The Acute Alcohol Withdrawal Syndrome: Findings and Problems

Abstract

Summary The acute alcohol withdrawal syndrome includes a whole serifs of gastrointestinal, cardiovascular, autonomic, neurological and psychic symptoms. In this study delirium tremens is regarded as the most severe stage of the withdrawal syndrome. In a study of 184 alcoholics (112 with delirium tremens) in which 14 symptoms of the types mentioned above were considered, a general syndrome was identified which could be divided into somatic and psychic subsyndromes. There were significant differences in the percentages of patients with and without delirium tremens who developed particular symptoms. No significant differences were found, however, between those patients in which delirium tremens occurred following alcohol withdrawal and those in which it occurred without prior withdrawal. These findings are in agreement with clinical and experimental observations of the symptoms within the acute alcohol withdrawal syndrome while alcohol intake was still being increased. It is therefore assumed that the syndromes discussed are not dependent solely on alcohol withdrawal but rather are based on a general impairment in the mechanism for adaptation to alcohol.

Complaints of insomnia in hospitalized alcoholics

“…The findings regarding the sleep alterations in the sample are in accordance with the ones in other studies, 7,20 in which the prevalence of insomnia in alcoholics ranges between 36% and 61%; in our study sleep efficiency, the most objective marker of insomnia, was disrupted in 56.8% (33/58) of the interviewees. When analyzing sleep efficiency in women, 46% (6/13) reported it being altered as compared to 60% (27/45) of men, being this in accordance with the literature.…”

“…10 The report of a lower proportion of alteration in sleep efficiency in women can be explained by their higher consumption of non specified hypnotics. 17,20 Anxious and depressive symptoms were reported by most interviewees, and the presence of these symptoms per se can produce sleep alterations, but alcohol consumption also produces both alterations and worsens sleep problems. 21 In the sample as well as in the general population, there is a tendency of women having a higher consumption of hypnotics, 69%, (9/13), as compared to 25% (12/45) of men, although the bad quality of sleep was present in both genders, 83% (37/45) among men and 100% (13/13) among women.…”

“…22,23 The anxious and depressive symptoms presented with higher frequency in the patients evaluated, similarly to what was expected among alcoholics. 20 According to the high prevalence of chronic insomnia found with the ICSP-VC in the studied population, alcoholics deserve medical care and treatment for their sleeping problem within their therapeutic plan. Further studies should be designed as to find a causal association between alcoholism and chronic insomnia complaints in order to help predicting relapses of alcohol consumption due to sleep disturbances.…”

Insomnia, Self-Medication, and Relapse to Alcoholism

“…Baekeland et al (4) reported that 36% of 294 alcoholic outpatients had high scores on sleep disturbance as measured by a clinic physician. Similarly, Feuerlein (5) reported that 37% of 184 inpatients and outpatients with alcoholism had "sleep disturbance" as determined by a semistandardized interview. Caetano et al (6) investigated insomnia as a withdrawal symptom and found a 42% rate among 445 people referred to educational programs for driving under the influence, and a 67% rate among 748 men admitted to detoxification and residential treatment centers.…”

“…The occurrence of insomnia and its self-medication with alcohol has not been investigated simultaneously in alcoholic samples (4)(5)(6). Nevertheless, other studies provide useful frequency estimates of self-medication.…”