Alcohol withdrawal syndrome: symptoms, treatment

Definition: what is alcohol withdrawal syndrome?

Alcohol withdrawal comes down to abrupt cessation of alcohol consumption, whether it is accidental, on the initiative of the subject or whether it is part of a therapeutic perspective, in an alcohol-dependent person. “The withdrawal syndrome brings together symptomatic manifestations which can occur from the 3rd day following this sudden stop, explains Dr. Pascal Possoz, alcoholic doctor. These manifestations reflect a mental, behavioral and physical cravings related to alcohol cessation“. The objective of therapeutic withdrawal is the entry into a process of complete and lasting abstinence from alcohol. “It is a gentle but also dangerous method. if it is not carried out under medical and secure conditions“. There are risks of seizures, delirium tremens, or sudden death impossible to predict and which can be fatal.

What are the symptoms of withdrawal?

“Symptoms differ depending on the severity and alcohol immersion of the patient“, insists the doctor. The most frequent are:

• tremors,
• sweat,
• anxiety,
• nervousness,
• depression,
• anguish,
• feeling of “discomfort”,
• insomnia (or nocturnal awakenings),
• nausea,
• diarrhoea,
• vomiting.

“Stopping alcohol will also lead to massive dehydration of cells and hypoglycaemia. During withdrawal, the patient should drink plenty of water and eat sugar“. The late onset or the persistence of these symptoms beyond 5 days should raise suspicion other associated addictions, in particular to benzodiazepines.

What are the causes of alcohol withdrawal syndrome?

With chronic alcohol consumption, adaptation mechanisms are set up at the level of the central nervous system. They concern both the cell membrane and neurotransmission. “The sudden cessation of alcohol will be a source of dysfunction, recognize the specialist. There then occurs a rsudden reduction in GABA activity, resulting in hyperactivity other brain metabolisms“.

Which specialist to consult?

“Patients first consult their general practitioner, who unfortunately has little knowledge of alcohol use disorders, regrets Dr. Possoz. It is important refer the patient quickly to a specialized care center in the management of addictions where he will be followed by a medicalized and multidisciplinary team (addictologist, psychologists, psychiatrists, etc.). Prior to weaning, the doctor may assess alcohol dependence and risk of withdrawal syndrome through the clinical signs but also with a blood test. An increase in the volume of red blood cells can be a sign of severe alcohol dependence and a risk of epilepsy.

If withdrawal syndrome is not treated, 5% of patients will progress to delirium tremens

What are the potential complications ?

“Alcohol withdrawal syndrome can also progress to more serious symptoms such as confusional signs, seizures (epilepsy) or hallucinations which are characterized by a transient disorder of the sensory and somatic perception of the environment“, specifies our interlocutor. 25% of patients presenting a withdrawal syndrome will be victim of it. “In the absence of therapeutic care, hallucinatory delirium may set in within 7 to 48 hours after stopping alcohol consumption.“. The evolution towards delirium tremens is the severe form of alcohol withdrawal syndrome. “This state associates a autonomic nervous system hyperactivity, disorientation, confusion, hallucinatory delirium, and the possible occurrence of seizures. This is an absolute emergency“. If the withdrawal syndrome is not treated, 5% of patients will progress to delirium tremens. This condition develops over a period of 5 days to 2 weeks. Without suitable treatment, we previously observed a mortality of 35%, specifies the French Society of Emergency Medicine (SFMU). The establishment of treatment with benzodiazepines reduced this rate to 15%, then to 5% due to optimal therapeutic management.

80% of patients present with depressive disorders during withdrawal

Otherwise, 80% of patients present with depressive disorders during withdrawal. These regress in 2 to 4 weeks. We will wait a period of 2 to 4 weeks before introducing an antidepressant, in the absence of suicidal risk or severe depressive syndrome.

What is the treatment for alcohol withdrawal syndrome?

Alcohol withdrawal can be achieved in two ways. He can be “residential“, based on a stay of variable duration (from one week to approximately 3 months) in a hospital or in a specialist care centre. “It is all the more indicated that the subject has already experienced a weaning failure or that his level of intoxication is high“, insists our interlocutor. Or “ambulatory” with some close medical consultations (chosen in 60 to 70% of cases). The patient takes his treatment and resides at home. In all cases, a work stoppage is generally necessary. The main treatment remains sedation. “In most cases, the choice falls on benzodiazepine class drugs with a long half-life (Valium, Tranxene, Xanax, etc.). They not only help to limit tremors, anxiety and insomnia due to withdrawal but also prevent epileptic seizures and delirium tremens. In general, the prescription does not exceed five days“. According to various studies and therapeutic trials, it has been formally demonstrated that patients treated with benzodiazepines show a decrease in progression towards severe forms of withdrawal (delirium tremens). “They are often associated with vitamins (B1, B6 and PP) which fill the deficiencies frequent in alcohol-dependent people, deficiencies which can be the cause of serious neurological disorders (dementia, beriberi, polyneuritis, etc.)”. In addition to these treatments, increased attention is paid to rehydration of the patient in withdrawal (several liters of water per day during the critical phase of the first five days). “In effect, stopping consumption leads to massive dehydration“After this withdrawal stage, other medications may be prescribed in order to help maintain abstinence.”Once past the withdrawal syndrome, a medical, psychiatric and psychological care, sometimes socialis essential in order to best prevent the resumption of alcoholic intoxication, and therefore the risk of occurrence of a new withdrawal syndrome“.

How long does alcohol withdrawal last?

It all depends again on the severity and the patient’s alcohol impregnation. “Weaning in stage 1 lasts an average of 6 days. When it becomes complex, in the context of poly-intoxications (cocaine, tobacco, cannabis, opiates, benzodiazepines, etc.), he will require a 12-day hospitalization“observes the doctor.

“7 million people have a problem with alcohol and only 7% of them are treated.“, regrets Dr. Possoz. There is no risk of alcohol consumption. The risks associated with alcohol consumption, for health, increase throughout life with the amount consumed. However, an opinion issued by a group of experts commissioned by Public Health France and the National Cancer Institute (INCa) attempted to define acceptable risks and proposes a single benchmark for both sexes, expressed as a number of standard drinks of: 10 standard drinks per week and no more than 2 standard drinks per day. Remembering the principle: Maximum 2 glasses per day and not every day.

These same experts recommend having days in the week without alcohol consumption and, for each drinking occasion, to:

• reduce the total quantity of alcohol drunk on each occasion
• drink slowlyeating and alternating with water
• avoid risky places and activities
• make sure you are surrounded by people you trust and to be able to return home safely

In general, it is recommended not to consume alcohol in the following situations:

• throughout the duration of the pregnancy and breastfeeding
• during childhood, adolescence and the whole period of growth
• in case of car driving
• in case of practice risk sports
• in case of consumption of certain medications
• in case of existence of some diseases

Thanks to Dr Pascal Possoz alcoholic doctor, head of the addiction service at the park clinic in Castelnau-le-Lez (34).