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Condition and Changes

Alcohol withdrawal

Alcohol withdrawal occurs when an individual suddenly stops drinking after heavy and/or prolonged alcohol use.1-3

As alcohol alters the balance of inhibitory and excitatory neurotransmitters, when alcohol is abruptly halted, this can cause excessive neuronal activity and cause alcohol withdrawal symptoms to develop.4,5

Dual addiction

As many patients with alcohol withdrawal have multiple management issues and addiction, they may require a coordinated, multidisciplinary approach to their treatment.

There is an increased risk of physical ill health, development of cancers and chronic conditions, accidents and criminal behaviour. Patients with multiple addictions often disenfranchise from their family and can suffer greater direct and indirect effects.

Side effects of alcohol withdrawal

Alcohol withdrawal symptoms can vary from minor symptoms such as insomnia and tremulousness to more severe complications such as withdrawal seizures, delirium tremens and death.4,6

If alcohol intake has stopped suddenly, then two or more of the below (within several hours to a few days) can be a sign of alcohol withdrawal:4

  • Autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 beats per minute)
  • Increased hand tremor
  • Insomnia
  • Nausea or vomiting
  • Transient visual, tactile, or auditory hallucinations or illusions
  • Psychomotor agitation
  • Anxiety
  • Grand mal seizures

Thiamine deficiency

Chronic alcohol exposure can result in damage to myelin, a fatty, insulating structure responsible for action potential increase. Thiamine is crucial to the protection of myelin, however, a poor diet and the consequential reduction in the absorption of thiamine may occur with alcohol abuse. When this damage occurs, the axon of the neuron is left exposed and action potentials reduced, leading to electrical signals not being transmitted effectively, causing alcohol related brain damage.7

Alcohol-related thiamine deficiency can be difficult to spot. The signs are:8

  • Early signs
    • Loss of appetite
    • Nausea/vomiting
    • Fatigue, weakness, apathy
    • Giddiness, diplopia
    • Insomnia, anxiety, difficulty in concentration
    • Memory loss
  • Late signs
    • One or more of the classic triad of signs (ataxia, eye signs, mental signs)
    • Quiet global confusion with disorientation in time/place
    • Confabulation/hallucinations
    • Onset of coma

Wernicke’s encephalopathy

Wernicke’s encephalopathy (WE) is an acute neurological disorder caused by thiamine deficiency.9

Symptoms can include:

Using Caine’s criteria, a patient is diagnosed with WE when they demonstrate two of the four signs above.10 Of those people who misuse alcohol, post mortem studies have shown that Wernicke’s encephalopathy may occur in as many as 12.5%.11

Korsakoff’s Psychosis

Wernicke’s encephalopathy (WE) is an acute neurological disorder caused by thiamine deficiency.12 Korsakoff’s psychosis (KP) can occur following inadequately treated WE.12 It is chiefly a memory disorder, in particular loss of episodic memory.12,13

Working (recent) memory is generally impaired and people with KP are typically unable to remember incidents or episodes from their past, they may also have difficulty in learning new facts, concepts and language. Confabulation may also occur in KP.12 This may be the unprovoked outpouring of erroneous memories, i.e. events that have not happened, or memory distortions.

Without adequate treatment, up to 84% of patients with WE are found to develop Korsakoff’s psychosis when followed up long-term.14

Alcohol Related Liver Disease

Alcohol Related Liver Disease (ARLD) is when hepatic lesions develop due to prolonged and heavy alcohol consumption.15,16

Cirrhosis is the late stage of hepatic scarring and is generally not reversible. The World Health Organization’s Global Status Report on Alcohol and Health estimated that 50% of all deaths caused by cirrhosis were due to alcohol.17

Contents

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  • References

    1. Alcohol Withdrawal, Alcohol rehab guide. Available from: https://www.alcoholrehabguide.org/alcohol/withdrawal/ Last accessed June 2023.

    2. What is alcohol withdrawal? WebMD. Available from: https://www.webmd.com/mental-health/addiction/alcohol-withdrawal-symptoms-treatments#1 Last accessed June 2023.

    3. Mayo-Smith M.F, et al. Arch Intern Med. 2004;164(13):1405-1412.

    4. Bayard, M, et al. Am Fam Physician. 2004; 15;69(6):1443-1450.

    5. Saitz, R. Alcohol Health Res World. 1998; 22(1): 5-12.

    6. Alcohol dependence, British National Formulary. Available from: https://bnf.nice.org.uk/treatment-summaries/alcohol-dependence.html Last accessed June 2023.

    7. ARBD Wales, 2021. Available from: www.arbdwales.co.uk/about-arbd/what-is-arbd. Last accessed May 2023.

    8. Thompson AD.et al. Pract Gastroenterol. 2009; 33 (6): 21-30.

    9. Thomson AD, Marshall EJ. The natural history and pathophysiology of Wernicke’s Encephalopathy and Korsakoff’s Psychosis. Alcohol Alcohol 2006; 41: 151–158.

    10. Caine D, Halliday G, Kril J, Harper C. J Neurol Neurosurg Psychiatry 1997; 62 (1): 51–60.

    11. National Institute for Health and Care Excellence. June 2010. (updated April 2017). Alcohol use disorders and clinical management of alcohol-related physical complications [Clinical Guidance 100].

    12. Kopelman MD, Thompson AD, Guerrini I, et al Alcohol Alcohol 2009; 44:148–154.

    13. Smith I, Hillman A. Management of alcohol Korsakoff syndrome. Adv Psychiatr Treat 1999; 5: 271–278.

    14. Thomson AD, Cook CCH, Touquet R, Henry JA. Alcohol Alcohol 2002; 37: 513-521.

    15. Alcohol-related liver disease, Drinkaware. Available from: https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/alcohol-related-diseases/alcohol-related-liver-disease Last accessed May 2023.

    16. Osna, NA, et al. Alcohol Res. 2017; 38(2): 147–161.

    17. Alcohol-related liver disease, NHS Inform. Available from: https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/alcohol-related-liver-disease Last accessed June 2023.

    KKI/GB/PAB/0277 November 2023