Long-term, heavy use of alcohol can lead to a range of neurobiological adaptations including decreased levels of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits electrical activity in the brain, and to reduced sensitivity of GABA receptors . These effects, coupled with over stimulation of glutamate (an excitatory neurotransmitter) and an increase in glutamate receptors are thought to contribute to the CNS hyperactivity which characterizes many of the symptoms of alcohol withdrawal following reduction or cessation of use .
The alcohol withdrawal syndrome can be mild to severe, with the onset of symptoms typically occurring within hours after the last drink, peaking in intensity at days 2-3 and subsiding by days 5-6.
Common symptoms of mild to moderate withdrawal are tremor, restlessness, insomnia, nightmares, sweats, tachycardia, fever, nausea, and vomiting. More severe withdrawal can include seizures, hallucinations (auditory, visual, tactile), severe agitation and tremulousness, while delirium tremens (DTs), cardiac arrest and death can occur in very severe withdrawal .
Benzodiazepines are most commonly prescribed for alcohol withdrawal and are effective for symptom control.