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DTs - Alcohol Withdrawal


Overview, Causes, & Risk Factors

Alcohol withdrawal is a set of symptoms that may occur when a person suddenly stops drinking after using alcohol for a long time.

What is going on in the body?

When a person has been drinking to excess for several months or years, his or her body comes to rely on alcohol and its effects. Alcohol is a depressant that acts like a sedative or tranquilizer on the body. When the intake of alcohol is suddenly stopped, the body may go through withdrawal.

What are the causes and risks of the condition?

Alcohol withdrawal rarely occurs in a person who only drinks once in a while. Someone who has gone through alcohol withdrawal before is more likely to have withdrawal symptoms each time he or she quits drinking alcohol.


Symptoms & Signs

What are the signs and symptoms of the condition?

Symptoms of alcohol withdrawal usually occur within 12 to 72 hours after the last drink of alcohol. Major withdrawal symptoms may occur for up to 7 days, with recurring symptoms lasting for several months. A person going through withdrawal may have a wide variety of symptoms, including:

  • anxiety
  • depression
  • excessive sweating, especially on the hands and face
  • fatigue
  • hallucinations
  • headache
  • insomnia
  • irritability
  • nausea and/or vomiting
  • nervousness
  • palpitations, or an abnormal awareness of the heart beating in the chest
  • rapid heartbeat
  • seizures
  • shaking and tremors
  • trouble concentrating
  • If left untreated, alcohol withdrawal can lead to a more serious set of symptoms called delirium tremens or DTs. These symptoms usually appear about 2 to 10 days after the drinking stops. A person with DTs is anxious at first. Later, other symptoms occur that can include:

  • confusion
  • difficulty sleeping, including nightmares
  • disorientation with visual hallucinations
  • excessive sweating
  • fever
  • hallucinations and illusions that arouse fears and restlessness
  • severe depression

  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of alcohol withdrawal begins with a history and physical exam. While there is no test to determine if a person is an alcoholic, the negative effects of alcohol on the body can be seen. Liver function tests can measure liver damage. Special tests, called MRIs and ultrasounds, can check the different organs inside the body for damage.


    Prevention & Expectations

    What can be done to prevent the condition?

    A person can prevent alcohol withdrawal by not drinking alcohol excessively. A person with alcoholism who wishes to stop drinking should consult his or her healthcare provider. Certain treatment and programs may curtail alcohol withdrawal symptoms.

    What are the long-term effects of the condition?

    Alcohol withdrawal can lead to DTs, which can be fatal if untreated. A person may find it hard to handle stressful situations and may begin drinking again.

    What are the risks to others?

    Alcohol withdrawal is not contagious, and poses no direct risk to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    The goals of treatment are to treat the immediate withdrawal symptoms, to prevent complications, and to begin long-term preventive treatment.

    In mild forms of alcohol withdrawal, medicine may be given to make the person feel less agitated. A person with more severe forms of withdrawal needs to be hospitalized during the period of detoxification. The person is usually given central nervous system depressants and sedatives to reduce the symptoms.

    Vitamin deficiency causes potentially life-threatening withdrawal symptoms. Healthcare providers in emergency departments usually give large intravenous doses of vitamins C and B, as well as thiamine. Close monitoring of the pulse, breathing, temperature, and blood pressure is important during the first stages of alcohol withdrawal.

    After the urgent medical problems are resolved, a detoxification and rehabilitation program should be started. In the first phase of treatment, alcohol is completely withdrawn. Then an alcoholic has to change his or her behavior. Self-help groups, such as Alcoholics Anonymous, are encouraged.

    What are the side effects of the treatments?

    Side effects vary, depending on the medicines used. For instance, antidepressants may cause irritability and shakiness. Sedatives can be addicting.

    What happens after treatment for the condition?

    A person who completes treatment often will continue some form of counseling or self-help group. The individual will often voluntarily continue to attend self-help groups for the rest of his or her life. A person who starts drinking again will most likely go through alcohol withdrawal again.

    How is the condition monitored?

    Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:09/13/01
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:09/14/01

    Sources

    "Introduction to Alcohol Withdrawal", silk.nih.gov/silk/niaaa1/publication/iss22-1.htm

    Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

    The Merck Manual of Medical Information, 1997


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