Withdrawal symptoms cause clinically signific ant distress or impairment in social, oc-
cupational, or other important areas of functi oning (Criterion C). The symptoms must not
be attributable to another me dical condition and are not be tter explained by  another men-
tal disorder (e.g., generalized anxiety diso rder), including intoxication or withdrawal
from another substance (e.g., sedative, hypnotic, or anxiolytic withdrawal) (Criterion D).
Symptoms can be relieved by administering alcohol or benzodiazepines (e.g., diazepam).
The withdrawal symptoms typically begin when blood concentrations of alcohol decline
sharply (i.e., within 4–12 hours) after alcohol us e has been stopped or re duced. Reflecting the
relatively fast metabolism of alcohol, symptoms  of alcohol withdrawal usually peak in inten-
sity during the second day of abstinence and ar e likely to improve markedly by the fourth or
fifth day. Following acute withdrawal, however, symptoms of anxiety, insomnia, and auto-
nomic 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 dra-
matic symptoms (e.g., severe autonomic hypera ctivity, tremors, alcohol withdrawal delir-
ium). Tonic-clonic seizures occur in fewer than 3% of individuals.
Associated Features Supporting Diagnosis
Although confusion and changes in consciousness are not core criteria for alcohol with-
drawal, alcohol withdrawal delirium (see “De lirium” in the chapte r “Neurocognitive Dis-
orders”) may occur in the context of withdrawal . As is true for any agitated, confused state,
regardless of the cause, in addition to a disturbance of cons ciousness and cognition, with-