In-Custody Acute Alcohol Withdrawal

If you are an arresting or a detentions officer, and you believe that a subject is in or at risk for acute alcohol withdrawal, seek emergency medical treatment immediately. The consequences of acute alcohol withdrawal can be fatal, even during...


In March, 2012 Kendall Lyons filed a lawsuit in the U.S. District Court in Eugene, Oregon.  Lyons suffered a seizure and struck his head on a cement bed while withdrawing from alcohol. He claims that his injuries could have been prevented had sheriff’s officials been more responsive to his medical condition. The lawsuit seeks $352,000 in noneconomic damages and $31,496 in medical expenses.

In May, 2011 New York City agreed to pay $2 million to settle a civil rights action lawsuit alleging that a postal worker died in jail because his severe alcohol withdrawal went untreated due to deliberate indifference by medical personnel and correction officers.

In June, 2006 the State of Alaska paid $573,000 to settle a federal civil rights lawsuit involving the death of Troy Wallace, who was 31 years old.  Wallace suffered seizures and DT before collapsing in his Ketchikan jail cell.  The lawsuit alleged that jail employees, including corrections officers, were negligent and deliberately indifferent to Wallace's medical needs.

The Problem

Approximately 18 million Americans are alcohol dependent.  Alcohol dependence, also known as alcoholism, is a condition characterized by impaired control over drinking, compulsive drinking, a preoccupation with drinking, an increased tolerance to alcohol, and physical withdrawal symptoms.  Alcoholics invariably have an increased rate of contact with law enforcement and subsequent incarceration. It is estimated that 12% of all the inmates in the country’s jails are alcohol dependent. It is essential that all patrol and corrections officers recognize the symptoms of acute alcohol withdrawal and intervene quickly and appropriately. Failure to do so could result in the injury or death of a detainee or inmate, as well as the possibility of a lawsuit filed against you and/or your department. 

Law enforcement officers will encounter alcoholics who have stopped drinking either because of lack of access to alcohol or illness. This sudden cessation may lead to a number of physical and mental symptoms that can range from mild to life threatening.  Depending on when their alcohol supply has been cut off, the symptoms of withdrawal may not occur until after the individual has been arrested and placed in a squad car, holding cell, or jail. 

Acute alcohol withdrawal symptoms can occur in any individual who is physically dependent on alcohol that stops or decreases their alcohol consumption.  Inmates are not always honest about their alcohol and drug habits on intake. Some over-report hoping for special treatment and medications.  Others under-report, fearing criminal charges. Without honest information the intake nurse may not identify a need for withdrawal monitoring. Officers need to be aware of symptoms of withdrawal that indicate a need for medical intervention.  The three primary signs of early alcohol withdrawal are pacing, sleeplessness, and elevated heart rate (140+). Additionally, individuals withdrawing from alcohol typically do not have an appetite/frequently refuse food, tremble, and perspire profusely. 

What Happens When an Alcoholic is Deprived of Alcohol?

Alcohol has a sedating effect on the brain.  When an individual’s brain is continually exposed to the depressant effect of alcohol it begins to adjust its own chemistry.  The brain starts producing serotonin and norepinephrine in larger than normal quantities.   If alcohol is suddenly stopped the brain is not able to readjust its chemistry. The brain becomes over-stimulated and can create a state of temporary confusion, which may lead to dangerous changes in circulation, respiration, seizures, as well as, numerous other psychiatric and physical symptoms. Individuals who experience acute alcohol withdrawal symptoms typically have abused alcohol on a daily basis for at least three months, or they have consumed large quantities for at least one week.   Delirium tremens (DT) is the most acute manifestation of alcohol withdrawal.  Delirium refers to a syndrome of disorientation, confusion and often hallucinations caused by a specific disease process. DT is a medical emergency that requires immediate treatment.

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