Mental HealthPending review

Alcohol dependence

A neuroadaptive state in which chronic GABA-potentiation and glutamate suppression by alcohol forces the brain to re-tune its own excitatory-inhibitory balance, so that stopping abruptly unmasks a dangerous rebound hyperexcitability.

In a nutshell

Chronic alcohol use down-regulates GABA-A and up-regulates NMDA-glutamate receptors to maintain normal function in its presence: dependence is this neuroadaptation. Abrupt cessation unmasks rebound hyperexcitability (tremor, seizures, delirium tremens), managed with cross-tolerant benzodiazepines, while thiamine must precede glucose to prevent Wernicke's encephalopathy.

Classic presentation

A patient with a long history of heavy daily drinking develops tremor, agitation, sweating and tachycardia 6–24 hours after their last drink, with a history of morning drinking to avoid these symptoms.

Key points

Withdrawal is caused by unopposed CNS hyperexcitability once alcohol's GABA-potentiating, glutamate-suppressing effect is removed from a neuroadapted brain.

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Educational content pending clinical review. Not medical advice.