Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 11/22/2021
Number of References: 17 Sources
Alcohol withdrawal produces a multitude of unpleasant and potentially dangerous effects, both physical and psychological. The intensity with which alcohol use affects the neurotransmitters GABA, norepinephrine, and glutamate results in a state of neurological hyperactivity and has downstream effects on a variety of body systems. These can range from simply uncomfortable to life-threatening and everything in between. Here we do an examination of exactly what happens to your body and mind when you stop drinking and withdrawal sets in.
In This Article:
The experience of quitting alcohol is very unpleasant and is characterized by a variety of uncomfortable or dangerous physical effects and negative mental states. These symptoms can vary from person to person, but the common thread is that it is an objectively bad time. The physical symptoms will often require hospitalization and medical care since they can present real risks to someone’s health and even their life. The psychological symptoms, while not directly dangerous, are very unpleasant and can often lead someone back to drinking for some sense of relief.
Some of the effects include:
The psychological symptoms often persist much longer than the physical symptoms and include:
While most of these symptoms will resolve given the proper treatment and enough time, the effects of alcohol withdrawal are oftentimes a nightmare. The physical effects can worsen and amplify the psychological effects, and vice versa, causing a snowball effect of increasing discomfort. Let’s take a look at some of these specific effects as well as their causes and manifestations.
The physical effects of alcohol withdrawal are by far the most dangerous since the systems most greatly affected include the central nervous system and the cardiovascular system. The inhibitory neurotransmitter GABA is much less potent during withdrawal, while the effects of the excitatory neurotransmitters norepinephrine and glutamate are greatly amplified. This results in a neurochemical triple threat of the nervous system operating at an increased speed and intensity with a reduced ability to slow down through the braking function normally provided by GABA.
The affected system which poses the greatest risk is certainly the cardiovascular system. This is mainly due to the increased intensity of norepinephrine function, but glutamate may also contribute to some degree. One of the functions of norepinephrine is to manage the levels of adrenaline in the blood. Due to norepinephrines increased impact during alcohol withdrawal, adrenaline levels are greatly increased. Adrenaline is a key component of the fight-or-flight response and acts to speed up cardiovascular function in anticipation of fighting or fleeing from a predator. In the context of alcohol withdrawal, the levels of adrenaline are elevated for much longer than the normal increases which result from fight-or-flight.
These increased levels of adrenaline result in an greatly increased heart rate and elevated blood pressure. This not only is bad for the heart and veins, but adrenaline also causes blood sugar levels to spike by telling muscles and fats to release stored glucose. If someone were diabetic, they could suffer severe consequences from these effects such as diabetic ketoacidosis, stroke, or heart attack. Additionally, if someone were to have a heart condition or blood pressure issues, they would be at an increased risk of complications from these issues as well. This increase in heart rate and blood pressure can also contribute to the psychological symptoms as well by amplifying anxiety and restlessness.
The effects of alcohol withdrawal on someone’s motor control are commonly the most visible and obvious sign of alcohol withdrawal. These effects stem mainly from the increased presence and influence of glutamate, and to a lesser degree norepinephrine. A lack of B vitamins (particularly thiamine) can also contribute to these motor problems, as the cerebellum is extremely sensitive to thiamine deficiencies and is a major center for muscle coordination and motor control. Glutamate is a signal amplifier in the brain which is normally balanced out by GABA. Due to the neurotransmitter imbalances produced by alcohol withdrawal in addition to the deficiencies in B vitamins which is extremely common in alcoholics, it can become nearly impossible to reliably control one’s body during alcohol withdrawal. This may be as subtle as being unable to write properly, to as extreme as being unable to walk due to the intense tremors produced from alcohol withdrawal.
Additionally, alcohol withdrawal seizures are fairly common and these typically manifest as a generalized tonic-clonic, or grand mal, seizure. These are also caused by increased glutamate levels and decreased GABA levels. These will cause someone to lose consciousness and then begin convulsing, sometimes quite violently for several minutes. These seizures usually self terminate after 2 minutes or less, but they may sometimes progress to potentially brain-damaging or fatal seizure conditions known as status epilepticus. These are seizures that last longer than 5 minutes or multiple seizures with no return of consciousness in between episodes. Status epilepticus is potentially fatal and is considered a medical emergency that requires immediate medical attention.
While chronic alcoholism can be very damaging to the gastrointestinal tract, the effects of alcohol withdrawal may cause some stomach and intestinal issues as well. The disruptions to GABA and norepinephrine systems produced through alcohol withdrawal will cause a hyperactive state in the stomach and intestines. This may result in nausea, vomiting, a lack of appetite, and diarrhea during alcohol withdrawal. Aside from being objectively unpleasant on its own, this can further worsen the other withdrawal symptoms as dehydration is a common result of constant sweating and frequent diarrhea. Finally, the nutrient deficit will increase certain other risks and may be managed by a specialty alcohol detox diet.
There are a variety of other systems which are affected during withdrawal which do not necessarily fit neatly into one physical body system. Some of these peripheral physical effects include:
While the physical effects of alcohol withdrawal are unpleasant, the psychological effects may be even scarier, although less dangerous. These can include perceptual distortions and delusions which can make someone feel as if they are losing their mind. A variety of intense mood disorders are hallmarks of withdrawal as well. These are a direct result of the severe neurotransmitter imbalances which are produced through chronic drinking, and they may take some time to resolve.
These are the most intense effects of alcohol withdrawal and usually manifest only in severe cases. The profound disruption to glutamate and GABA systems, in particular, can cause someone to become severely disoriented with regard to the time and place. People may not know where they are and have no memory of the hours or days prior to the present. This can subsequently lead to increased irritability and even aggression, as people often become frightened and defensive.
An especially severe set of symptoms is known as delirium tremens, which is characterized by almost total disorientation and confusion with the addition of vivid hallucinations. This usually only occurs in cases of heavy alcoholism and/or people who have experienced repeated episodes of alcohol withdrawal. Experiencing alcohol withdrawal episodes repeatedly will worsen the symptoms for each subsequent episode, and increase the chances of suffering from delirium tremens.
Someone need not go into delirium tremens to experience hallucinations, as these are a very common effect of alcohol withdrawal. The terms alcohol hallucinosis and alcohol-induced psychotic disorder both refer to this phenomenon which is common among heavy drinkers. This is distinct from delirium tremens, however, these symptoms will also worsen the more times someone experiences withdrawal. The symptoms may manifest as auditory hallucinations such as voices, but may also present as visual or tactile hallucinations.
People who suffer these symptoms are known to talk to themselves and become increasingly introverted. The exact causes are unclear but most likely have to do with glutamate disturbances and damage to the cerebellum. In addition to directing motor functions, the cerebellum is also a hub for integrating information from all of the senses and producing a singular perception of reality. Through neurotransmitter disruptions as well as cerebellar damage due to B vitamin deficiencies, these hallucinatory and psychotic effects may become very intense and sometimes quite long-lasting.
Anxiety disorders are some of the most common effects of alcohol withdrawal and often persist long after withdrawal has resolved. These issues are most likely due to a combination of glutamate and norepinephrine increases along with GABA decreases which result in an uncomfortably heightened state of vigilance. This can cause someone to feel anxious at all times, and is particularly severe with regards to social anxiety.
This may manifest as a constant nervousness with intermittent panic attacks. These effects will typically resolve over time, but it often requires both medications and therapy to achieve a significant reduction. Additionally, these anxiety effects may become more pronounced and severe with each subsequent episode of withdrawal that someone experiences.
Along with the strong interactions with other neurotransmitters, alcoholism also produces changes in serotonin and dopamine systems in the brain. Serotonin is a mood elevator and regulator, while dopamine is an excitatory neurotransmitter which is responsible for feelings of reward and pleasure among other things. Through disruptions in these two systems during alcohol use and subsequent withdrawal, the brain will become extremely unbalanced with regard to mood. This often results in a profound depression which may last for long periods, even after alcohol use has been discontinued for several months.
These psychological effects may be characterized by a severe mental fatigue and lethargy coupled with a feeling of sadness, loneliness, and hopelessness. It may seem like life without alcohol is not worth living, which is not the case, and the anxiety which is another common effect of alcohol withdrawal may amplify this depression. The fear of others and social anxieties in particular will work to keep someone isolated which may further deepen feelings of disconnection and loneliness. These two effects of anxiety and depression, while distinct, may synergize and compound each other.
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