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Alcohol Dependence and Withdrawal

What are alcohol dependence and withdrawal?

  • Alcohol dependence , also known as alcoholism, is a chronic (long-term) and severe (very bad) type of drinking problem. Alcohol dependence occurs when you drink alcohol too much and too often for a long period of time. Alcohol is made up of a chemical called ethanol, which may come from grains or fruits, such as grapes. It is found in beer, wine, liquor, such as vodka and whiskey, or other adult drinks. It has a depressant effect which slows down the brain's activity. With alcohol dependence, you have a craving for alcoholic drinks, making it hard to do your normal day-to-day activities. Alcohol dependence may cause problems thinking correctly, concentrating, and controlling your actions. It occurs most often between 20 to 35 years of age.
  • Alcohol withdrawal occurs when you stop drinking or drink less while having alcohol dependence. Symptoms develop as your body tries to get used to this change. Alcohol withdrawal may become dangerous and life-threatening. Diagnosing and treating alcohol dependence and withdrawal as soon as possible may improve your quality of life.

What causes alcohol dependence and withdrawal?

Alcohol dependence may start early as a teenager and remain as an adult. The exact cause of alcohol dependence is not known. You may become dependent to alcohol after physical or emotional stress, such as the loss of a loved one. You may also drink alcohol to try to relieve your anxiety, depression (deep sadness) , loneliness, or tension. The following are other possible causes and conditions which may increase your chance of having alcohol dependence:

  • Age: Drinking alcohol at an early age.
  • Family history: Having a close family member with a drinking problem.
  • Genetics: The make up of your genes. A gene is a little piece of information that tells your body what to do or what to make.
  • Sex: Men are more likely to become alcohol dependent than women.
  • Other diseases: Having other mental disorders or personality problems, such as anti-social behavior or depression.
  • Other substance abuse: Heavy cigarette smoking or using illegal drugs, such as cocaine, heroin, and marijuana.
Alcohol withdrawal may be caused by chemical changes in your body and brain. When you drink alcohol too much and too often, the brain is always exposed to the effects of alcohol. This makes the brain adjust and adapt to your drinking habits by producing certain chemicals in larger amounts than normal. This causes the brain to be overstimulated and overactive. If alcohol is suddenly stopped, the brain remains overactive and signs and symptoms of alcohol withdrawal appear. The following conditions may increase your chance of having severe alcohol withdrawal:
  • Drinking higher levels of alcohol every day, such as a case of beer or more than a half gallon of wine.
  • Heavy drinking for a longer period of time, such as drinking for more than five years.
  • History of previous alcohol withdrawal.
  • Poor nutrition or physical condition, or decreased liver function.
  • Using certain drugs at the same time, such as sedatives, cocaine, or narcotics.

What are the signs and symptoms of alcohol dependence and withdrawal?

  • Alcohol dependence includes any of the following signs and symptoms:
    • Continuing to drink despite knowing its harmful effects. You keep on drinking alcohol even if you know that it increases your chance of having health problems. These health problems may include liver problems, stomach ulcers (sores), hypertension (high blood pressure), or stroke.
    • Developing tolerance for alcohol. Tolerance means the amount of alcohol you usually drink no longer causes the depressant effects you may desire. You may need to drink even more alcohol to get its previous effects.
    • Extra effort and time is given so you may drink alcohol. You may often go to events or activities that will include drinking. You may also spend much of your time drinking alcohol or being with people who also drink.
    • Having withdrawal (physical or mental) symptoms after not drinking for a short period. The same amount of alcohol may be needed to relieve or avoid withdrawal symptoms. You may also have to drink to stop tremors (shakes) or to cure a hangover.
    • Increased craving for alcohol. There may be a desire to drink more frequently and larger amounts of alcohol.
    • Problems with decreasing or controlling alcohol use. Not being able to control your drinking habits, or you keep on going back to drinking even after quitting.
    • Spending less time doing more important things. You have trouble with social or daily activities at school, work, or home.
  • Alcohol withdrawal may include any of the following signs and symptoms:
    • Minor symptoms: These usually begin 5 to 8 hours after your last alcohol drink. You may feel anxious, agitated, restless, nervous, shaky, or trembling. You may also have problems sleeping, too much sweating, a fast heartbeat, or decreased appetite.
    • Major symptoms: Twenty-four to 72 hours after your last drink, your minor withdrawal symptoms may become worse. You may feel confused or more restless, agitated, shaky, or trembling. You may also have frequent rapid eye movements, excessive cold sweats, nausea (upset stomach), or vomiting (throwing up). Other symptoms may include a fast heartbeat, high blood pressure, problems thinking clearly, or seizures (convulsions). You may start hallucinating (seeing or hearing things that are not present).
    • Delirium tremens: Delirium tremens may occur from 72 to 96 hours after the last drink. You may have fever, very high blood pressure, or a fast heartbeat. You may also be sweating a lot, delirious (manic or hysterical), or shaking very badly. Seizures, heart attacks, breathing problems, or strokes may also occur.

How are alcohol dependence and withdrawal diagnosed?

  • Psychiatric Assessment: Caregivers will ask if you have a history of psychological trauma, such as physical, sexual, or mental abuse. They will ask if you were given the care that you needed when you needed it. Caregivers will ask you if you have been a victim of a crime or natural disaster, or if you have a serious injury or disease. They will ask you if you have seen other people being harmed, such as in combat. You will be asked if you drink alcohol or use drugs at present or in the past. Caregivers will ask you if you want to hurt or kill yourself or others. The answers to these questions can help caregivers decide on your treatment. Caregivers will ask you about factors that can help you during treatment. These factors may include how you feel about treatment and your hobbies and goals. Caregivers will also ask you about the people in your life who support you.
  • Tests and rating scales: Blood, urine, saliva, or breath tests may be done to check the amount of alcohol in your body. You may have to take different tests or rating scales to learn more about your drinking problem:
    • Alcohol dependence: Caregivers use a guide to diagnose alcohol dependence. You have alcohol dependence if the symptoms are present anytime in the same one-year period. The symptoms must also greatly affect and cause you not to do well in school, work, or relationships. You will be diagnosed with alcohol dependence if you meet at least three of the following:
      • Continuing alcohol use despite knowing its harmful effects.
      • Drinking more alcohol than you first and usually did.
      • Giving extra effort and time so you may drink alcohol.
      • Having a tolerance for alcohol.
      • Having withdrawal (physical or mental) symptoms after not drinking for a short period.
      • Problems with decreasing or controlling your alcohol use.
      • Spending less time doing more important things.
    • Alcohol withdrawal: A guide is also used to diagnose alcohol withdrawal. The symptoms must have developed within several hours or days after stopping prolonged and heavy alcohol use. They must have a great effect in your daily activities, including in school or work, or relationships. The symptoms must also not be caused by other medical or mental conditions. Two or more of the following alcohol withdrawal symptoms must be present:
      • Agitation or anxiety.
      • Hallucinations or illusions.
      • Hard time falling asleep.
      • Increased hand tremor or shakiness.
      • Nausea or vomiting.
      • Seizures.
      • Sweating too much or having a heartbeat more than 100 beats per minute.

How is alcohol dependence and withdrawal treated?

The aim of treatment is to help you learn how to control your drinking problem. Caregivers will also work with your family, friends, classmates, or co-workers. These will help them know how to cope with your alcohol dependence. You may need any of the following:

  • Detoxification: Your caregiver may need to put you in an alcohol detoxification program or detox. This is done to flush out the toxic residues of alcohol present in your body. During detox, medicines are given to help prevent withdrawal symptoms when you stop drinking alcohol. As you improve, your caregiver may slowly change how much detox medicines you are given.
  • IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  • Medicines: Ask your caregivers before using any of the following medicines:
    • Alcohol dependence: Your caregiver may suggest certain medicines to help you control your alcohol dependence and other related problems. Ask your caregiver for more information about these medicines.
    • Alcohol withdrawal:
      • Anticonvulsant medicine: Anticonvulsants are given to control seizures.
      • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up).
      • Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
      • Sedative: A sedative medicine may be given to help you stay calm and relaxed.
      • Sympatholytics: These medicines are usually used to control high blood pressure and other signs and symptoms of alcohol withdrawal. They may also be used to help decrease shakiness or uncontrolled movements. Sympatholytics may help you feel calmer, more focused, and less irritable.
  • Therapies:
    • Cognitive behavioral therapy: With a therapist, you will learn how to control your actions and improve your behavior. This is done by teaching you how to change your behavior by looking at the results of your actions. You may also need to know how to cope with situations which make you depend on alcohol use.
    • Motivational enhancement therapy: Motivational enhancement therapy is used to encourage you to stop using alcohol. A therapist or counselor motivates and helps you set goals so you may change your destructive behaviors. By doing these changes, you may stop depending on alcohol and have a better lifestyle.
  • Respiratory support:
    • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
    • Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.
  • Other treatments:
    • Glucose: This medicine may be given to increase the amount of sugar in your blood.
    • Mineral and vitamin supplements: Mineral and vitamin supplements, such as Vitamin B1 or thiamine, may be given. They may help prevent other alcohol-related conditions that may affect the brain.

Where can I find support and more information?

Having alcohol dependence or withdrawal is a life-changing condition for you and your family. Accepting that you have alcohol dependence or withdrawal may be hard. Talk to your caregiver, family, or friends about your feelings. Your caregiver can help you and your family better understand how to support you. You and your family may also want to join a support group. This is a group of people who may also have alcohol dependence or withdrawal. Contact the following for more information:

  • Alcoholics Anonymous
    Web Address:
  • National Clearinghouse on Drug and Alcohol Information
    Phone: 1- 800 - 7296686
    Web Address:

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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