Withdrawal symptoms from alcohol

Chronic alcohol and marijuana use can lead to dependence on these substances. The withdrawal symptoms from alcohol can be dangerous and should be monitored in detoxification faciflties. The withdrawal from marijuana is milder and... 

Withdrawal from long-term high-dose use of alcohol or sedative-hypnotic drugs can be life threatening if physical dependence is present. Benzodiazepines, such as chlordiazepoxide Librium) and diazepam Valium), are sometimes used to lessen the intensity of the withdrawal symptoms when alcohol or sedative-hypnotic drug use is discontinued. Benzodiazepines are also employed to help relieve the anxiety and other behavioral symptoms that may occur during rehabilitation. 

Chronic administration of opiates and alcohol leads to physical dependence a phenomenon, which is only weakly expressed following chronic administration of psychostimulants or other drugs of abuse. Physical dependence results from neuroadaptive intracellular changes to an altered pharmacological state. Abstinence from chronic opiate or alcohol use leads to a variety of physiological and psychological withdrawal symptoms based on these adaptations of the neuronal system. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

The treatment of alcohol withdrawal incorporates general supportive measures, as well as management of specific symptoms. Supportive measures include abstinence from alcohol, ample rest, adequate general nutrition, and reality orientation. It is important to treat the syndrome vigorously and, when appropriate, to prevent it by using sufficient doses of medication. 

Ethanol. As with morphine addiction, tolerance to alcohol is developed, and a lack of ethanol produces withdrawal symptoms. Tire principal route of metabolism of ethanol (both ingested and the small amount of endogenous alcohol) is believed to be oxidation in the liver to the chemically reactive acetaldehyde (p. 774),874/875 which is further oxidized to acetate. Some theories of alcoholism assume that addiction, and possibly also the euphoric feeling experienced by some drinkers, results from a metabolite of ethanol in the brain. For example, acetaldehyde could form alkaloids (Eq. 30-5).876... 

Detoxification refers to the clearing of alcohol from the body and the readjustment of all systems to functioning in the absence of alcohol. The alcohol withdrawal syndrome at the mild end may include only headache and irritability, but about 5% of alcoholic patients have severe withdrawal symptoms manifested by tremulousness, tachycardia, perspiration, and even seizures (rum fits). The presence of malnutrition, electrolyte imbalance, or infection increases the possibility of cardiovascular collapse. 

Significant progress has been made in establishing safe and effective medications for alcohol withdrawal. Pharmacotherapy with a benzodiazepine is the treatment of choice for the prevention and treatment of the signs and symptoms of alcohol withdrawal. Many patients detoxify from alcohol without specific treatment or medications. However, it is difficult to determine accurately which patients require medication for alcohol withdrawal. Patients in good physical condition with uncomplicated, mild to moderate alcohol withdrawal symptoms usually can be treated as outpatients. 

Benzodiazepines can be used during detoxification from alcohol and other substances, as well as in surgery, dentistry, diagnostic studies (computed tomography, MRI, and endoscopy), cardioversion, and chemotherapy. They help reduce fear and anxiety, and in cases of detoxification, can actually lessen the symptoms of alcohol withdrawal. 

Vandrey, R. G., Budney, A. J., Hughes, J. R., and Liguori, A. (2008). A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances. Drug Alcohol Depend. 92, 48-54. 

A reaction to a chemical irritant can feel much like the hangover from excessive consumption of alcohol. It s even possible for somebody to first experience a pleasant up from certain substances, followed by a down (hangover). The withdrawal symptoms, which have been described by Dr. Rea, can be quite intense and often indicate poisoning and detoxification. After the liver has processed the substances, these symptoms tend to disappear. 

Tolerance may occur to the point that patients can appear to be alert and talking coherently with blood alcohol levels in excess of 400 mg/dl, but these individuals are still at risk of respiratory arrest and death at that level of intoxication. Later, they will not remember what occurred during this time (they are in a blackout), and they may experience alcohol withdrawal symptoms when their BAL drops from 400 to 200, a level that is still indicative of intoxication for most people. 

TABLE 7.2. Signs and Symptoms of Physical Withdrawal from Alcohol... 

---