It is exceedingly rare that someone in Western society will have gone through their life without this being presented as a question. In fact, it is one of the more often debated subjects in addiction. It is clear that as a country we the United States have not given the mental health field the dedicated studying it deserves, and our rate of mental health issues and addiction correspond to this fact.
The question is: How does the fall into addiction happen to some and not to others?
Predisposition to alcoholism has been a much researched topic in both psychological and medical fields, and seems to be correlated somewhat to how much stress someone experiences as baseline. Most of this research that involves intervention has been performed on non-human models. A study performed in 1990 using rhesus monkeys showed that more anxious monkeys were predisposed to increased alcohol consumption. However, when stress was induced in the monkeys by separation, they would increase their intake to the same levels as the naturally anxious monkeys.
When a person comes to a doctor’s office, two things will point toward a diagnosis of alcohol withdrawal: the first is long-term alcohol use with sudden cessation, and the second being symptoms typical of withdrawal (these will be explained in the following paragraphs). For the symptoms, physicians use a largely accepted algorithm known as the CIWA-Ar (Clinical Institute Withdrawal Assessment) protocol. This survey takes a snapshot of a patient to determine how severe their withdrawal is at a point in time during their visit.
What doctors look for when determining severity of alcohol withdrawal: The categories assessed by the patient include nausea and vomiting, tremor (often in the hands), auditory, tactile or visual hallucinations, sweats, anxiety, headache, agitation, and disorientation. Additionally, the doctor will measure heart rate, blood pressure, and do a physical exam. Each category is measured out of 7 points, with 7 being the worst (the exception to this is disorientation, which is measured out of 4 points). The maximum score in the assessment is a 67, with patients under 10 usually being safe without medication, and with any number over 20 being considered severe withdrawal. However, this scale is meant to determine the severity of withdrawal, and is not as helpful in laying out a timeline of when these symptoms will present. For that, it is more helpful to understand the body’s reaction to the cessation of alcohol use.
It makes a lot of sense to start this talk by defining the sympathetic nervous system. The sympathetic nervous system (known in laymen’s terms as the “fight-or-flight” response) is the body’s activation of processes that prepare itself for demonstrative physical response. This is largely a reflexive response to new and foreign stimuli, and is in constant contact with the bloodstream to monitor the balance of needs. The actions of the sympathetic nervous system are counteracted by the body’s parasympathetic nervous system, or its resting response. A good way to think of this is as a gas (sympathetic) and brake (parasympathetic) in a motor vehicle.