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Daily heavy alcohol users frequently experience a withdrawal syndrome if they suddenly stop drinking. I’m pretty confident that 2 standard drinks per day is rarely enough to trigger withdrawal, and those who drink 8-10/day almost always experience some withdrawal, but I’m not clear on where the line is. I realize there is a lot of inter-individual variability in this, but I’m wondering if it has been investigated systematically. The duration of use clearly also affect this.*

Ideally, I would like to see a 3D graph showing the likelihood of withdrawal (at some threshold level of severity) according to daily dosage and length of exposure. Not being confident that this exists, any studies looking into the threshold daily intake required to trigger withdrawal would be welcome.


*There’s also a (somewhat controversial) concept known as ‘kindling’ whereby repeated detox attempts may cause worsening of withdrawal, but for the purpose of this question I’m assuming a first detox attempt.

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    I'm not offering this as an answer as I have not looked at the provenance of the data, but are the charts on this page along the lines of what you are looking for? – JohnP May 7 '15 at 18:46
  • Definitely, thanks! I'm very curious where those numbers came from: The numbers of drinks in Figure 1 and figure 2 are ballpark guesstimates based on my experience with alcohol and with heavy drinkers and with my investigation of the best sources available on the topic. But no mention of what these 'best sources' are. (I take his point about the ethical limitations on experimentation in the area, but observational data will do just fine for the descriptive info I'm seeking.) – Susan May 7 '15 at 18:51
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I don't think that you will find a definitive answer on this, unfortunately. There are too many factors on an individual basis to make it a blanket kind of projection. The closest that I found for any kind of writeup that addresses it is this published article.

The pertinent part of that is this section here:

How Much Alcohol Must Be Ingested (and over what period) for a Person to Develop Alcohol Dependence and to Be at Risk for Alcohol Withdrawal?

There is no absolute relationship between pattern of alcohol use and the risks of physiologic dependence and withdrawal, which most likely reflects the significant number of variables, in addition to duration and quantity of alcohol use, that can contribute to dependence and withdrawal risk for a given individual. Some of these additional variables include age, medical comorbidities (such as hepatic dysfunction), concomitant medication use, and seizure threshold.

It has been easier to quantify the risk of benzodiazepine withdrawal, based on degree of benzodiazepine use (even though benzodiazepines act at the same receptor as does alcohol and are cross-reactive with it). For example, daily use of 20 mg of diazepam for 3 weeks or longer is believed to be sufficient to induce physiologic dependence.3 However, the shorter half-life of alcohol (1–2 hours) has made similar predictions elusive in the case of alcohol abuse. In general, any suspicion of daily alcohol use over several weeks or more, regardless of quantity, should raise concern over possible alcohol withdrawal.

So, while you can make some possible predictions, you may just have to look at the drinking history pattern and project from that, and make preparations for withdrawal symptoms to occur in cases of extended consumption, even if it the first time the patient has consumed in that manner.

As far as the preparations, there is this article which addresses the clinical features, assessment and management of AWS (Alcohol Withdrawal Syndrome).

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  • Thanks, JohnP! I still think it might be possible to study more directly, but this is a good start. (Incidentally, I think that article may be just wrong when it claims a “half-life of alcohol.” My understanding is that alcohol follows zero order elimination kinetics. The term ‘half-life’ is meaningless in that case (or, if you prefer, it varies by concentration...which makes it fairly useless).) – Susan May 8 '15 at 11:21
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    @Susan - Also appears to increase in efficiency, suggesting that elimination can be "trained". Wonder if that holds true (or has been studied) in other medications? – JohnP May 8 '15 at 14:44
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    It is/has/does, particularly with the hepatic cytochromes. Drug-drug interactions are frequently due to induction/inhibition of this enzymes. Alcohol is an inducer of the same enzymes that metabolize it, hence the “training” effect you mention. – Susan May 8 '15 at 14:53
  • @Susan - Ah, cheers! – JohnP May 8 '15 at 14:55

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