Source: National Institutes of Health

Withdrawals Can Be Mild, Moderate or Severe
Alcohol withdrawal refers to a group of symptoms that may occur from suddenly stopping the use of alcohol after chronic or prolonged ingestion.

Not everyone who stops drinking experiences withdrawal symptoms, but most people who have been drinking for a long period of time, or drinking frequently, or drink heavily when they do drink, will experience some form of withdrawal symptoms if they stop drinking suddenly.

There is no way to predict how any individual will respond to quitting. If you plan to stop drinking and you have been drinking for years, or if you drink heavily when you do drink, or even if you drink moderately but frequently, you should consult a medical professional before going "cold turkey."

Withdrawal Symptoms:
Mild to moderate psychological symptoms:
Feeling of jumpiness or nervousness
Feeling of shakiness
Anxiety
Irritability or easily excited
Emotional volatility, rapid emotional changes
Depression
Fatigue
Difficulty with thinking clearly
Bad dreams

Mild to moderate physical symptoms:
Headache - general, pulsating
Sweating, especially the palms of the hands or the face
Nausea
Vomiting
Loss of appetite
Insomnia, sleeping difficulty
Paleness
Rapid heart rate (palpitations)
Eyes, pupils different size (enlarged, dilated pupils)
Skin, clammy
Abnormal movements
Tremor of the hands
Involuntary, abnormal movements of the eyelids

Severe symptoms:
A state of confusion and hallucinations (visual) -- known as delirium tremens
Agitation
Fever
Convulsions
"Black outs" -- when the person forgets what happened during the drinking episode

Liver Patients Offered a Lifeline
Jo Revill, Health Editor
Observer (London)
Sunday, January 2, 2005

The increasing number of middle-aged patients with chronic liver disease caused by heavy drinking is forcing doctors to look at new ways of saving their lives.

A pioneering trial to help seriously ill people will begin this month, using the patient's own cells to regenerate the organ. By injecting patients with their own stem cells, the basic 'building blocks' for all kinds of cells, doctors hope that the liver can regrow itself to a point where the organ starts to work again.

The trial is experimental, but follows other work which shows that stem cells have helped patients with heart failure. The dire shortage of donor organs for transplant has encouraged the specialists to think of new ways of helping patients who otherwise have a very bleak future.

One in 20 people in Britain is now dependent on alcohol and a similar number are at serious risk of liver disease. Physicians and government experts have warned that alcohol-related harm - severe liver disease and injuries caused by drink-related violence - are on the rise as the nation's drinking habits become heavier.

Deaths from liver disease in patients under 50 have risen sevenfold in the past 30 years and surgeons have warned they are seeing a growing number of patients with cirrhosis of the liver, a condition where the healthy liver tissue is gradually replaced by scarred, useless tissue. The disease is insidious, because apparently healthy people may have it without knowing and the first signs do not occur until a late stage of the disease.

When alcohol is drunk, it is quickly absorbed and passes in the bloodstream to the liver, where it can cause excessive fat to be deposited within the liver cells. Between 20 and 30 per cent of those who drink heavily beyond the initial stages of liver damage will develop alcoholic hepatitis, a condition which can be fatal. A smaller number, about 10 per cent, go on to develop cirrhosis. Although alcohol is the leading cause of cirrhosis, it can also be brought on by forms of hepatitis or by some toxic chemicals.

Scientists at Imperial College London believe stem cell therapy holds out enormous hope for those who need new organs. Professor Nagy Habib, head of liver surgery at London's Hammersmith Hospital, who is running the trial, said: 'The liver is a wonderful organ in the way it can regenerate itself, but if there is a lot of damage it stops functioning properly. If we can get 15 to 20 per cent of the organ regenerated, then that is enough to really improve the patient's condition. These cells seem to have the fantastic ability to become whatever is needed in order to repair the damage.'

By injecting the patient's own stem cells, taken from their blood, directly into the bloodstream, the researchers hope they may be able to improve the function of the liver by getting the stem cells to repopulate the liver.

The procedure, known as leukapheris, involves taking blood from a patient and then separating it into its component parts. The stem cells are taken from the white blood cells, while the red blood cells are returned to the body through the arm. Habib and his team then inject the stem cells into the hepatic artery, the vessel which goes into the liver.

Habib believes they have to look at all the potential cures. There are about 700 liver transplants in the UK each year, but 7,500 die annually from liver disease. Alcohol is the major reason for a transplant, followed by the virus hepatitis C. 'The demand for a transplant has really risen,' said Habib. 'We don't have the equivalent of a kidney dialysis machine for these patients, so unfortunately most of them will die while waiting for an organ.'

It is not yet known how many stem cells may be needed for the trial to succeed. The worse the patient's liver function, the more cells may be necessary. 'If you can provide 1 per cent of liver cell mass, and then allow that 1 per cent to grow over a three-month period, it's possible that the liver will have enough healthy cells to behave properly, and start to produce what it needs,' said Habib.

Like many specialists, he worries that people do not understand the damage that can be done by heavy, prolonged drinking. 'If people could see what life was like in the final stages of liver failure, they might think seriously about giving up at a much earlier point,' he said. 'The liver is a very forgiving organ, but there's a limit to how much alcohol it can process before the damage sets in.'

By Lloyd Vacovsky

The millennium has signaled the dawn of a new era in the treatment of alcohol and substance dependence in the United States. New treatment protocols, which include pharmacotherapy, are attracting increased attention from the Alcohol and Substance Dependence Treatment Community. At the forefront of this movement is The Pennsylvania Model of Recovery, which is so named in that its protocols are based on the research and work of the University of Pennsylvania School of Medicine, Treatment Research Center in Philadelphia. This is a medical model, which offers a full range of empirically tested treatment options to individuals dependent upon alcohol and other drugs. The Pennsylvania Model differs dramatically from the Minnesota Model or 12 Step format in that it wholeheartedly embraces Pharmacotherapy as a cornerstone of treatment, along with individual and group psychosocial support.

The Pennsylvania Model can be compared to a three-legged stool. The three legs are the biological, psychological and social components of recovery. All three components are essential. Take away one of the legs, and the stool becomes ineffective. The Pennsylvania Model seeks to address each of these components of addiction, for individuals seeking recovery.

The biological component includes not only the physical addiction to the alcohol or drug, as manifested for example by the presence of "the Shakes", but also the intense cravings that persist long after the physical discomfort have dissipated. Most people can deal with the physical discomfort. It is the emotional issues caused by imbalances in the brain chemistry that precipitate most relapses. Relapses are common, indeed expected. This despite the dire consequences that many individuals face by their continued drinking. Social and non-drinkers do not understand what drives an alcohol dependent individual to drink alcohol, without regard to consequences. A simple explanation is that it can be said that an alcohol dependent person does not drink to feel "good" but rather drinks in order to not feel "bad". The use of safe, effective, approved medications addresses the biological component of the recovery process.

Cognitive Behavioral Therapy is utilized for the psychological issues which must also be addressed. Recovery is at best an extremely difficult path. Being burdened by such issues as clinical depression makes it all but impossible to achieve abstinence. The use of alcohol is clearly the most common form of self-medication utilized by individuals suffering from psychological trauma. Simply stopping the alcohol consumption for example, in most situations, will not eliminate depression or any other psychological symptom. Using depression as an example, many individuals simply do not understand that they are suffering from depression. Depression for them, over the years, becomes the "norm". They have forgotten the difference between feeling good and feeling bad. For most alcohol dependent individuals, feeling "bad" is the "norm" and alcohol is their only known form of relief.

Equally important are the social issues faced by individuals in recovery. Learning how to adjust to sobriety is often more difficult than making the decision to stop. Dealing sober with family, friends and employers can be so intimidating to individuals in recovery that many relapse. Alcohol dependent individuals over the years become extremely skillful in manipulating situations and lying in order to insure a supply of alcohol. The "news" that one has made a commitment to stop drinking is most often met with justifiable skepticism. The individual has probably given the news about stopping the drinking so often that listeners react much as those who heard the warning from "the boy crying wolf". Support from concerned family and friends is essential to recovery, yet the bridge has been burned so badly, that such support is no longer offered.

Alcohol dependent individuals often experience intense isolation and loneliness, even when surrounded by family and friends. Often they do not realize or are in denial as to the impact that their drinking has on the people around them. As with most addicted individuals, alcoholics tend to rely on their own ability to control their addiction. The end result is usually another failed attempt to achieve sobriety. Most individuals seeking help do so only after disastrous events have compelled them to do so. For recovery to become possible, numerous issues as discussed must be addressed. In the end, it is critical for the individual to realize that the help of others is a vital component of recovery.


On December 30, 1994, the United States Food & Drug Administration approved for use in the treatment of alcohol dependence, the opioid antagonist Naltrexone HCI. The approval of naltrexone marked a turning point in the history of treatment for alcohol dependence. Naltrexone is at the forefront of emerging pharmacotherapy protocols utilized by the Pennsylvania Model. Since the approval of naltrexone in 1994, additional medications have been added to the arsenal in the battle against alcohol dependence. These medications include Ondansetron, Campral and Topamax.

Within a few minutes of ingestion, Naltrexone will dramatically reduce or suppress the intense craving to consume alcohol. The medication is extremely safe, has very minor or no side effects, is not addicting either physically or emotionally, can be discontinued at anytime without adverse effects and is generally administered for six months or less.

It is clear neither that Naltrexone, nor any of the other effective medications, in themselves are a cure for alcohol dependence. They are not magic nor are they the silver bullet that will destroy this disease known as alcoholism. They are however, extremely valuable tools, that when properly utilized, will enable motivated individuals to embark upon a successful path to recovery.

The primary difficulty with medications such as Naltrexone is that they only addresse specific issues of a very complicated disease. Naltrexone will effectively suppress the cravings, however it does not address any of the remaining issues for example clinical depression and or social problems which in themselves can cause relapse. It does however create a window of opportunity in which an alcohol dependent individual can address the countless issues of maintaining sobriety, without the overwhelming desire to drink alcohol. Even with the use of naltrexone, the path to recovery is at best difficult.

Alcohol can be compared to a sandbox. Consuming alcohol enables individuals to stick their head in the sand and avoid issues and problems. The problems, the pain, do not go away. They simply lurk in the background, waiting for the individual to attempt to get their head out of the sand. Relapse occurs when the individual is not able to deal with the intense cravings, coupled with their inability to face the almost countless lurking demons that exist in everyday living. Medications effectively take away the sandbox, forcing the individual to address the numerous issues that occur during the recovery process.

Individuals that have "a Life" but cannot get past the cravings in their efforts to abstain from alcohol find Naltrexone "a wonder drug". Generally, within an hour, the monkey that has been on their back for years, jumps off, and does not return if the medication is taken for the recommended period of time. It is rare however for an individual that is alcohol dependent not to have numerous and severe issues which effect recovery. Individuals with more intense issues are far more likely to slip or relapse.

Again, it must remember that the Naltrexone only addresses the cravings. Years of drinking are not washed away by the taking of a pill. Perhaps the most difficult part of recovery is learning how to be happy. Just as the bottom line of a business is profit, the bottom line of recovery is happiness and contentment. The individual must further recognize that happiness and contentment are not always available to us 24 hours a day, 7 days a week. That we have good days and bad days, and that the sandbox is not the answer for the bad days.

Minnesota Model protocols expect failure, over and over, until the individual has bottomed out. Then, out of desperation, the individual is expected to rebuild a life that the bottle took years to destroy. A Pennsylvania Model program does not expect the individual to fail. This does not mean that failures do not occur. The lure of the sandbox and all the lurking demons often overwhelm the individual. However, by properly addressing the Biological, Psychological and Social issues, the sandbox can be filled with concrete, never again to be used in desperation.