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Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal (AW). Signs and symptoms of AW can include, among others, mild to moderate tremors, irritability, anxiety, or agitation. The most severe manifestations of withdrawal include delirium tremens, hallucinations, and seizures. These manifestations result from alcohol-induced imbalances in the brain chemistry that cause excessive neuronal activity if the alcohol is withheld. Management of AW includes thorough assessment of the severity of the patient's symptoms and of any complicating conditions as well as treatment of the withdrawal symptoms with pharmacological and nonpharmacological approaches. Treatment can occur in both inpatient and outpatient settings. Recognition and treatment of withdrawal can represent a first step in the patient's recovery process. KEY WORDS: AOD withdrawal syndrome; biochemical mechanism; neurotransmission; neurotransmitter receptors; central nervous system; symptom; tremor; anxiety state; delirium tremens; AODR (alcohol and other drug related) hallucinosis; AODR seizure; AOD abstinence; disease severity; patient assessment; treatment method; alcohol withdrawal agents; drug therapy; detoxification; addiction care; literature review
Every year more than one-anda-half million people in the United States either enter alcoholism treatment or are admitted to a general hospital because of medical consequences resulting from alcohol dependence. These patients, as well as a substantial number of other people who stop drinking without seeking professional treatment, experience alcohol withdrawal (AW). AW is a clinical syndrome that affects people accustomed to regular alcohol intake who either decrease their alcohol consumption or stop drinking completely. In these people, the central nervous system (CNS) has adjusted to the constant presence of alcohol in the body and compensates for alcohol's depressive effects on both brain function and the communication among nerve cells (i.e., neurons). Consequently, when the alcohol level is suddenly lowered, the brain remains in a hyperactive, or hyperexcited, state, causing withdrawal syndrome.
AW syndrome varies significantly among alcoholics in both its clinical manifestations and its severity. These manifestations1 can range from mild insomnia to severe consequences, such as delirium tremens (DT's) and even death. Substantial variability also exists in the incidence with which symptoms occur in various drinkers. Some people who regularly consume alcohol never experience any withdrawal symptoms. Conversely, in some alcoholics withdrawal symptoms can occur at blood alcohol concentrations (BAC's) that would be intoxicating in nonalcohol-dependent...