What are the typical features of alcohol withdrawal?

Alcohol withdrawal occurs in people physically dependent on alcohol. Severity ranges from mild discomfort to life-threatening. Timeline: (1) 6-24 hours: minor withdrawal — tremors (especially hands), anxiety, headache, nausea/vomiting, sweating, increased pulse and blood pressure, insomnia, agitation; (2) 12-48 hours: withdrawal seizures (typically tonic-clonic, brief) — at-risk window 12-48 hours; (3) 12-48 hours: alcoholic hallucinations — visual hallucinations more common than auditory (different from psychotic hallucinations which are typically auditory); sensorium intact; (4) 48-96 hours: delirium tremens (DTs) — disorientation, severe agitation, hallucinations (often vivid, fearful), severe autonomic instability (very high BP, tachycardia, hyperthermia), tremors, diaphoresis; mortality 5-15% without treatment, <5% with treatment. CIWA scale (Clinical Institute Withdrawal Assessment) quantifies severity and guides medication. Treatment: (1) Benzodiazepines — gold standard; cross-tolerance with alcohol allows controlled detoxification; lorazepam, diazepam, chlordiazepoxide commonly used; can be scheduled or symptom-triggered (CIWA-based); (2) Thiamine BEFORE glucose — to prevent Wernicke encephalopathy (B1 deficiency in alcoholics; characterized by confusion, ataxia, ophthalmoplegia); (3) Folate, multivitamin; (4) Electrolyte replacement (magnesium especially); (5) Fluids; (6) Quiet, well-lit environment; (7) Seizure precautions; (8) Frequent reorientation. Severe cases need ICU monitoring. Long-term treatment for alcohol use disorder: medications (naltrexone, acamprosate, disulfiram), 12-step programs (AA), therapy (CBT, motivational interviewing), residential treatment.