Environmental. The probability of developing alcohol withdrawal increases with the quantity and frequency of alcohol consumption. Most individuals with this condition are drinking daily, consuming large amounts (approximately 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 genetic component), those with prior withdrawals, and individ- uals who consume sedative, hypnotic, or anxiolytic drugs.
Autonomic hyperactivity in the context of moderately high but falling blood alcohol levels and a history of prolonged heavy drinking indicate a likelihood of alcohol withdrawal.
Functional Consequences of Alcohol Withdrawal
Symptoms of withdrawal may serve to perpetuate drinking behaviors and contribute to relapse, resulting in persistently impaired social and occupational functioning. Symptoms work productivity. Overall, the presence of withdrawal is associated with greater func- tional impairment and poor prognosis.
Other medical conditions. The symptoms of alcohol withdrawal can also be mimicked by some medical conditions (e.g., hypoglycemia and diabetic ketoacidosis). Essential tremor, a disorder that frequently runs in families, may erroneously suggest the tremu- lousness associated with alcohol withdrawal.
Sedative, hypnotic, or anxiolytic withdrawal. Sedative, hypnotic, or anxiolytic with- drawal produces a syndrome very similar to that of alcohol withdrawal.
Withdrawal is more likely to occur with heavier alcohol intake, and that might be most of— ten observed in individuals with conduct disorder and antisocial personality disorder.
Withdrawal states are also more severe in older individuals, individuals who are also de- pendent on other depressant drugs (sedative-hypnotics), and individuals who have had more alcohol withdrawal experiences in the past.
The following alcohol-induced disorders are described in other chapters of the manual with disorders with which they share phenomenology (see the substance/medication-induced mental disorders in these chapters): alcohol—induced psychotic disorder (”Schizophrenia Spec- induced major or mild neurocognitive disorder (”Neurocognitive Disorders”). For alcohol intoxication delirium and alcohol withdrawal delirium, see the criteria and discussion of de- lirium in the chapter ”Neurocognitive Disorders.” These alcohol—induced disorders are diag- nosed instead of alcohol intoxication or alcohol withdrawal only when the symptoms are sufficiently severe to warrant independent clinical attention.
The symptom profiles for an alcohol-induced condition resemble independent mental disor- ders as described elsewhere in DSM-5. However, the alcohol—induced disorder is temporary and observed after severe intoxication with and / or withdrawal from alcohol. While the symp- toms can be identical to those of independent mental disorders (e.g., psychoses, major depres- sive disorder), and while they can have the same severe consequences (e.g., suicide attempts), alcohol-induced conditions are likely to improve without formal treatment in a matter of days to weeks after cessation of severe intoxication and / or withdrawal.