Alcohol Withdrawal 501
Prevalence
It is estimated that approximately 50% of mi ddle-class, highly functional individuals with
alcohol use disorder have ev er experienced a full alcohol withdrawal syndrome. Among
individuals with alcohol use disorder who are hospitalized or homeless, the rate of al-
cohol withdrawal may be greater than 80%. Less than 10% of individuals in withdrawal
ever demonstrate alcoho l withdrawal delirium or withdrawal seizures. 
Development and Course
Acute alcohol withdrawal occurs as an episode usually lasting 4–5 days and only after
extended periods of heavy drinking. Withdrawal  is relatively rare in individuals younger
than 30 years, and the risk and seve rity increase with increasing age.
Risk and Prognostic Factors
Environmental. The probability of developing alco hol withdrawal increases with the
quantity and frequency of alcohol consumptio n. Most individuals with this condition are
drinking daily, consuming large amounts (appr oximately more than eight drinks per day)
for multiple days. However, there are large inter-individual differences, with enhanced
risks for individuals with concurrent medical conditions, those with family histories of al-
cohol withdrawal (i.e., a gene tic component), those with pr ior withdrawals, and individ-
uals who consume sedative, hy pnotic, or anxiolytic drugs.
Diagnostic Markers
Autonomic hyperactivity in the context of moderately high but falling blood alcohol levels
and a history of prolonged heavy drinking in dicate a likelihood of alcohol withdrawal.
Functional Consequences  of Alcohol Withdrawal
Symptoms of withdrawal may serve to perpet uate drinking behaviors and contribute to
relapse, resulting in persistently impaired so cial and occupational functioning. Symptoms
requiring medically supervised detoxification result in hospital utilization and loss of
work productivity. Overall, the presence of withdrawal is associated with greater func-