Alcohol withdrawal  syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption.

Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs — which are characterized by confusion, rapid heartbeat, and fever — is estimated to range from 1% to 5%.

Because alcohol withdrawal symptoms can rapidly worsen, it’s important to seek medical attention even if symptoms are seemingly mild. Appropriate alcohol withdrawal treatments can reduce the risk of developing withdrawal seizures or DTs.

It’s especially important to see a doctor if you’ve experienced previous alcohol withdrawal episodes or if you have other health conditions such as infections, heart disease, lung disease or a history of seizures.

Severe alcohol withdrawal symptoms are a medical emergency. If seizures, fever, severe confusion, hallucinations, or irregular heartbeats occur, either take the patient to an emergency room or call 999 or 911

Causes of Alcohol Withdrawal Syndrome

Heavy, prolonged drinking — especially excessive daily drinking — disrupts the brains neurotransmitters, the brain chemicals that transmit messages.

For example, alcohol initially enhances the effect of GABA, the neurotransmitter which produces feelings of relaxation and calm. But chronic alcohol consumption eventually suppresses GABA activity so that more and more alcohol is required to produce the desired effects, a phenomenon known as tolerance.

Chronic alcohol consumption also suppresses the activity of glutamate, the neurotransmitter which produces feelings of excitability. To maintain equilibrium, the glutamate system responds by functioning at a far higher level than it does in moderate drinkers and nondrinkers.

When heavy drinkers suddenly stop or significantly reduce their alcohol consumption, the neurotransmitters previously suppressed by alcohol are no longer suppressed. They rebound, resulting in a phenomenon known as brain hyperexcitability. So, the effects associated with alcohol withdrawal — anxiety, irritability, agitation, tremors, seizures, and DTs — are the opposite of those associated with alcohol consumption.

Preventing Future Alcohol Withdrawal Episodes

Because successful treatment of alcohol withdrawal syndrome doesn’t address the underlying disease of addiction, it should be followed by treatment for alcohol abuse or alcohol dependence.

Relatively brief outpatient interventions can be effective for alcohol abuse, but more intensive therapy may be required for alcohol dependence. If you have alcohol dependence, your doctor may prescribe other medications to help you stop drinking. He or she also may recommend joining a 12-step group — such as Alcoholics Anonymous and Narcotics Anonymous — or staying at a comprehensive treatment facility that offers a combination of a 12-step model, cognitive-behavioral therapy, and family therapy.

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