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Alcohol Withdrawal Management: How Clinical Guidelines Should Be Improved

Alcohol Withdrawal Management: How Clinical Guidelines Should Be Improved

Alcohol withdrawal is a serious condition. Someone who abuses alcohol habitually can experience tremors, insomnia and even seizures when attempting to ween themselves off booze. Unlike other forms of drug withdrawal, it can be potentially deadly if not treated properly. This past summer, the American Society of Addiction Medicine announced that they would be working toward the improvement of alcohol withdrawal management. Many doctors find the common protocols for treating patients to be inadequate. “There is a current lack of guidance,’ says Dr. Kelly Clark, President of the ASAM, “that has led to inadequate clinical practices”. It is vital, therefore, that the current modes of diagnosis and treatment for alcohol withdrawal be looked at and improved upon. A reassessment of the clinical guidelines could help to reduce suffering and increase successful treatment of patients. Hopefully, the work of the ASAM will alter the guidelines that helps to minimize deaths as well as relapses.

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How is Alcohol Withdrawal Diagnosed?

The DSM-IV defines alcohol withdrawal according to a number of symptoms. These symptoms may appear following the prolonged or heavy usage of alcohol. The patient’s condition can only be diagnosed as withdrawal if booze is or has been present in the person’s body. The symptoms are as follows:

Shaking or Tremors

Certain people will find that they can’t stop shaking during withdrawal. These shakes or tremors are one sign that the body is craving booze. Shaking may be accompanied by a severe withdrawal headache.

Nausea or Vomiting

If going through alcohol withdrawals, you may get extremely sick. Vomiting can last up to ten days after your last drink.


The inability to sleep is a common symptom. This may be due, in part, to extreme pain or an overactive nervous system.

Loss of Control Over Bodily Functions

Someone experiencing withdrawals may experience abnormal hyperactivity. They may not be able to focus their eyes or maintain the stillness of their limbs. They might experience palpitations of the heart or stomach.


As with any drug addiction, those who attempt to stop using alcohol are likely to experience severe anxiety. This anxiety will taper off a few weeks after you stop drinking.


Alcohol dependency has a serious effect on the brain. The mind becomes accustomed to operating under the circumstances it creates. When attempting to withdraw, it is possible that the lack of alcohol in the brain makes it difficult to think clearly. This should pass within the first few days.


Some people see and hear things during the withdrawal process. This can also include feeling sensations, such as imaginary bugs crawling on the skin. These hallucinations usually only last for the first 48 hours after the last drink, but are a sign of that more severe symptoms may be present.


Seizures might occur during the first two days of detox. Some users might have clusters of small seizures every few minutes while others may experience prolonged seizures every few hours.×708.jpg

Withdrawal Timeline

There are four stages of alcohol withdrawal recognized by the ASAM. An alcohol abuser will not necessarily experience all of them. Only in some cases do people progress to the worst stages.

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Autonomic Hyperactivity

This is the medical term for the stage in which you shake and feel anxiety. People will experience this stage in varying degrees of intensity. Some folks may simply feel slight tremors while others will vomit and vibrate uncontrollably. This stage usually peaks within two days of the last drink.


Once someone starts to hear or see things, they’ve entered the second stage of alcohol withdrawal. This stage, in their worst form, will last up to one week. One major sign of entering the hallucinatory stage is a slowly loosened grip on reality. This is a clear sign that the person should seek professional help.

Neuronal Excitation

Only around 10% of patients get to this stage. At this point, seizures will start to occur. During these seizures, the person will lose consciousness completely. The duration of these seizures may be around five minutes. The patient will experience extreme vomiting or diarrhea. It is vital that a person in this stage consults a doctor.

Delirium Tremens

The worst cases of alcohol withdrawal will produce delirium tremens, commonly known as the DTs. The symptoms are uncontrollable tremors and confusion to the point of losing reality. While milder cases may have similar symptoms, the DTs produce much more intense versions. The are a sign of extreme danger and should be treated as soon as possible. People who have this will need to be treated by an intensive care doctor. Delirium tremens are a result of the brain being overcome by withdrawal. The neurotransmitters struggle intensely to find signs of alcohol in the body. As the attempt to locate alcohol, they overwork themselves. This produces an emergency state within the brain.

Can You Die from Alcohol Withdrawal?

Improper detox can be deadly. Severe alcoholics can cause extreme damage to their bodies when using the cold-turkey method. People go into shock during alcohol withdrawal due to the fact that their body is dependent on the substance. This means that, without alcohol in their system, their organs don’t know how to function properly. Death can occur during the delirium tremens stage of alcohol withdrawal. A number of factors can be responsible. Seizures, for example, can cause the brain to shut down. Gastric bleeding induced by vomiting can also play a major factor.

Current Protocols for Treatment

The severity of a patient’s symptoms will determine treatment. In certain cases, alcoholics can recover from withdrawal at home. In most instances, however, a doctor will need to treat the patient in the hospital. The current protocol for treatment is called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). Using CIWA, doctors will use a predetermined rubric to decide which type of treatment the patient needs. Medications are prescribed in fixed doses, except during intensive care treatments. Currently, it is common for doctors to prescribe benzodiazepines (benzos) to treat alcohol withdrawal. These medications include highly addictive substances such as:

  • Chlordiazepoxide
  • Diazepam
  • Lorazepam

CIWA Protocol

When using CIWA, doctors are supposed to diagnose alcohol withdrawal under two circumstances. First, the patient must have a history of recent alcohol use. Those who have been sober for years or do not use alcohol can be experiencing symptoms from the substance. Additionally, patients must be able to communicate. If they are unable to speak, sign, or explain their symptoms in anyway, they cannot be diagnosed as withdrawing from alcohol. If they meet both criteria, patients are then judged on their symptoms and treated accordingly.

Recent Studies on the Downside of CIWA

According to recent studies, the CIWA protocol is often misused. The study shows the CIWA rubric to be faulty. This sometimes results in disastrous effects among patients. One study showed that 48% of patients undergoing CIWA didn’t meet both criteria. In fact, 31% met neither criteria. 14% of those diagnosed were drinkers but could not talk. This is part of a larger subsection of people who were tested but did not use alcohol. Even more, 55% were capable of communicating but did not drink. These people, however, were still diagnosed with alcohol withdrawal. This resulted in a large percentage of unnecessary treatment.

What’s Wrong with CIWA?

Ultimately, misdiagnosis is a dangerous thing. Those who receive an improper diagnosis are in danger of receiving the wrong treatment. Particularly when dealing with addicts, after all, it is necessary to avoid medications that may lead to further addiction. CIWA’s tendency to prescribe benzos for alcohol withdrawal is a major flaw in the protocol. Replacement alcohol with other addictive substances can lead to relapses. Those who have a history of addiction should avoid taking benzos and seek other means of treatment if possible.

Dietary Treatment

In order to get (and stay) clean from alcohol after alcohol detox, it is important to make dietary changes. This is one of the aspects of recovery that the ASAM does not emphasize enough. Making changes in diet can help addicts to prepare for withdrawal. Eating a combination of the right foods can ease symptoms and decrease the possibility of relapsing.

Alcohol Detox Diet

Most of us have poor diets in general. Alcoholics, on the other hand, show signs of being more nutritionally deficient than the majority of people. Because alcohol is comprised of empty calories that make us feel full, we often fail to eat the amount of food we need. In turn, an alcoholic’s body lacks the vitamins and minerals necessary for a healthy body. When detoxing from alcohol, it is vital to get the proper dietary intake. Eating the right foods will help you to get the vitamins and minerals you need. These foods include: Fruits and vegetables: Fruits and veggies are high in fiber and low in calories. For this reason, they’re helpful to the digestive system. When withdrawing from booze, you want to start moving toxins out of your body. Maintaining a healthy digestive system will help you to do so. Protein: Although you should avoid fatty foods, you’ll need some protein to keep you strong. Poultry like chicken and turkey is a good source of protein. Beans, peas, nuts and seeds are also great, especially if you don’t eat meat. Stay away from red meats like steak when trying to go through alcohol detox treatment. Plenty of water: Water is the key to flushing toxins out of your system. After years of alcohol abuse, your body is flooded with them. Drinking water is very important, as it will help to cleanse your bloodstream. It will also help you to absorb all of the nutrients in your healthy meals. Avoid Processed Foods Don’t eat processed foods while withdrawing or recovering. Foods with too much unnatural sugar can increase cravings and put strain on the digestive system. If fresh foods are out of your budget, canned fruits and vegetables will work fine. Also, stay away from fats during your recovery period. Toxins are stored in fat cells, so you want to minimize them as much as possible. ” column_min_width=”[object Object]” column_spacing=”[object Object]” rule_style=”[object Object]” rule_size=”[object Object]” rule_color=”[object Object]” hide_on_mobile=”[object Object]” class=”[object Object]” id=”[object Object]”][object Object]

To Better Forms of Alcohol Withdrawal Management

As the ASAM conducts research into alcohol withdrawal, we hope that they work toward a better understanding of the condition. The current modes of treatment save many people each year. However, more comprehensive diagnoses and treatment methods will be good for everybody. Those who struggle with alcohol and drug addiction, in particular, will benefit from an improvement in the ASAM’s clinical guidelines. By working toward alternative treatments that don’t require drug usage, the organization can help to prevent deaths and relapses in the future. By making progress in the ways we manage withdrawal, the ASAM can help addicts, and their families, greatly.