Management of Moderate and Severe Alcohol Withdrawal Syndrome

Management of Moderate and Severe Alcohol Withdrawal Syndrome

Addiction to alcohol affects a significant part of global human population and a section of them get hooked to the habit badly over time. When someone becomes alcoholic and later tries to get rid of the addiction, some problems can crop up. Similar to other addictions that impact human nervous system, withdrawal syndromes may affect an alcoholic when he or she tries to kick the habit. Broadly speaking, Alcohol withdrawal syndrome denotes a range of symptoms that take place when a person who drinks alcohol heavily, tries to stop all of a sudden.

Why Alcohol Withdrawal Syndrome Happens?

Prolonged and heavy consumption of alcohol paves way for physical dependence and tolerance. The withdrawal syndrome can be explained as an elevated response of the CNS to lack of liquor. Research has shown Alcohol enhances the impact of Gamma-aminobutyric acid. This is basically a neurotransmitter that generates a sense of calm and relaxation. There is another neurotransmitter named Glutamate which generates feeling of excitability. Chronic alcohol usage suppresses both these neurotransmitters.

When heavy drinkers cut down alcohol consumption, these neurotransmitters that were suppressed by alcohol do not remain suppressed any more. They rebound and cause brain hyperexcitability. Hence, alcohol withdrawal symptoms include seizures and anxiety.

Severity Of The Alcohol Withdrawal Syndrome

Alcohol withdrawal syndromes can affect different individuals differently as it is. The symptoms can kick in some time after the last drink and persist for days. Since these withdrawal symptoms can worsen rapidly, medical attention may be required. People with health conditions like infections and lung ailment facing these symptoms should seek medical help fast. Severe alcohol withdrawal symptoms can lead to seizures, hallucinations, and more complications.

 Signs and Symptoms of Alcohol Withdrawal Syndrome

As it is, alcohol withdrawal syndrome affects the central nervous system. The main symptoms are

  • Anxiety
  • Sweating
  • Insomnia
  • Mood Swings
  • Transient hallucinations
  • Nausea or vomiting
  • Increased hand tremor
  • Lack of sleep
  • Autonomic instability

Delirium tremens or DT is thought to be the highest form of withdrawal.


Nowadays, a majority of healthcare setups resort to Clinical Institute Withdrawal Assessment for Alcohol to assess the level or severity of the syndrome. The doctors may analyse the victim’s medical history and ask him and her specific questions related to alcohol consumption. A physical test may be conducted to check medical conditions like nervous system impairment, liver disease, gastrointestinal bleeding, irregular heartbeats, etc. These tests help doctors understand the severity and select a suitable method of treatment

Treatment for Alcohol Withdrawal Syndrome

People with mild withdrawal symptoms can be treated at hospital’s outpatient section. This is feasible when you have a supportive set of friends and family members. Outpatient detoxification tends to be safer than inpatient detoxification.

People with DTs, withdrawal seizures, previous detoxifications or psychiatric illnesses will require inpatient treatment.

The treatment has three fold goals:

  • Reduction of immediate withdrawal symptoms
  • Prevention of health complications
  • Induction of long term therapy for alcohol abstinence

The prescription drugs used to treat victims of severe alcohol withdrawal syndrome are benzodiazepines like chlordiazepoxide and diazepam. People with moderate symptoms are given carbamazepine, an anticonvulsant drug. To relieve hallucinations and agitation, antipsychotic drugs can also be given.

To ensure Wernicke syndrome does not trigger in victims during alcohol withdrawal treatment, they are given folic acid and thiamine supplements. Doctors may also recommend people with alcohol dependence more intensive therapy. They are also encouraged to join groups like Alcoholics Anonymous.


Ignoring alcohol withdrawal syndrome or failure to treat it properly can have serious consequences including permanent brain damage as well as death. NMDA antagonists and glucocorticoid antagonists can be used to thwart brain damage caused by this syndrome.

Reviewed By:

Dr. Kaushal M. Bhavsar (MBBS, MD)

Assistant Professor in Pulmonary Medicine, GMERS Medical College, Ahmedabad