The video below is the section for Alcohol Withdrawal from Part 3 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 3, click HERE. To watch Part 1 and 2, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Alcohol Withdrawal
NARRATIVE DEFINITION: Alcohol Withdrawal is listed in the DSM-5 as one of five disorders under Alcohol-Related Disorders. Alcohol Withdrawal often occurs in individuals who cease to drink or cutback markedly in drinking after a period of prolonged or heavy alcohol consumption. It usually occurs in individuals who have developed Alcohol Dependence.
Withdrawal from a given substance typically involves an abstinence syndrome of behaviors and physiological reactions that include responses that are the “opposite” of the responses induced by the substance per se. Thus, according to the DSM-5, individuals must demonstrate at least two of the following symptoms to meet criteria for the diagnosis of Alcohol Withdrawal: autonomic hyperactivity (e.g., sweating, tachycardia), hand tremors, insomnia, nausea or vomiting, short-lived hallucinations or illusions, psychomotor agitation, and/or grand mal seizures. Such symptoms are in many respects the opposite side of the coin, compared to responses induced by alcohol ingestion or intoxication.
These symptoms must cause clinically significant distress or impairment in social or occupational functioning and not be caused by a general medical condition. These symptoms are often associated with craving of alcohol, fueling a vicious cycle of resuming use of the substance.
These symptoms usually appear within a few hours to a few days after the termination of alcohol use, tapering after four to five days. However, some symptoms (anxiety, insomnia, autonomic nervous system dysfunction) may persist for 3-6 months.
Fewer than 10 percent of people going through Alcohol Withdrawal will experience severe symptoms, such as extreme autonomic hyperactivity or tremors. And only a portion of those will experience Alcohol Withdrawal Delirium or delirium tremens (popularly known as the “DTs,” “the shakes,” or “rum fits”). Symptoms of delirium tremens include vivid hallucinations, increased irritability and behavioral agitation, delirium, delusions, autonomic hyperactivity, and seizures. Seizures occur in about 3 percent of individuals with Alcohol Withdrawal.
Between 1 percent and 5 percent of delirium tremens episodes have a fatal outcome. Individuals who have concurrent medical problems (e.g., liver damage, head trauma, hypoglycemia) are more susceptible to the development of delirium tremens.
If hallucinations or illusions are present, the specifier With Perceptual Disturbances should be added to the diagnosis.
In some cases, Alcohol Withdrawal may induce Psychotic Disorders, Mood Disorders, Anxiety Disorders, and Sleep Disorders.
Treatment of Alcohol Withdrawal, if severe, involves reintroduction of a sedative-hypnotic agent (like alcohol). Indeed, one way to temporarily abate the symptoms of Alcohol Withdrawal is to have more to drink, leading to a classic vicious cycle characteristic of substance dependence. In a medical setting, serious withdrawal would be treated with substitution of a longer-acting, safer sedative-hypnotic agent, followed by either medical or psychological intervention (or a combination) to try to stop drinking behavior in the future.
- Characteristic syndrome of behavioral and physiological responses related to ceasing alcohol use, or cutting back, typically after periods of heavy use
- Typically associated with alcohol dependence
- As in all substance withdrawal syndromes, the symptoms are largely the opposite of those involved in alcohol use or intoxication (e.g., autonomic hyperactivity, tremors, insomnia, short-lived hallucinations or illusions, agitation, grand mal seizures)
- Typically fosters craving for alcohol (which could temporarily allay the syndrome), leading to vicious cycle of re-use
- Symptoms occur within several hours to several days of cessation or cutting back of alcohol use
- Rarely, Alcohol Withdrawal Delirium (“delirium tremens” or DTs) occurs, with auditory, visual, and/or tactile hallucinations
- Treatment is supportive, with a need in some cases to add a longer-acting and safer sedative-hypnotic substance (which is then tapered) to ease the symptoms
Robert, a 23-year-old male, is brought to the emergency room by his girlfriend. His girlfriend states that over the past few hours, Robert has been vomiting and his hands have been shaking. She also notes that Robert has been sweating profusely and has complained that his heart is racing. Robert had gone to bed in an attempt to “sleep off” his symptoms, but reported that he was unable to fall asleep. Robert would most likely be diagnosed with:
A. anxiolytic intoxication.
B. alcohol withdrawal.
C. cannabis intoxication.
D. amphetamine withdrawal.
RATIONALE: B is correct, as this pattern of autonomic over-reactivity, agitation, tremor, and nausea would most likely be associated with withdrawal from a sedative-hypnotic agent like alcohol. A is incorrect, as anxiolytic intoxication is linked to sedation; C is incorrect, as cannabis intoxication is not linked to this kind of over-reactivity; D is incorrect, as amphetamine withdrawal would be linked to somnolence, large appetite, and depression.