After a longer time of use, alcohol consumption can be stopped or even greatly reduced without experiencing alcohol withdrawal syndrome (AWS). After the last drink, mild symptoms may appear hours later and, if unchecked, may worsen to the point of becoming life-threatening. Patients may receive treatment in an inpatient or outpatient environment, depending on the severity of their withdrawal symptoms. Although several medicines can be useful in treating this disease, benzodiazepines continue to be the preferred medication.

Pathophysiology

Multiple mechanisms work together to mediate the alcohol withdrawal symptoms. Through inhibitory and excitatory neurotransmitters, the brain maintains a balance of neurochemicals. GABA, which operates via the GABA-alpha (GABA-A) neuroreceptor, is the primary inhibitory neurotransmitter. The N-methyl-D-aspartate (NMDA) neuroreceptor is one of the main targets for the excitatory neurotransmitter glutamate.

Alcohol increases GABA's impact on GABA-A neuroreceptors, lowering total brain excitability. Alcohol tolerance rises as a result of compensatory reductions in GABA-A neuroreceptor responsiveness to GABA caused by prolonged alcohol consumption.

Alcohol dependency is a severe kind of alcohol use disorder that may first show up when someone has withdrawal symptoms after quitting drinking, whether as a result of peer pressure, personal drive, physical illness, or a lack of access to alcohol. Regular drinkers frequently believe that continuing to consume alcohol is better for them than quitting. It's possible that some of this is true for people who have acquired dependence because they could experience withdrawal symptoms such autonomic arousal, hallucinations, seizures, and delirium tremens (DT). Due to the fact that many persons downplay or deny their drinking, they frequently experience withdrawal symptoms when hospitalised for other physical issues other than alcoholism, which makes up a significant portion of consultation-liaison psychiatry.

Alcohol use disorder is one of the top seven causes of death and disability, which is a concern for world health. As a result, the majority of clinicians must deal with its problems in some of their patients. In the United States alone, there are thought to be eight million alcohol-dependent individuals, and every year, 500,000 episodes of withdrawal severe enough to necessitate pharmacologic therapy take place. Or, to put it another way, 2–7% of patients who are admitted for general medical care and who have a history of frequent alcohol use will experience acute alcohol withdrawal.

This article reviews the inpatient care of syndromes linked to mild, moderate, and severe alcohol withdrawal. The treatment of mild alcohol withdrawal in the outpatient setting, the initial identification and management of alcohol dependency, and specific conditions resulting from alcohol-related organ damage (eg, cirrhosis).

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