Alcohol withdrawal
291.81 Alcohol Withdrawal
Refer, in addition, to the text and criteria for Substance Withdrawal (see p. 201). The essential feature of Alcohol Withdrawal is the presence of a characteristic withdrawal syndrome that develops after the cessation of (or reduction in) heavy and prolonged alcohol use (Criteria A and B). The withdrawal syndrome includes two or more of the following symptoms: autonomic hyperactivity (e.g., sweating or pulse rate greater than 100); increased hand tremor; insomnia; psychomotor agitation; anxiety; nausea or vomiting; and, rarely, grand mal seizures or transient visual, tactile, or auditory hallucinations or illusions. When hallucinations or illusions are observed, the clinician can specify With Perceptual Disturbances (see below).
Withdrawal symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (e.g., Sedative, Hypnotic, or Anxiolytic Withdrawal or Generalized Anxiety Disorder) (Criterion D).
Symptoms can be relieved by administering alcohol or any other brain depressant. The withdrawal symptoms typically begin when blood concentrations of alcohol decline sharply (i.e., within 4-12 hours) after alcohol use has been stopped or reduced. Because of the short half-life of alcohol, symptoms of Alcohol Withdrawal usually peak in intensity during the second day of abstinence and are likely to improve markedly by the fourth or fifth day. Following acute Withdrawal, however, symptoms of anxiety, insomnia, and autonomic dysfunction may persist for up to 3-6 months at lower levels of intensity.
Fewer than 10% of individuals who develop Alcohol Withdrawal will ever develop dramatic symptoms (e.g., severe autonomic hyperactivity, tremors, and Alcohol Withdrawal Delirium). Grand mal seizures occur in fewer than 3% of individuals. Alcohol Withdrawal Delirium (p. 143) includes disturbances in consciousness and cognition and visual, tactile, or auditory hallucinations ("delirium tremens," or "DTs"). When Alcohol Withdrawal Delirium develops, it is likely that a clinically relevant general medical condition may be present (e.g., liver failure, pneumonia, gastrointestinal bleeding, sequelae of head trauma, hypoglycemia, an electrolyte imbalance, or postoperative status).
Specifier
The following specifier may be applied to a diagnosis of Alcohol Withdrawal:
With Perceptual Disturbances. This specifier may be noted in the rare instance when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered.
Diagnostic criteria for 291.81 Alcohol Withdrawal
- Cessation of (or reduction in) alcohol use that has been heavy and prolonged.
- Two (or more) of the following, developing within several hours to a few days after Criterion A:
- autonomic hyperactivity (e.g., sweating or pulse rate greater than 100)
- increased hand tremor
- insomnia
- nausea or vomiting
- transient visual, tactile, or auditory hallucinations or illusions
- psychomotor agitation
- anxiety
- grand mal seizures
- The symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.
Specify if:
With Perceptual Disturbances