Alcoholism, Abuse & Withdrawal

Alcoholism (alcohol dependence) and alcohol abuse are two different forms of problem drinking.

• Alcoholism is when you have signs of physical addiction to alcohol and continues to drink, despite problems with physical health, mental health, and social, family, or job responsibilities. Alcohol may control your life and relationships.
• Alcohol abuse is when your drinking leads to problems, but not physical addiction.

Causes, incidence, and risk factors

There is no known cause of alcohol abuse or alcoholism. Research suggests that certain genes may increase the risk of alcoholism, but which genes and how they work are not known.
How much you drink can influence your chances of becoming dependent. Those at risk for developing alcoholism include:

• Men who have 15 or more drinks a week
• Women who have 12 or more drinks a week
• Anyone who has five or more drinks per occasion at least once a week

One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.
You have an increased risk for alcohol abuse and dependence if you have a parent with alcoholism.
You may also be more likely to abuse alcohol or become dependent if you:

• Are a young adult under peer pressure
• Have depression, bipolar disorder, anxiety disorders, or schizophrenia
• Have easy access to alcohol
• Have low self-esteem
• Have problems with relationships
• Live a stressful lifestyle
• Live in a culture alcohol use is more common and accepted

Alcohol abuse is rising. Around 1 out of 6 people in the United States have a drinking problem.

Symptoms

People who have alcoholism or alcohol abuse often:

• Continue to drink, even when health, work, or family are being harmed
• Drink alone
• Become violent when drinking
• Become hostile when asked about drinking
• Are not able to control drinking — being unable to stop or reduce alcohol intake
• Make excuses to drink
• Miss work or school, or have a decrease in performance because of drinking
• Stop taking part in activities because of alcohol
• Need to use alcohol on most days to get through the day
• Neglect to eat or eat poorly
• Do not care about or ignore how they dress or whether they are clean
• Try to hide alcohol use
• Shake in the morning or after periods when they have not a drink

Symptoms of alcohol dependence include:

• Memory lapses after heavy drinking
• Needing more and more alcohol to feel “drunk”
• Alcohol withdrawal symptoms when you haven’t had a drink for a while
• Alcohol-related illnesses such as alcoholic liver disease

Treatment

• Completely stopping the use of alcohol is the ideal goal of treatment. This is called abstinence. A strong social network and family support are important in achieving this.
• Completely stopping and avoiding alcohol is difficult for many people with alcoholism. There will be times when it is difficult. You should aim to avoid drinking for as long as possible.
• Some people who abuse alcohol may be able to simply reduce the amount they drink. This is called drinking in moderation. If this method does not work, you should try to quit drinking completely.

Complications

Alcoholism and alcohol abuse can increase your risk of many health problems, including:

• Bleeding in the digestive tract
• Brain cell damage
• Brain disorder called Wernicke-Korsakoff syndrome
• Cancer of the esophagus, liver, colon, and other areas
• Changes in the menstrual cycle (period)
• Delirium tremens (DT’s)
• Dementia and memory loss
• Depression and suicide
• Erectile dysfunction
• Heart damage
• High blood pressure
• Inflammation of the pancreas (pancreatitis)
• Liver disease, including cirrhosis
• Nerve damage
• Poor nutrition
• Sleeping problems (insomnia)

Alcohol use also increases your risk for sexually transmitted infections (STIs) and violence.
Drinking alcohol while you are pregnant can lead to severe birth defects in the baby. See: Fetal alcohol syndrome

Calling your health care provider

Seek immediate medical care or call your local emergency number (such as 911) if:

• You or someone you know has alcohol dependence and develops severe confusion, seizures, or bleeding

Prevention

The National Institute on Alcohol Abuse and Alcoholism recommends:

• Women should not drink more than 1 drink per day
• Men should not drink more than 2 drinks per day

One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

References

1. Kleber HD, Weiss RD, Anton RF Jr., George TP, Greenfield SF, Kosten TR, et al. Work Group on Substance Use Disorders; American Psychiatric Association; Steering Committee on Practice Guidelines. Treatment of patients with substance use disorders, second edition. Am J Psychiatry. 2007;164:5-123. [PubMed]
2. In the clinic. Alcohol use. Ann Intern Med. 2009 Mar 3;150(5):
3. O’Connor PG. Alcohol abuse and dependence. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 31.
4. Schuckit MA. Alcohol-use disorders. Lancet. 2009;373:492-501. [PubMed]

Review Date: 3/20/2011.
Reviewed by: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.

ALCOHOL WITHDRAWAL

Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol every day suddenly stops drinking alcohol.

Causes, incidence, and risk factors

• Alcohol withdrawal usually occurs in adults, but it may happen in teenagers or children as well. It can occur when a person who uses alcohol excessively suddenly stops drinking alcohol.
• The withdrawal usually occurs within 5 – 10 hours after the last drink, but it may occur up to 7 – 10 days later.
• Excessive alcohol use is generally considered the equivalent of 2 – 6 pints of beer (or 4 oz. of “hard” alcohol) per day for 1 week, or habitual use of alcohol that disrupts a person’s life and routines.
• The more heavily a person had been drinking every day, the more likely that person will develop alcohol withdrawal symptoms when they stop. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Symptoms

Mild-to-moderate psychological symptoms:

• Jumpiness or nervousness
• Shakiness
• Anxiety
• Irritability or easy excitability
• Rapid emotional changes
• Depression
• Fatigue
• Difficulty thinking clearly
• Bad dreams

Mild-to-moderate physical symptoms:

• Headache — general, pulsating
• Sweating — especially the palms of the hands or the face
• Nausea and vomiting
• Loss of appetite
• Insomnia (sleeping difficulty)
• Pallor
• Rapid heart rate
• Eye pupils enlarged(dilated pupils)
• Clammy skin
• Tremor of the hands
• Involuntary, abnormal movements of the eyelids

Severe symptoms:

• Delirium tremens — a state of confusion and visual hallucinations
• Agitation
• Fever
• Convulsions
• Black outs — when the person forgets what happened during the drinking episode

Signs and tests

The health care provider will check for:

• Rapid heartbeat (tachycardia)
• Rapid breathing (tachypnea)
• Elevated temperature
• Abnormal eye movements
• Shaky hands
• General body shaking
• Abnormal heart rhythms
• Internal bleeding
• Liver failure
• Dehydration

A toxicology screen may be performed as well as other blood tests.

Treatment

The goals are to treat the immediate withdrawal symptoms, prevent complications, and begin long-term preventative therapy.

The person will probably have to stay at the hospital for constant observation. Heart rate, breathing, body temperature, and blood pressure are monitored, as well as fluids and electrolytes (chemicals in the body such as sodium and potassium).

The patient’s symptoms may progress rapidly and may quickly become life-threatening. Drugs that depress the central nervous system (such as sedatives) may be required to reduce symptoms, often in moderately large doses.

Treatment may require maintenance of a moderately sedated state for a week or more until withdrawal is complete. A class of medications known as the benzodiazepines are often useful in reducing a range of symptoms.

A drying-out period may be appropriate. No alcohol is allowed during this time.
The health care provider will watch closely for signs of delirium tremens.
Hallucinations that occur without other symptoms or complications are uncommon. They are treated with hospitalization and antipsychotic medications as needed.

Testing and treatment for other medical problems associated with use of alcohol is necessary. This may include disorders such as alcoholic liver disease, blood clotting disorders, alcoholic neuropathy, heart disorders (such as alcoholic cardiomyopathy ), chronic brain syndromes (such as Wernicke-Korsakoff syndrome ), and malnutrition.

Rehabilitation for alcoholism is often recommended. This may include social support such as Alcoholics Anonymous, medications, and behavior therapy.

Expectations (prognosis)

Alcohol withdrawal may range from a mild and uncomfortable disorder to a serious, life-threatening condition. Symptoms usually begin within 12 hours of the last drink. The symptoms peak in 48 – 72 hours and may persist for a week or more.

Symptoms such as sleep changes, rapid changes in mood, and fatigue may last for 3 – 12 months or more. If a person continues to drink excessively, they may develop many medical conditions such as liver and heart disease.

Calling your health care provider

Call your health care provider or go the emergency room if symptoms indicate alcohol withdrawal, especially in a person who has a history of habitual use of alcohol, or a history of stopping use of alcohol after a period of heavy alcohol consumption. Alcohol withdrawal is a serious condition that may rapidly become life-threatening.

Call for an appointment with your health care provider if symptoms persist after treatment.
Go to the emergency room or call the local emergency number (such as 911) if potentially lethal symptoms occur, including seizures, fever, delirium or severe confusion, hallucinations, and irregular heart beat.

Update Date: 6/3/2005
Updated by: Thomas A. Owens, M.D., Departments of Internal Medicine and Pediatrics, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.