Withdrawal Symptoms

Alcohol withdrawal differs significantly from most other drugs because it can be directly fatal. Drugs which have a similar mechanism of action to alcohol also have a similar risk of causing death during withdrawal, including barbiturate and benzodiazepine withdrawal. For example it is extremely rare for heroin or cocaine withdrawal to be fatal. When people die from heroin or cocaine withdrawal they typically have serious underlying health problems which are made worse by the strain of acute withdrawal. An alcoholic however, who has no serious health issues has a significant risk of dying from the direct effects of withdrawal if it is not properly managed.

Alcohol’s primary effect is the increase in stimulation of the GABAA receptor, promoting central nervous system depression. With repeated heavy consumption of alcohol, these receptors are desensitized and reduced in number, resulting in tolerance and physical dependence. Thus when alcohol is stopped, especially abruptly, the person’s nervous system suffers from uncontrolled synapse firing. This can result in symptoms that include:

• anxiety
• life threatening seizures
• delirium tremens
• hallucinations, shakes and possible heart failure.

Acute withdrawal symptoms tend to subside after 1 - 3 weeks. Less severe symptoms (e.g. insomnia and anxiety) may continue as part of a post withdrawal syndrome gradually improving with abstinence for a year or more. Withdrawal symptoms begin to subside as the body and central nervous system makes adaptions to reverse tolerance and restore GABA function towards normal. Other neurotransmitter systems are involved, especially glutamate and NMDA.