What exactly is alcohol withdrawal and what does it look like?

Alcohol withdrawal is a condition that follows a reduction in alcohol consumption or when an alcohol dependent individual stops drinking abruptly. In addition to a high level of distress, alcohol withdrawal is also associated with impairment in social, occupational, and other areas of an individual’s functioning. Relatively uncomplicated cases of alcohol withdrawal are usually characterized by signs and symptoms of autonomic hyperactivity, and could possibly include increased heart rate, increased blood pressure, hyperthermia, tremor, nausea, vomiting, insomnia and frequently anxiety. Symptoms of uncomplicated alcohol withdrawal usually occur between 4 and 12 hours after an individual has had his last drink of alcohol. The severity of symptoms tend to peak around the second day, usually subsiding by about the fourth or fifth day of abstinence. After this period of time, less anxiety, insomnia and other autonomic symptoms may continue for the next few weeks, with some individuals experiencing prolonged alcohol withdrawal symptoms for up to five or six months after they quit drinking. A minority, but significant number of alcohol dependent individuals (10%) can experience complicated alcohol withdrawal episodes, an alcohol withdrawal delirium also referred to as delirium tremens can occur in approximately 5% of the cases, usually between 36 and 72 hours following alcohol cessation. This condition may be characterized by delusions, auditory, visual or tactile hallucinations, psychomotor agitation, fluctuating cloudiness of consciousness and disorientation. Grand mal seizures are also associated with alcohol withdrawal in between 3% and 5% of the cases, usually within the first 48 hours following the reduction or cessation of alcohol consumption. In both instances of complicated alcohol withdrawal, either the lack or delay of instituting treatment is associated with increased mortality rate. Prior history of delirium tremens and/or alcohol withdrawal seizures, older age, poor nutritional status, comorbid medical conditions and a history of high tolerance to alcohol are predictors of increased severity of alcohol withdrawal.

The following criteria define alcohol withdrawal: