3 Things That Make Alcohol Withdrawal Dangerous. What Is Happening?

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Acute alcohol withdrawal is pretty unpleasant, both physically and mentally. Below is from personal experience, then it gets more specific. So if you are only interested in facts, scroll down to Acute Alcohol Withdrawal Symptoms.

My AWS experience.

Physically your body always tries to maintain an equilibrium. So when you slow it down with alcohol (a depressant) and the alcohol wears off, the body speeds up to bring itself to its natural operating rhythms as soon as possible.

It speeds everything up. When you have a hangover, maybe your hands shake a little. When you are in withdrawal they will shake a lot, in fact much of your body can tremble and shake. With a hangover you might sweat more on a Monday morning, in withdrawal you might sweat for the next couple of days.

Sleep is usually the best way to deal with a hangover, in withdrawal, with the nervous system in overdrive, sleep can be impossible. Leaving the detoxing person to lay there in their own sweat, twithching and shaking, and unable to do the one thing that will offer them some small relief, sleep. This is what it is like for an alcoholic in the middle to early late stages of alcoholism.

If you are fully late stage, things get worse. You will have all the above and more. You can have heart palpitations, your blood pressure can spike making it hard to walk. Occasionally I would have to hold onto walls so I could walk because I thought I might be going to collapse. Once I had to actually crawl to get to the bathroom because I could not stand up.

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Your dehydrated. You will need water. If you drink that water it will help but you may not be able to drink normally. If your hands are shaking too much your will have a hard time drinking by raising a glass to your lips. For some reason, your mouth doesn’t want to drink if it sees that the glass coming at it is going to rattle your teeth. I used to keep straws around the house for when this would happen. Otherwise I could not drink at all.

After a 12 – 24 hours you may feel some hunger. You will know that this is a bad idea but your brain will start to tell you to eat because it might help get your strength back. So for the first few instances of withdrawal you might try to eat. This is a bad idea. It will result and immediate and probably violent diarrhea. After a few time going through withdrawal you will know better and hold off, there will likely still be diarrhea even after waiting for several hours, but it won’t be so bad.

Another thing your brain will tell you after about 24 hours is that it is a good idea is to take a shower (if you know you can stand up). Remember, you will be in bed, twitching and shaking, sick, unable to sleep, and covered in sweat. You will think if you are less gross, maybe you will be more comfortable and can sleep. Sleep is good, it will help you, so you will be willing to go to a shower. Except the shower will feel weird, your skin is all clammy. You will be climbing back into your sweaty bed and you will begin to sweat again. The shower won’t help. You will have just spent all that energy taking a shower and it will have accomplished nothing.

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Mentally withdrawal is brutal too. You are going to be ashamed. You will hate yourself. You are going to know that you should be at work or doing something else that normal people do, but you are too much of a mess to do anything.

You will know you are destroying your life. You are going to want to quit drinking. You may even try to quit but it won’t work unless you know how to quit so you will know that this is going to happen again. You will hate yourself for being weak to give it up too.

If you still have people who love you, they are going to be upset too. You will be ashamed of disappointing them too

If you are rich, you will be OK financially. I was not rich. Obviously, I lost my job, then I found a job that would allow me to make money whenever I was able to work. I was a cab driver. There you just show up in the morning, if a cab is available you rent it, and you go out and make money. Your life will begin to revolve around your drunkenness and your withdrawal.

The early stages of alcohol are the glory days, the late and end stages are misery. Lets get a little more technical for those of you trying to figure out how to deal with the next round of withdrawal. Because if you are in withdrawal now it is highly unlikely you have the energy to be on the internet, so I assume you know another bout is coming soon or that you love someone who is suffering with it now or will be soon and you want to know what is happening. (at the very bottom there are some OTC remedies but they will have very small impact on the problem, nevertheless, they will help a little)

Alcohol Withdrawal Symptoms

anti alcohol campaignAcute alcohol withdrawal symptoms can occur in any habitual drinker. Of all the mood altering substances people can detoxify from, alcohol is the most life-threatening. In rare cases (like during Delirium Tremens) the symptoms can lead to death. Acute alcohol withdrawal is made more troubling due to the fact that estimates show that barely 10-20 % of sufferers experiencing acute alcohol withdrawal are treated in a medical facility, therefore it’s possible that as many as 2 million Americans may undergo symptoms of acute alcohol withdrawal at home every year. This means that alcohol is not merely the most typically abused chemical; it’s also the drug that most Americans detoxify from at home. Unfortunately, countless people that try this outside of a clinic/hospital will probably be so overwhelmed by the discomforts of Acute Withdrawal Syndrome (AWS) that they will go back to consuming alcohol in order to relieve the pain and discomfort caused by the detox symptoms. Anytime someone detoxes from alcohol without medical supervision they expose themselves to significant risk.
Indicators of Acute Alcohol Withdrawal Syndrome will appear roughly 8 to 12 hours after the final drink and might continue for as long as 2 weeks. During this time, symptoms can include nausea or vomiting, diarrhea, insomnia, tremors, hallucinations, grand mal seizures, delirium tremens, and precariously high blood pressure levels. We will be exploring the main categories of symptoms below.

Hyperarousal

Alcohol withdrawal hyperarousal is the earliest showing and most common withdrawal symptom. It includes irritability, anxiety, insomnia, inability to eat or loss of appetite, increased heart rate, and the shakes. Alcoholics attempt to avoid this condition usually consist of a morning drink or two.
Probably anyone who has been really drunk has experienced the mild form of some of these symptoms. The most common way for regular people to experience really mild forms of hyperarousal is by “sweating out” the toxins of the weekend on Monday. Or they may have hands with the “alcohol shakes” the next day. But these are very mild symptoms compared to what the alcoholic experiences.
Alcohol withdrawal hyperarousal will get worse as abstinence continues. The alcoholic will startle easily, shake more violently, sleep very lightly if they can sleep at all, and generally be “amped” up in a very unpleasant way. This alcohol withdrawal duration can be 2 to 3 days and then should be almost gone.
Acute alcohol withdrawal hyperarousal doesn’t start until all the alcohol has left the body. They may wake up after a long bender and be semi functional but, that is because all the alcohol isn’t out of their system yet. It can be 12 hours after they wake up before things get really nasty. That is probably when all the alcohol has been processed out of their bodies.
Remember, alcoholics have a high tolerance to alcohol which allows them to consume much more than a normal person would or could. Their liver, however, will only process alcohol out at the same rate as everyone else’s, if their liver isn’t damaged. If it is damaged then it will be slower. So when a normal person wakes up the alcohol is probably gone or almost gone. The drunk may still have quite a bit to process out.
I have experienced alcohol withdrawal hyperarousal. Think of anxiety about two notches down from a panic attack that goes on and on for hours and hours. You can stay pretty “amped” up for 2 or so days, it is impossible to sleep, you are covered in sweat, it can be hard to walk because you feel unsteady, and once you have the energy to take a shower the water will feel weird touching your clammy skin . My alcohol withdrawal hyperarousal usually lasted for three days. With the symptoms of withdrawal diminishing each day, so the first day was the worse and each day after being a little better.

Hallucinations

Hallucinations
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Alcohol withdrawal hallucinations occur in about 25% of alcoholics. They are usually auditory and visual but, can be tactile. So the person suffering from this may see or hear things. They may also feel like bugs are crawling all over them. Additionally, they may misinterpret or misperceive their environment. For them, these things are real and they will react accordingly.
These hallucinations are almost always negative. They are threatening or demeaning. They generally create a lot of guilt in the person. These aren’t the pleasant trips of the 1960’s flower children. People having these hallucinations need to be watched to insure they don’t hurt themselves or anyone else.
People in this condition will likely experience very vivid dreams. Again, they will most likely be negative. Most people report having terrible nightmares. The increased dreaming is due to the fact that alcohol suppresses REM sleep (that’s of the sleep stage we can remember our dreams from), when it is removed we swing the other way and have more dreams. It’s the body’s way of regaining equilibrium. (how withdrawal symptoms effect REM sleep are now being reconsidered)
All of these symptoms should decrease after 3 or 4 days but, may take up to a week to completely stop.
I have never experienced alcohol withdrawal hallucinations, only alcohol withdrawal seizures. So I can’t speak from personal experience.

Seizures

Alcohol withdrawal seizures are usually generalized, meaning your whole body will convulse. Your eyes will roll back in your head, your body will begin to shake violently and you will lose consciousness. The attack will usually last a minute or two and may leave you groggy for 6 to 8 hours. They are quite frightening to watch but, aren’t usually dangerous as long as the person can breathe and doesn’t hurt themselves while they are thrashing around on the floor, but seizures can kill you.  However, since most alcoholics detox at home, this can be a serious problem if they live alone.
The convulsions usually occur with 12 to 48 hours after a person has stopped drinking. About 1/3 of the people who exhibit this go on to develop the delirium tremens (DTs).
This is considered rebound activity because alcohol has an anticonvulsant effect which makes the seizure threshold higher. When it is removed the threshold decreases, and seizures become more likely, until the body has regained equilibrium.
I have had alcohol withdrawal seizures. It is quite disconcerting to not be in control of your body. I remembered everything about my seizure and was groggy for at least 6 hours after.  Don’t attempt an alcohol withdrawal seizure at home, it is horrible.

The DTs or Delirium Tremens

Delirium Tremens is alcohol withdrawal syndrome with a few new symptoms. It is rare.
From Patient.co.uk

Delirium tremens (DTs)
is a more severe reaction after stopping alcohol. It occurs in about 1 in 20 people who have alcohol withdrawal symptoms about 2-3 days after their last drink. Symptoms include: marked tremor (the shakes) and delirium (agitation, confusion and seeing and hearing things that are not there). Some people have convulsions. Complications can develop, such as dehydration and other serious physical problems. It is fatal in some cases.

From Medline Plus:

Delirium tremens is a severe form of alcohol withdrawal that involves sudden and severe mental or nervous system changes.
Causes Delirium Tremens
Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food.
Delirium tremens may also be caused by head injury, infection, or illness in people with a history of heavy alcohol use.
It is most common in people who have a history of alcohol withdrawal. It is especially common in those who drink 4 – 5 pints of wine or 7 – 8 pints of beer (or 1 pint of “hard” alcohol) every day for several months. Delirium tremens also commonly affects people who have had an alcohol habit or alcoholism for more than 10 years.
Symptoms Delirium Tremens
Symptoms most often occur within 48-96 hours after the last drink. However, they may occur up to 7 – 10 days after the last drink.
Symptoms may get worse quickly, and can include:
• Body tremors
• Changes in mental function
• Agitation, irritability
• Confusion, disorientation
• Decreased attention span
• Deep sleep that lasts for a day or longer
• Delirium
• Excitement
• Fear
• Hallucinations (seeing or feeling things that are not really there)
• Increased activity
• Quick mood changes
• Restlessness, excitement
• Sensitivity to light, sound, touch
• Stupor, sleepiness, fatigue
Seizures (may occur without other symptoms of DTs)
• Most common in first 12 – 48 hours after last drink
• Most common in people with past complications from alcohol withdrawal
• Usually generalized tonic-clonic seizures

From Medline Plus

Alcohol Withdrawal Timeline

You don’t have to be completely sober for alcohol withdrawal symptoms to set in. When your body is accustomed to acting with a certain amount of alcohol in it and it doesn’t have that amount the person may show symptoms of withdrawal.
With regular use of alcohol the Central Nervous System is constantly depressed. When alcohol is removed, the CNS reacts to the absence of alcohol depression by becoming overactive. This is rebound hyperactivity.
Withdrawal will usually last however long it takes for the CNS to reach an equilibrium. It’s normal operating level. It is during this rebound or equalizing phase that withdrawal symptoms show themselves.
The alcohol withdrawal timeline is just a matter of how long it takes your CNS to reach its normal operating level.
Not everyone experience withdrawal the same. Three things seem to be most important to the duration.
• For how long and how much has the person been drinking.
• What is the person’s physical state. Are they generally healthy or are they in bad shape.
• And, the person’s basic physiological makeup.
So accurately predicting how a person will progress through the withdrawal timeline can only be done in general terms.
Side note: For binge drinkers, folks who drink for several days and then stop, withdrawal will be much easier to predict. They have been through it several times and have a good idea what’s going to happen.

 

Syndrome Clinical manifestation Onset after last drink
Minor withdrawal symptoms:
These usually resolve within 24 to 48 hours
Tremulousness, anxiety, headache, diaphoresis, palpitations, GI symptoms including diarrhea and anorexia 6 to 36 hours
Alcohol related seizures,
Occur in approximately 3 % of chronic alcoholics
Generalized, tonic-clonic, rarely status epilepticus (3% of those with seizures) 6 to 48 hours
Alcoholic hallucinosis
Alcoholic hallucinosis refers to hallucinations that develop within 12 to 24 hours of abstinence and resolve within 24 to 48 hours (which is the earliest point at which delirium tremens typically develops)
Hallucinations are usually visual, although auditory and tactile phenomena may also occur. In contrast to delirium tremens, alcoholic hallucinosis is not associated with global clouding of the sensorium, but with specific hallucinations. 12 to 48 hours
Delirium Tremens (DT), seen in approximately 5% of those in alcohol withdrawal. Has a mortality rate of 5%. Death is usually due to arrhythmias or complicating illnesses such as pneumonia. DTs generally produce hallucinations, disorientation, tachycardia, hypertension, low-grade fever, agitation, and diaphoresis. Withdrawal may also have an important impact on fluid and electrolyte status. Almost all patients in acute withdrawal are dehydrated as a result of diaphoresis, hyperthermia, vomiting, and tachypnea. Hypokalemia is common due to renal and extra-renal losses, alterations in aldosterone levels, and changes in potassium distribution across the cell membrane. Hypomagnesemia occurs frequently with DTs and may predispose to withdrawal seizures. (7) Hypophosphatemia may occur due to malnutrition, may be symptomatic, and if severe, may contribute to cardiac failure and rhabdomyolysis. 48 to 96 hours

Chart taken almost entirely from Signavitae.

OTC (and other relief)

I promised some OTC “bandaids” for the problem. These will mostly help middle stage drunks. End stage alcoholics will receive almost no help from this until about the second day of their withdrawal.

You can take Valerian Root, it is a natural sedative and will help to slow down your racing autonomic nervous system. So will sleeping pills with Diphenhydramine.

Anything that will help you to sleep is good. However, slowing down the nervous system also slows down your body’s attempts to reach equilibrium, so it will prolong your withdrawal. Also, sometimes it will just make you throw up, worsening things.

Vitamins will help too. Alcohol strips your body of vitamins and it needs these to rebuild. It especially needs B vitamins to get your nervous system back into shape.

Ibuprofen and other pain relievers can help with pain, but they won’t help much.

Of course if you have pain relief like Vicodin or even marijuana to help you with pain and to sleep, that would help more than the OTC stuff above. If you have any anti-anxiety pills, now is the time to take them. But if you have access to this stuff you likely already know this.

For more on Detox Symptoms.
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