Alcohol dependence syndrome

Harmful use of alcohol
If the pattern of alcohol consumption has caused damage to the physical or mental health of the user, it is described as harmful use of alcohol. However this is not diagnosed if the patient is alcohol dependent. Those with the harmful use often have associated social problems, and are often criticized by others in their community about their level of alcohol use.

Alcohol dependence syndrome
This is a collection of physiological, behavioral and cognitive phenomena, in which the use of alcohol takes on a much higher priority for that individual, than other behaviors which once had greater value. The central characteristic of dependency is a strong desire or craving to take alcohol. A definite diagnosis of dependence should be made only if three or more ICD 10 criteria are present.

Features of acute alcohol withdrawal syndrome
Features of alcohol withdrawal occur with the fall in the blood alcohol levels. This could occur within hours of the last drink, and is commonest on waking from sleep and this is the reason why many dependent drinkers take an early morning drink or an eye opener to stave off withdrawal features on waking.

Common features of acute alcohol withdrawal syndrome:

• Tremor of hands, legs and trunk

• Restlessness, anxiety, easily startled, agitated and sweating

• Nausea, vomiting, retching, loss of appetite, and insomnia

• Tachycardia and systolic hypertension

Features of acute withdrawal syndrome can start within hours of the last drink and a peak in 24 to 48 hours; in most the symptoms are mild to moderate and disappear within 5 to 7 days. However 5% of dependent drinkers may develop delirium tremens which is a medical emergency.

Delirium tremens
In about 5% of dependent patients, the withdrawal syndrome becomes severe; 36 to 48 hours after the last drink they delirium tremens may develop.

Features of delirium tremens

• The patient Is disoriented/confused. He may be very agitated, and in his confusion may be of harm to himself and a disturbance to the patients in the ward.

• Objects may appear distorted in shape. Illusions, visual and auditory hallucinations may occur. There may be frightening in nature. Commonly described visual hallucinations include those of colorful animals, snakes etc. Auditory hallucinations may be disorganized voices, shouting or snatches of music. Paranoid ideation can also occur.

• Tachycardia and hypertension

• Fever

• Generalized fits her

Risk factors for development of delirium tremens and fits:

• Severe alcohol dependence or severe withdrawal features when presenting for treatment.

• Past history of long standing alcohol dependency with previous episodes of inpatient treatment for withdrawal features.

• Past experience of delirium tremens or fits.

• Older age and concomitant acute illness.