Alcoholism Withdrawal Syndrome

Dr. Purushothaman
September 10, 2013

Alcoholism withdrawal syndrome is the set of symptoms seen when an individual reduces or stops alcohol consumption after prolonged periods of excessive alcohol intake. Excessive abuse of alcohol leads to tolerance, physical dependence, and an alcohol withdrawal syndrome once the individual stops alcohol consumption. Unlike most withdrawals from drugs, alcohol withdrawal can be deadly.
Chronic use of alcohol leads to changes in brain chemistry especially in the GABAergic system. Various adaptions occur such as changes in gene expression and down regulation of GABAa receptors. During acute alcohol withdrawal, changes also occur such as up regulation of alpha4 containing GABAa receptors and down regulation of alpha1 and alpha3 containing GABAa receptors. Neurochemical changes occurring during alcohol withdrawal can be minimised with drugs which are used for acute detoxification. With abstinence from alcohol and cross tolerant drugs, these changes in neurochemistry gradually return to normal. The severity of the alcohol withdrawal syndrome can vary from mild symptoms such as mild sleep disturbances and mild anxiety to very severe and life threatening including delirium, particularly visual hallucinations in severe cases and convulsions (which may result in death).
Another form of alcohol withdrawal is the Protracted Alcohol Withdrawal Syndrome. A protracted alcoholism withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to as the post acute withdrawal syndrome. Some withdrawal symptoms can linger for at least a year after discontinuation of alcohol. Symptoms can include a craving for alcohol, inability to feel pleasure from normally pleasurable things (also known as anhedonia), clouding of sensorium, disorientation, nausea and vomiting or headache.
Insomnia is also a common protracted withdrawal symptom which persists after the acute withdrawal phase of alcohol. It has also been found to influence relapse rate. Studies have found that magnesium or trazodone can help treat persisting withdrawal symptom of insomnia in recovering alcoholics. Insomnia can be difficult to treat in alcoholics because many of the traditional sleep aids eg benzodiazepine receptor agonists and barbiturate receptor agonists work via a GABAA receptor mechanism and are cross tolerant with alcohol. However, trazodone is not cross tolerant with alcohol.
The acute phase of the alcoholism withdrawal syndrome can also occasionally be protracted. Protracted delirium tremens has been reported in the medical literature as a possible but unusual feature of alcohol withdrawal.

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