Alcohol withdrawal syndrome is a complex of pathological symptoms that occur in alcoholics when they refuse to drink alcoholic beverages. It resembles a hangover in its manifestations, but differs from it in a number of additional signs, including duration. Develops only in patients with stages 2 and 3 of alcoholism, in the absence of alcohol dependence is not observed. It is accompanied by sweating, palpitations, trembling of hands, impaired coordination of movements, sleep and mood disorders. The transition to alcoholic delirium (delirium tremens) is possible. Treatment is infusion therapy.
ICD 10
F10.3 F10.4
General information
Alcohol withdrawal syndrome (withdrawal syndrome) is a complex of psychological, neurological, somatic and autonomic disorders observed after stopping drinking alcoholic beverages. It develops only in people suffering from alcohol addiction. Occurs at the 2nd stage of alcoholism. Some of the manifestations of this syndrome are similar to a normal hangover, but with a hangover there are no symptoms, including an irresistible craving for alcohol. The hangover goes away within a few hours, the withdrawal syndrome lasts for several days.
Causes
The time period from the beginning of regular alcohol consumption to the appearance of alcohol withdrawal syndrome ranges from 2 to 15 years. There is a relationship between the time of occurrence of this condition, gender and age of patients. So, in young men and adolescents, signs of abstinence are observed already 1-3 years after the onset of alcohol abuse, and after 2-5 years, the disease becomes prolonged and pronounced. In women, this syndrome appears after about 3 years of regular alcohol intake.
Pathophysiology of alcohol withdrawal syndrome
After entering the body, ethanol is broken down in several ways: with the participation of the enzyme alcohol dehydrogenase (mainly in liver cells), with the help of the enzyme catalase (in all cells of the body) and with the participation of the microsomal ethanol-oxidizing system (in liver cells). The intermediate product of metabolism in all cases becomes acetaldehyde – a highly toxic compound that has a negative effect on the work of all organs and causes symptoms of a hangover.
In a healthy person, alcohol is broken down mainly with the help of alcohol dehydrogenase. With regular alcohol consumption, alternative variants of alcohol metabolism are activated (with the participation of catalase and microsomal ethanol-oxidizing system). This leads to an increase in the amount of acetaldehyde in the blood, its accumulation in organs and tissues. Acetaldehyde, in turn, affects the synthesis and breakdown of dopamine (a chemical that interacts with nerve cells).
Prolonged alcohol intake leads to depletion of dopamine reserves. At the same time, alcohol itself connects to the receptors of nerve cells, making up for the deficiency that has arisen. At the first stage of alcoholism, a patient in a sober state suffers from insufficient stimulation of receptors due to a lack of dopamine and the absence of alcohol replacing it. This is how mental dependence is formed. At the second stage of alcoholism, the picture changes: the cessation of alcohol intake entails a breakdown of compensation, not only the decay, but also the synthesis of dopamine sharply increases in the body. The level of dopamine increases, which leads to the appearance of vegetative reactions, which are the main signs of withdrawal syndrome.
Changes in dopamine levels are caused by symptoms such as sleep disorders, anxiety, irritability and increased blood pressure. The severity of withdrawal syndrome directly depends on the level of dopamine. If its content increases three times compared to the norm, the withdrawal syndrome turns into alcoholic delirium (delirium tremens). Along with the effect on the level of neurotransmitters, acetaldehyde negatively affects the ability of red blood cells to bind oxygen. Red blood cells deliver less oxygen to tissues, which leads to metabolic disorders and oxygen starvation of cells of various organs. Against the background of tissue hypoxia, somatic symptoms characteristic of withdrawal syndrome occur.
The depth of the lesion of the body during abstinence affects the duration of this condition. The usual hangover lasts only a few hours. Abstinence lasts on average 2-5 days, the maximum of symptoms is usually observed on the third day, at the height of the breakdown of compensatory mechanisms due to the cessation of alcohol intake. In severe cases, residual withdrawal symptoms may persist for 2-3 weeks.
Classification
There are several classifications of alcohol withdrawal syndrome, taking into account the severity, the time of occurrence of certain symptoms, as well as clinical variants with a predominance of one or another symptom. At the 2nd stage of alcoholism, there are three degrees of severity of abstinence:
- 1 degree. Occurs during the transition from the first stage of alcoholism to the second. It appears with short-term binge drinking (usually lasting no more than 2-3 days). Asthenic symptoms and disorders of the autonomic nervous system prevail. Accompanied by palpitations, dry mouth and excessive sweating.
- 2nd degree. It is observed “in the midst” of the second stage of alcoholism. Appears after binge drinking lasting 3-10 days. Vegetative disorders are joined by neurological disorders and symptoms from the internal organs. It is accompanied by redness of the skin and whites of the eyes, palpitations, fluctuations in blood pressure, nausea and vomiting, a feeling of turbidity and heaviness in the head, gait disorders, trembling of the hands, eyelids and tongue.
- 3rd degree. Usually occurs during the transition from the second stage of alcoholism to the third. It is observed with binge drinking lasting more than 7-10 days. Vegetative and somatic symptoms persist, but fade into the background. The clinical picture is mainly determined by mental disorders: sleep disorders, nightmares, anxiety, guilt, sad mood, irritation and aggression towards others.
At the third stage of alcoholism, the withdrawal syndrome becomes pronounced and includes all of the above signs. It should be borne in mind that the manifestations of abstinence can vary, the severity and prevalence of certain symptoms depends not only on the stage of alcoholism, but also on the duration of a particular binge, the state of internal organs, etc. Unlike a hangover, withdrawal syndrome is always accompanied by an irresistible craving for alcohol, which increases in the afternoon.
Symptoms of alcohol withdrawal syndrome
Taking into account the time of occurrence, two groups of withdrawal symptoms are distinguished. Early symptoms occur within 6-48 hours after refusing to take alcohol. If the patient resumes drinking alcoholic beverages, these signs may completely disappear or significantly soften. After giving up alcohol, the patient is restless, excited, irritable. There is a rapid heartbeat, trembling of the hands, sweating, increased blood pressure, aversion to food, diarrhea, nausea and vomiting. Muscle tone is reduced. Violations of memory, attention, judgment, etc. are revealed.
Late symptoms are observed within 2-4 days after the cessation of alcohol consumption. They relate mainly to disorders of the mental sphere. Mental disorders occur against the background of aggravation of some early symptoms (palpitations, agitation, sweating, shaking hands). The patient’s condition is changing rapidly. Possible confusion, hallucinations, delirium and epileptic seizures. Delusions are formed on the basis of hallucinations and usually have a paranoid character. Most often there is delirium of persecution.
As a rule, early symptoms precede late ones, but this pattern is not always noted. In mild cases, late symptoms may be absent. In some patients, late symptoms develop suddenly, against the background of a satisfactory general condition, with the absence or mild severity of early withdrawal symptoms. Some late symptoms may gradually be reduced without turning into alcoholic delirium. With the appearance of all signs and the progression of late symptoms, delirium tremens develops. In some cases, the first manifestation of withdrawal becomes an epileptic seizure, and the remaining symptoms (including early ones) are joined later.
Clinical options
There are 4 variants of the course of alcohol withdrawal syndrome with a predominance of symptoms from various organs and systems. This separation is of great clinical importance, since it allows you to determine which organs have suffered more as a result of abstinence, and to choose the most effective therapy. This classification includes:
- Neurovegetative variant. The most common variant of the course of withdrawal syndrome is the “basis” on which the other manifestations are “built up”. It is manifested by sleep disorders, weakness, lack of appetite, palpitations, fluctuations in blood pressure, trembling of the hands, swelling of the face, increased sweating and dry mouth.
- The cerebral variant. Disorders of the autonomic nervous system are complemented by fainting states, dizziness, intense headache and hypersensitivity to sounds. Seizures are possible.
- Somatic (visceral) variant. The clinical picture is formed due to pathological symptoms from the internal organs. Mild jaundice of the sclera, bloating, diarrhea, nausea, vomiting, shortness of breath, arrhythmia, pain in the epigastric region and the heart area are detected.
- Psychopathological variant. Mental disorders prevail: anxiety, mood changes, fear, pronounced sleep disorders, short-term visual and auditory illusions that can turn into hallucinations. Orientation in space and time deteriorates. Suicidal thoughts and suicide attempts are possible.
Regardless of the course of withdrawal, this condition is always accompanied by disorders of the patient’s psyche and thinking. During this period, all personality changes characteristic of alcoholism come to the fore, become “more prominent”, noticeable from the outside. Attention is drawn to the inertia and unproductivity of the patient’s thinking. The patient does not perceive explanations and instructions well, often acts and responds at random, his answers and speeches lack the lightness and spontaneity characteristic of ordinary informal communication. Humor and irony are absent or simplified and coarsened.
Anxiety prevails in young people, and mood decline prevails in the elderly. Patients feel hopeless, suffer from feelings of guilt due to the inability to refrain from drinking alcohol and their actions committed in a state of intoxication. In some cases, panic attacks occur. Depression alternates with episodes of purposefulness caused by increased cravings for alcohol. In this state, patients without remorse deceive loved ones, open locks or run away from home through the balcony, beg for money from friends and strangers, commit theft, etc.
Treatment of alcohol withdrawal syndrome
Withdrawal syndrome is treated by specialists in the field of narcology. Patients with mild forms of withdrawal can get help from a narcologist at home or on an outpatient basis. The treatment regimen includes intravenous drip infusion of saline solutions, vitamin therapy, detoxification therapy (ingestion of activated charcoal), means to restore the functions of various organs and improve the activity of the nervous system. Patients are prescribed benzodiazepines – drugs that reduce anxiety, have a sedative, hypnotic and anticonvulsant effect and simultaneously affect the autonomic nervous system, contributing to the elimination of autonomic disorders.
Indications for hospitalization are exhaustion, significant dehydration, severe hyperthermia, severe trembling of the limbs, eyelids and tongue, hallucinations, epileptic seizures and impaired consciousness. Inpatient treatment is necessary in the presence of somatic pathology, including gastrointestinal bleeding, respiratory failure, severe liver failure, pancreatitis, severe bronchitis and pneumonia. Patients are also hospitalized in the presence of mental disorders (schizophrenia, manic-depressive psychosis, alcoholic depression) and with a history of episodes of alcoholic psychosis.
The program of assistance to patients in inpatient conditions includes drug therapy (the outpatient treatment scheme is supplemented with neuroleptics, anticonvulsants, sleeping pills, tranquilizers, nootropics, means for the correction of mental and somatic disorders), a special diet, plasmapheresis and other non-drug therapies. Treatment is carried out after an appropriate examination. Patients are under the supervision of a narcologist.
Forecast
In mild cases, all the phenomena of withdrawal syndrome without treatment disappear in a period of up to 10 days, with treatment without hospitalization (at home or on an outpatient basis) – in a period of up to 5 days. The prognosis for severe withdrawal depends on the form of the disorder, the severity of mental disorders and the severity of somatic pathology. The most severe course is observed with the predominance of psychopathological symptoms and the transition to alcoholic delirium. Neurovegetative and visceral variants are easier and have a shorter duration.
It should be remembered that abstinence is a sign of an already developed alcohol addiction. If the patient continues to take alcohol, withdrawal symptoms will worsen over time, and alcoholism will progress. If withdrawal syndrome appears, you should consult a narcologist who will recommend the most effective treatment regimen for alcoholism (installation of a coding implant, drug treatment of alcoholism, hypnosuggestive therapy, Dovzhenko coding, etc.) and advise a suitable rehabilitation program.
