Withdrawing from alcohol, whether from a night of binge drinking or a longtime addiction, often results in the human body rebelling in a variety of ways. Excessive alcohol intake and long-term alcohol use affect nearly every system in the body. The effects, both psychological and physiological, can range from short-term to long-term and also mild to severe.
Many people have experienced the stereotypical hangover. After a night of excessive drinking, the body makes its displeasure known. These symptoms often appear the next morning but can start the same night as the alcohol intake. A hangover can be felt throughout the whole body with a general sense of fatigue, aches and pains, headache, dizziness, light and sound sensitivity, and a myriad of gastrointestinal problems. More than anything the body needs time to rid itself of the alcohol and to re-hydrate. In cases of extremely excessive alcohol consumption, medical attention and intervention may be required.
For an individual who has been drinking more regularly over an extended period of time, the body’s response to the abrupt elimination of alcohol will be more pronounced and will often require medical attention. This more pronounced reaction is due to the body’s dependence on alcohol’s interference within the body and its systems. Continued alcohol intake results in the body adapting to its presence, developing tolerance, and eventually dependence.
Under these circumstances, the body responds with a collection of symptoms commonly referred to as Alcohol Withdrawal Syndrome (AWS). AWS has symptoms that are a mixture of physical and emotional effects. The severity of the symptoms is tied to the length of time the person has been drinking alcohol regularly, the amount of alcohol usually consumed, the general health of the individual, and any other substances that were taken with the alcohol. Combined alcohol and drug use will typically result in more severe symptoms. Symptoms will typically appear within 4-6 hours of the last alcoholic drink and often peak at 24-48 hours since that drink. These symptoms may include tremors, anxiety, hallucinations, nausea, and seizures.
Physician offices and hospitals use the Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) to assess the severity of withdrawal symptoms so that treatment can be prescribed accordingly. A copy of this form is available online and may help in evaluating symptoms when deciding whether to be seen by a doctor. The CIWA-Ar requires the doctor or clinician completing the assessment to rate the patient’s symptoms in the following areas:
Yes. Alcohol withdrawal does cause nausea. Nausea and vomiting are not limited to severe cases of AWS. Both mild and severe cases of AWS display nausea as a symptom. The mildest cases may not exhibit any nausea, but the most severe cases will often exhibit constant dry heaving. When evaluating AWS using the CIWA-Ar, the doctor or nurse must rate the symptom on a scale from 0, which represents “no nausea and no vomiting”, to 7, which represents “constant nausea, frequent dry heaves, and vomiting”.
Mild nausea can often be treated at home in the same way that nausea from any cause would be treated. Over-the-counter medications such as bismuth subsalicylate (Pepto-Bismol or Kaopectate) or antihistamines containing dimenhydrinate (Dramamine) or meclizine hydrochloride (Dramamine Less Drowsy). Hydration is a key component of treating nausea but drinking water may not be enough. Vomiting and/or diarrhea can lead to an imbalance in electrolytes such as potassium and this can lead to bigger problems. Drinking items such as Pedialyte, Gatorade, Powerade, or Coconut Water will all contribute to re-hydration while also replenishing electrolytes. A bland diet can also help; it’s time to think BRAT (banana, rice, applesauce, and toast) until the nausea has passed. Finally, there is some evidence that acupuncture can reduce nausea and a quick online search will bring up a quick demonstration.
It is important to treat the nausea associated with alcohol withdrawal as left untreated, vomiting can result in more serious complications. If vomiting lasts more than one day, the individual develops a fever of greater than 102 degrees Fahrenheit, or there are other signs of dehydration, at-home treatment might not be working. Signs of dehydration include rapid breathing, increased heart rate or palpitations, lethargy, confusion, severe abdominal pain, or a severe headache. Any blood in the vomit, which may appear as if there are coffee grounds in the vomit requires more immediate medical attention.
If at-home treatment fails or symptoms worsen more quickly, medical intervention, either through a physician’s office, urgent care, or the emergency room may be required. A physician will be able to prescribe medication such as benzodiazepines (Valium, Ativan), anticonvulsants (Tegretol), and more in order to better manage the withdrawal process and reduce the risk for further complications.
Whether the management of the withdrawal happens at home or in a hospital will likely be related to both the severity of the symptoms, the individual’s overall health and the presence of a support system for the individual. Because the symptoms can progress, it is important that the individual has a support system to help both with the management of the symptoms and the continued abstinence from alcohol. Often those experiencing AWS are not in optimum health. Regular alcohol consumption can lead to nutritional deficiencies and chronic medical conditions. The health status of the individual will impact the ability of the individual to manage the symptoms at home.
Treatment for AWS is focused on managing the symptoms to prevent further health complications including seizures, delirium tremens (DTs), and death. These more severe withdrawal complications are not as common as some of the less severe symptoms. However, failure to successfully manage AWS or repeated cases of AWS in the same individual greatly increases the risk. Additionally, successful management of the symptoms associated with AWS enable the individual to focus on creating and maintaining an alcohol-free lifestyle. This change will require additional treatment that is more focused on the psychological and emotional aspects of remaining alcohol-free on a long-term basis.
If you or someone you know are currently experiencing withdrawal symptoms and need help with detoxing from alcohol, please get in touch with one of our intake professionals. If symptoms are life-threatening, please dial 911 immediately.