DEAR DOCTOR K: My husband has a problem with alcohol. He has finally decided to quit and has set a date for his final drink. How will his body react once he stops? Is there anything we can do to help ease his withdrawal symptoms?
DEAR READER: Alcohol withdrawal refers to the changes the body goes through when a person who has been drinking heavily for a long time suddenly stops.
Alcohol has a slowing effect on the brain. In a heavy, long-term drinker, the brain is almost continually exposed to this depressant effect of alcohol. In response, the brain adjusts its own chemistry to compensate. It does so by producing larger-than-normal amounts of stimulating chemicals.
If a person suddenly stops drinking alcohol, the brain is still bathed in the stimulating chemicals – but no longer has the alcohol to slow it down. It’s like a car with the gas pedal floored that has lost its brakes. Not surprisingly, most withdrawal symptoms occur when the brain is overstimulated.
The symptoms of alcohol withdrawal occur in a predictable pattern after the final drink. Not all people experience all symptoms:
— TREMORS (shakes). These usually begin within five to 10 hours after the last drink and typically peak at 24 to 48 hours. Along with trembling, they include a rapid pulse, an increase in blood pressure, rapid breathing, sweating, nausea and vomiting, anxiety or a hyper-alert state, irritability, nightmares or vivid dreams and insomnia.
— ALCOHOL HALLUCINOSIS. This symptom usually begins within 12 to 24 hours after the last drink, and may last as long as two days once it begins. If this happens, a person sees, hears or feels things that are not real.
— ALCOHOL WITHDRAWAL SEIZURES. Seizures may occur six to 48 hours after the last drink. It is common for several seizures to occur over several hours. The risk peaks at 24 hours.
— DELIRIUM TREMENS. This is the most dangerous form of alcohol withdrawal. This condition occurs in about one out of every 20 people who have withdrawal symptoms. Its peak intensity is usually four to five days after the last drink.
People suffering from delirium tremens are very agitated and have hallucinations. In my experience, they often see animals that aren’t there – domesticated and wild. They have very rapid pulse, rapid breathing, high blood pressure, very high fevers and profuse sweating. They may get severely dehydrated, and their body minerals can get dangerously out of balance. If untreated, delirium tremens can be fatal.
It sounds as though your husband is planning to quit at home. Before he does, he should consult with his doctor. The doctor may think it is safer if he is in a medical setting. If not, the doctor can give him advice and prescribe medicines to make withdrawal symptoms more tolerable. If your husband experiences severe vomiting, seizures or delirium tremens during withdrawal, let his doctor know – but also get him to a hospital. He will need to be under medical care ASAP.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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