Withdrawal: When Stopping Alcohol Can Be Dangerous | Alcohol
Alcohol affects the brain, body and mental health, with repeated use changing reward, stress and inhibitory systems.
Stopping alcohol is often treated socially as a matter of determination.
For someone who has become physically dependent, it can also be a medical event.
Alcohol repeatedly suppresses parts of the nervous system. With substantial ongoing exposure, the brain compensates by adjusting excitatory and inhibitory signalling. If alcohol is suddenly removed, those compensations do not immediately disappear.
The result can be an overactive nervous system.
Early withdrawal symptoms
Symptoms can include:
anxiety or agitation
tremor
sweating
nausea or vomiting
headache
insomnia
sensitivity to sound or light
racing heart or raised blood pressure
feeling generally unwell
Severity varies widely.
Some people experience relatively mild symptoms. Others progress to dangerous complications.
Withdrawal seizures
Generalised seizures can occur during alcohol withdrawal and require urgent medical assessment.
A previous withdrawal seizure is an important warning sign when planning future attempts to stop drinking.
Alcohol withdrawal delirium
Severe withdrawal can progress to alcohol withdrawal delirium.
The person may become profoundly confused, agitated and unable to maintain normal attention or awareness. Hallucinations and marked autonomic activation can occur.
This condition can be life-threatening and requires medical care.
Who may be at greater risk?
Risk assessment is individual, but concern is greater when there has been prolonged heavy alcohol use, previous severe withdrawal, previous withdrawal seizures or delirium, significant medical illness, use of other sedative drugs, or other complicating conditions.
A person's drinking history alone may not reveal the full risk.
Do not assume sudden stopping is always safe
Someone drinking heavily or regularly who may be physically dependent should seek medical advice about stopping rather than relying on general advice from friends, family or the internet.
This is particularly important if they have previously experienced withdrawal symptoms.
Withdrawal treatment may include monitoring, medication, fluids, nutritional support and thiamine where clinically appropriate. The setting can range from supervised community withdrawal for appropriately assessed lower-risk cases to hospital care for people at greater risk.
Managing withdrawal safely is important, but withdrawal management is not the same thing as treating alcohol use disorder.
Once the immediate withdrawal period is over, the reasons alcohol became important, and the biological, psychological and social processes maintaining its use, still need attention.