The unprecedented COVID19 pandemic demands an extraordinary response. Hence, along with various other measures to deal with this pandemic, India has instituted a countrywide ‘lockdown’. During the lockdown, barring the essential goods and services, availability of almost everything else is curtailed. This includes availability of alcohol.

Those who use alcohol in a non-dependent pattern will experience mild or no discomfort in this situation. However, for those affected by alcohol dependence (i.e. their bodies have become physically dependent upon alcohol), the situation could have grave consequences. They might have to deal with a challenging medical condition known as alcohol withdrawal syndrome.

 Alcohol dependent person

Markedly reduced / abrupt stopping of alcohol use

Alcohol withdrawal state

       Mild to moderate withdrawal

Severe withdrawal Convulsions

Delirium tremens Wernicke-Korsakoff syndrome

     .

Upon trying to reduce the daily drinking amount or upon stopping drinking completely a person with dependence is likely to experience the mild-moderate alcohol withdrawal, the symptoms which may include:

• Difficulty in sleeping

• Tremors

• Increased sweating

• Palpitations

• Headache

• Stomach upset, poor appetite

• Anxiety, irritability, restlessness

• Severe craving i.e. an irresistible urge to consume alcohol

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These symptoms are quite distressing. To avoid discomfort, some may resort to purchasing alcohol from the grey market or might end up consuming adulterated liquor. In most cases (85-90%), these symptoms will resolve within a span of few days to two weeks (depending on the severity) without any lasting consequences.

However, the symptoms of alcohol withdrawal listed above are those experienced by most patients with alcohol dependence (who would experience mild-moderate symptoms). If alcohol or specific treatment for alcohol withdrawal is not available, a significant proportion of patients (10-15%) are at the risk of experiencing severe alcohol withdrawal features. These features include (over and above the symptoms of severe alcohol withdrawal):

• Seizures (convulsions)

• Delirium Tremens (comprised of confusion, disturbed level of consciousness,

impaired awareness of surroundings, hallucinations and abnormal behaviour)

• Wernicke-Korsakoff syndrome (a variety of neurological and cognitive symptoms)

especially common in malnourished patients

The severe alcohol withdrawal features listed above are not exclusive of each other. They may be life-threatening and carry the risk of mortality (5%), if not treated timely. In some cases, there may be long lasting adverse neurological sequalae as well. Some of the risk factors for developing severe alcohol withdrawal include:

• A history of sustained drinking

• A past episode of severe alcohol withdrawal • Age greater than 30

• The presence of other medical disorders

 

Dr Anshul Mahajan 

Consultant psychiatrist