Alcohol Tolerance And Withdrawal

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Dependence on alcohol, and many other drugs, is characterized by TOLERANCE and WITHDRAWAL. Tolerance refers to the fact that with chronic use, increasing doses of the drug are needed to achieve the same behavioral effects. Thus, the degree of acute impairment outlined above will vary with the individual's tolerance. People who have developed alcohol tolerance also show cross-tolerance to other CNS depressants, including general anesthetics. Loss of tolerance appears to occur in the ELDERLY and in alcoholics who have developed organic brain impairments due to alcohol use or other factors, such as head injury. However, tolerance does not appear to develop to the direct neurotoxic effects of long-term alcohol abuse.

Following heavy drinking, many alcoholics experience a tremulous-hyperexcitable withdrawal syndrome, which is characterized by postural tremor, agitation, confusion, and ataxia. Generalized seizures can also appear in withdrawal, typically 10 to 48 hours after cessation of drinking. It has been hypothesized that long-term alcohol use may establish an epileptogenic state of the brain that becomes manifest upon alcohol withdrawal. For this reason, it has become common practice in many treatment facilities to guard against withdrawal seizures in patients with known susceptibility by giving prophylactic anticonvulsants or tranquilizers. Long-term treatment is usually not indicated because the withdrawal syndrome is self-limiting. In some patients, the acute withdrawal syndrome can progress to DELIRIUM TREMENS (DTs). This more severe form of withdrawal is characterized by delirium, HALLUCINATIONS, and a hyperautonomic state manifested by sweating and tachycardia. DTs are associated with approximately 15 percent mortality rate, possibly due to cardiac toxicity caused by the hyperadrenergic state. Treatment of the disorder involves rehydra-tion and haloperidol (a neuroleptic drug) as well as medication to control withdrawal.

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