Epidemiology

The World Health Organization (WHO) estimates that 43% of the world population consumes alcohol, with 18.2% of drinkers ages over 15 years engaging in heavy episodic alcohol consumption.[13]

In the US, the 2020 National Survey on Drug Use and Health recorded 10.3% of adults over 26 years, 15.6% of adults ages 18-25 years, and 2.8% of youths (ages 12-17 years) with alcohol use disorder.[14]

It is estimated that of these alcohol-dependent patients, approximately 50% will experience symptoms of alcohol withdrawal upon reduced alcohol intake.[11][15]

Approximately 8% of all patients admitted to the hospital are at risk of alcohol withdrawal.[16][17] Among intensive care unit patients, some studies have shown 16% to 31% are at risk of alcohol withdrawal; 31% of trauma patients may be at risk of alcohol withdrawal.[18][19][20][21] In subsequent studies, the incidence of alcohol withdrawal syndrome (AWS) among trauma patients was less than 1%.[22][23] However, a majority of the trauma patients with AWS (53%) experienced severe AWS, including alcohol withdrawal delirium (11%).[23]

Up to 25% of AWS patients experience hallucinations, while seizures occur in 10% of patients.[24] If AWS is not treated or is inadequately treated, 5% of patients will progress to alcohol withdrawal delirium (also known as delirium tremens), typically 48-72 hours after the last drink.[11][25][26] Alcohol withdrawal delirium-related mortality is less than 1% if early and appropriate treatment is given.[11][16]

Risk factors

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history of alcohol withdrawal syndrome (AWS) and alcohol withdrawal delirium

Prior alcohol withdrawal syndrome (AWS) and alcohol withdrawal delirium (also known as delirium tremens) reliably predict the course of subsequent episodes.[42] A higher number of previous withdrawal episodes increases the risk of complicated withdrawal and complications of withdrawal, a phenomenon referred to as the "kindling effect."[5] A history of severe or complicated withdrawal is a risk factor for seizures and alcohol withdrawal delirium in the current episode.[5]

abrupt withdrawal of alcohol

The severity of symptoms that occur when alcohol use is abruptly ceased is proportional to the previous duration and amount of alcohol consumed.

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