Definition

Alcohol withdrawal syndrome (AWS) is a symptom that occurs after a sudden cessation of alcohol consumption after long-term consumption.

If you have been consuming large amounts of alcohol over weeks to years, you may experience mental and physical distress if you abruptly stop drinking alcohol. Symptoms range from mild to severe, including mild anxiety and vomiting to hallucinations and seizures. AWS can be life-threatening.

Causes

Prolonged and excessive intake of alcohol can irritate the nervous system. Regular daily consumption of alcohol can lead to dependence over time. When this dependence occurs, the nervous system becomes less able to adjust quickly to a reduction in the amount of alcohol consumed, resulting in symptoms associated with Alcohol Withdrawal Syndrome (AWS).

Risk factor

Factors that may increase the risk of developing AWS are:

• Age over 30 years
• Previous history of AWS
• Alcohol dependence
• Consuming large amounts of alcohol daily (defined as Eight glasses of alcohol/week for women and 15 glasses of alcohol/week for men)
• Unable to progressively reduce the amount of alcohol consumed

Symptoms

The manifestations of Alcohol Withdrawal Syndrome (AWS) can be classified according to the time elapsed since the last alcohol intake. These symptoms may emerge within a few days of discontinuing alcohol consumption and are as follows:

Within 6 hours after the last alcohol consumption:

• Mild anxiety
• Hand tremors
• Headache
• Nausea
• Vomiting
• Sleeplessness (insomnia)
• Excessive sweating
• Cognitive impairment, inability to think clearly
• Nightmares
• Mood swings
• Irritability
• Fatigue

12-48 hours after the last alcohol consumption

As alcohol withdrawal progresses, usually in the next 24 to 48 hours after the last drink, more severe symptoms may appear, including hallucinations and seizures. Individuals undergoing this stage of withdrawal may experience auditory, tactile, or visual hallucinations, experiencing sensations or stimuli that do not exist. The occurrence of seizures during this period adds to the severity of the withdrawal process.

48-72 hours after last alcohol consumption

Delirium Tremens (DT) can appear 48-72 hours after the last alcohol consumption. This critical phase of withdrawal is characterized by intense symptoms, including hallucinations and delusions, in which the individual may have difficulty distinguishing between reality and imagination. Additionally, during this period, individuals may experience:

• Confusion
• Severe palpitations (hard and fast heartbeat)
• Increased blood pressure
• Fever
• Sweating a lot
• Agitation or restlessness

It is important to note that symptoms of Alcohol Withdrawal Syndrome (AWS), including those associated with Delirium Tremens, can last for 5-7 days.

Diagnosis

If a doctor suspects that you might be dealing with Alcohol Withdrawal Syndrome (AWS) they will inquire about your alcohol consumption history and any previous incidents similar to this. Additionally, they will ask about the complaint you have. The treatments you have pursued. The doctor may conduct blood tests, urine tests, toxicology tests (to detect substances in your system), and imaging tests. During the examination, the doctor will assess:

•  Eye movement
•  Heart rhythm
•  Signs of dehydration
•  Presence of fever
•  Frequency of rapid breathing
•  Tremors in the hands

Management

The goals of AWS treatment include:

• Reduces withdrawal symptoms
• Prevent complications from alcohol use
• Undertake therapy to help you stop consuming alcohol

Patients who experience moderate-severe symptoms of AWS require hospital treatment to treat the symptoms. They require close monitoring due to hallucinations and symptoms of delirium tremens. The treatment carried out is:

• Monitoring blood pressure, body temperature, heart rhythm, and checking chemical levels in the body
• Replacing fluids using an IV
• Nutritional supplementation
• Using sedative drugs until the withdrawal phase is complete
• Quiet and protective on-site care

Patients who experience mild-moderate symptoms of AWS can be treated outpatient. During this process, the patient needs someone to look after and supervise for some time. Patients must also visit their doctor periodically to ensure no additional severe symptoms.

The treatment includes: 

• Reducing withdrawal symptoms using sedatives.
• Due to dependency, these medications should be used under strict supervision.
• Replace lost essential vitamins. Discuss this with your doctor.
• Periodic blood tests
• Talk to your closest friends and family about cutting down on drinking.
• Examination and therapy for excessive alcohol usage

The closest person who can accompany and supervise you during this process is necessary. Some areas provide alcohol rehab locations to help a person remain abstinent.

Long-term, lifelong cessation of alcohol consumption is the definitive treatment for AWS.

Complications

Complications from AWS include:

• Mild complications include insomnia, mild anxiety, stomach pain, anorexia, headache, sweating, and palpitations. This can take several months after AWS occurs
• Seizures within 12-48 hours after last alcohol consumption
• Hallucinations 12–24 hours after last alcohol consumption)
• Delirium Tremens (DT), namely a condition of hallucinations, confusion, palpitations, high blood pressure, and high body temperature after stopping alcohol
• If a person cannot stop consuming alcohol, damage to the liver, heart, and nervous system can occur.

Prevention

The most effective way to prevent AWS is to avoid consuming alcoholic beverages or drinks in controlled amounts.

Controlled alcohol consumption is defined as consuming less than 1 drink per day for women and less than 2 drinks per day for men. The size of the glass used is around 240-280 ml. However, if a person has experienced alcohol abuse, AWS can be prevented by reducing alcohol consumption under the supervision of a doctor.

When to see a doctor?

AWS is a condition that can be life-threatening. Contact the nearest health facility immediately if you experience symptoms of AWS, especially if you have recently reduced the amount of alcohol you usually drink. If you experience seizures, fever, confusion, hallucinations, or an irregular heartbeat, visit the emergency room immediately. Please provide information about your history of alcohol consumption to health workers so they can immediately take further action.