Alcohol Withdrawal Can Kill

Alcohol addiction is a debilitating disease classified by the DSM-IV guidelines. The NIH recently (2001-2002) conducted a study to see how the alcohol dependence and alcohol abuse rates have change in the past decades. They compared the 2001-2002 results to 1991-1992 study they conducted ten years before. In 2001-2002 the disease afflicted 17.6 million adults in the USA. In addition to the increased risk of physical violence and sexual assaults associated with alcohol abuse, it carries significant risk to the person by increasing the risk for many health disorders such pancreatitis, mental disorders, cardiovascular disease, end-stage liver dysfunction, and increased risk for certain types of cancers. In the United States the American Academy of Family Physicians has stated that the "one year prevalence in adults is 7.4 percent". Overall, the alcohol abuse and dependence still remains a main issue in the United States.

Dependence is classified as the appearance of withdrawal symptoms once a substance has been discontinued for some time. In alcohol sense, withdrawal symptoms can present within a few hours after the last drink, depending on the dependence of the person. The DSM-IV diagnoses alcohol withdrawal under the following guidelines: (The CIWA scale - Clinical Institute Withdrawal Assessment Scale classifies the severity of alcohol withdrawal)

1.) Cessation or reduction in heavy and prolonged ethanol use

2.) Presence of 2 or more of the following withdrawal symptoms:

a. Nausea/Vomiting

b. Hand tremor

c. Anxiety

d. Psychomotor agitation

e. Visual, tactile, auditory hallucinations

f. seizures

3.) Must cause significant distress to the person

The most important thing to remember about alcohol withdrawal as compared to other forms of withdrawal (such as heroin and valium) is that alcohol withdrawal can lead to death! Alcohol withdrawal is divided into four different stages of withdrawal. Stages one and two are typically not associated with mortality and usually present with moderate autonomic activity, nausea and vomiting, and possible hallucinations. On the other hand Stage 3 can result in mortality. Commonly known as the "Rum Fits", the patient presents with generalized tonic/clonic seizures which can progress to status epileptics - a life threatening seizure lasting > 30 minutes. The good thing about this stage of alcohol withdrawal is that it is treatable, and the current gold standards of treatment are benzodiazepines such as valium (diazepam) and Xanax (alprazolam).

On the contrary, stage 4 of alcohol withdrawal commonly known as "Delirium Tremens" carries a great risk of mortality. Although only 3-5% of patients progress to stage 4, its mortality rates range from 1-5%, and are further increased with patients who have a history of mental illness, older age, or abnormal liver function tests. Alcohol associated delirium commonly presents with severe autonomic agitation and a very high fever. Currently, there is no treatment for delirium tremens and the key to decreasing mortality is prevention (benzodiazepines will treat the seizures in stage 3 but are worthless for stage 4).

Overall, alcoholism is classified as a disease which has deleterious effects on the people and families. It can lead to FAS, decreased obligations to families and work, increased arguments among loved ones, and can even be a cause of death through increased hazardous activities such as drunk driving or life threatening withdrawal symptoms.