Alcohol use disorder (AUD) includes symptoms like intense cravings and continued use despite adverse consequences. It also causes withdrawal symptoms when not drinking. Alcohol withdrawal side effects can vary in severity. Sometimes, in severe instances, the symptoms can be life-threatening, highlighting the need for proper treatment for alcohol withdrawal.
What Is Alcohol Dependence?
Alcohol addiction includes physical dependence, characterized by tolerance and withdrawal and psychological dependence. Psychological alcohol dependence includes compulsive use and strong cravings. While the terms dependence and addiction are often used to mean the same thing, dependence refers specifically to physical alcohol dependence.
Alcohol addiction or AUD includes loss of control over alcohol consumption, needing more alcohol to get desired effects and continuing to drink even though it’s causing negative effects on health, relationships, work or other areas of life.
Withdrawal symptoms can be physical and mental, occurring when you lower your alcohol consumption or stop altogether.
What To Expect During Alcohol Withdrawal Syndrome?
Management of alcohol withdrawal depends on the specific symptoms and their severity. The symptoms that can occur include:
Early Symptoms
From 6-12 hours after the last drink, you might experience:
- Tremors and shakes
- Anxiety
- Sweating
- Nausea and vomiting
- Headache
- Insomnia
- Increased heart rate
Even patients with mild alcohol dependence may experience the above symptoms.
Peak Symptoms
From 24-72 hours after the last drink, peak symptoms of alcohol withdrawal include:
- Delirium tremens (DTs), which in severe cases can include hallucinations, agitation, confusion, fever and seizures.
- Severe tremors
- Extreme anxiety
- Disorientation
Late Symptoms
From 2-7 days after someone has their last drink of alcohol, they may have continued symptoms like:
- Ongoing anxiety and agitation
- Irritability
- Insomnia
- Mood swings
- Delirium
- Depression
- Fatigue
The Risks of Alcohol Withdrawal
Going through the symptoms of alcohol withdrawal is often considered the most dangerous of any substance. Complications can include:
- Delirium tremens (DTs): This is the name of a severe form of alcohol withdrawal. It can be life-threatening. It affects 3-5% of people going through alcohol withdrawal and requires prompt treatment as it is a medical emergency. DT symptoms include severe confusion, rapid heart rate, hallucinations and seizures.
- Seizures: Alcohol withdrawal seizures will typically occur within 48 hours of the last drink. The seizures are often generalized tonic-clonic, occurring singly or in clusters.
- Electrolyte imbalances: The chronic use of alcohol disrupts electrolyte balance, and suddenly stopping drinking can further worsen the imbalance. Complications can include dehydration and dangerously low levels of calcium and magnesium.
- Other medical complications: Underlying medical conditions can be worsened during withdrawal, like liver disease, heart issues or psychiatric disorders.
- Suicide risk: During severe alcohol withdrawal, there may be a greater risk of suicidal ideation or behavior, especially in someone with a history of mental health disorders like depression.
Because of the risks associated with withdrawal from alcohol, it’s important to get medical help to go through the process. Medical detoxification at a specialized facility can ensure that you receive appropriate treatment for alcohol withdrawal to reduce complications, keeping you safe and increasing your comfort.
Medications for Alcohol Withdrawal
There are two broad types of medications for alcohol withdrawal that can be part of a medical detox.
The first category is medicines specifically approved to treat symptoms and cravings of alcohol withdrawal. The second is medication often used off-label to treat particular symptoms of withdrawal.
Medications to Reduce Cravings and Prevent Relapse
There are medications for alcohol withdrawal that are specifically approved to reduce cravings and the risk of relapse. These include:
- Acamprosate (Campral): This medicine helps to restore neurotransmitter balance in the brain, particularly glutamate and GABA, which are often disrupted in people with an AUD. It reduces alcohol cravings and can help relieve physical and emotional symptoms of withdrawal. Acamprosate is typically started after detoxification and used as a long-term maintenance medicine supporting sobriety and recovery.
- Disulfiram (Antabuse): It interferes with your body’s breakdown of alcohol in the body. The result is an accumulation of acetaldehyde. When it builds up, this toxic substance can cause unpleasant side effects. These can include nausea and vomiting. The symptoms can be a deterrent to drinking to avoid the unpleasant symptoms.
- Naltrexone (Vivitrol, ReVia): Naltrexone blocks the rewarding effects of alcohol. By stopping these pleasurable effects, naltrexone can help reduce cravings and make alcohol less appealing.
- Topiramate (Topamax): An anticonvulsant medicine, topiramate is also helpful in reducing alcohol cravings, likely through its effects on specific neurotransmitter systems in the brain.
- Gabapentin (Neurontin): An anticonvulsant as well, gabapentin can help modulate the brain’s neurotransmitter activity, reducing cravings and improving outcomes for people with AUD. It may help with anxiety and insomnia in early recovery, and then later, it can be used for relapse prevention.
These are all part of medication-assisted treatment for AUD. They aren’t standalone treatments for alcohol dependence. Instead, they’re used as a treatment for alcohol withdrawal along with psychosocial interventions, supportive services and counseling for a holistic approach.
Medications to Treat Symptoms of Alcohol Withdrawal
Other medicines that can be provided on an individualized and as-needed basis as a treatment for alcohol withdrawal can include:
- Benzodiazepines: These medicines can calm the central nervous system and regulate brain activity through effects on GABA. Benzodiazepines can be used to reduce many of the symptoms of alcohol withdrawal. Symptoms they may help specifically include anxiety, tremors, agitation and seizures. Diazepam (Valium), lorazepam (Ativan) and chlordiazepoxide (Librium) are most often used in this way.
- Anticonvulsants: Medications for alcohol withdrawal in this category include carbamazepine and valproate. They may be used in addition to or instead of benzodiazepines to manage symptoms, especially seizures. These medicines can stabilize brain activity, helping to reduce seizure risk.
- Beta-blockers: Propranolol and other beta-blockers may help with symptoms of autonomic hyperactivity, including tremors, sweating and elevated heart rate. They can help with physical symptoms of agitation and anxiety.
- Alpha-2 agonists: Medicines like clonidine fall into this category, helping with symptoms such as hypertension and tachycardia. They reduce the activity of the sympathetic nervous system, primarily responsible for our fight-or-flight response.
- Baclofen: A GABA agonist, this medicine may be used for reducing alcohol cravings and withdrawal symptoms, especially in those with severe symptoms or who haven’t responded well to other drugs.
Treatment for alcohol withdrawal, because of the risks, should take place in a controlled setting, like a professional detox center. You can receive not only medications for alcohol withdrawal but also medical monitoring and support.
You’re also prepared to proceed to further treatment during a medical detox, such as counseling and psychosocial programs.
Find Alcohol Detox and Treatment Now
If you’d like to learn more about treatment for alcohol withdrawal and addiction, contact us at First Step Behavioral Health today.
