. Medical management of DTs is an absolute necessity, and inpatient treatment is highly recommended.
The management of alcohol withdrawal depends on the severity of symptoms. Individuals with mild withdrawal symptoms may need little or no formal supervision, although this will vary from person to person. Individuals undergoing more moderate to severe alcohol withdrawal may require medically assisted treatment to manage their symptoms, and the development of seizures during alcohol withdrawal can signal a potentially fatal outcome. Individuals with moderate to severe alcohol use disorders should only attempt to negotiate the withdrawal process under the close supervision of a physician trained in addiction medicine. For many of these individuals, other severe medical issues will also contribute to the severity of the withdrawal process. These can include issues with one’s liver, cardiovascular system, central nervous system, and other complications.
Individuals who have chronically abused alcohol and neglected their diet have the potential to develop a severe neurological condition known as Wernicke-Korsakoff syndrome, which requires immediate medical attention. This syndrome occurs when the person lacks the B1 vitamin due to poor dietary habits. Typically, this represents a chronic situation. The symptoms of the syndrome include difficulty walking, visual problems, and a dense amnesia that results in the person confabulating (making up things to cover for severe memory loss). In some cases, these changes can be permanent.
The withdrawal process from alcohol can present with serious complications. The best course of action is to withdraw from the substance under medical supervision.