A new observational study of 384 Ayyappa devotees who regularly drank alcohol before the Vrischika fasting period found that the overwhelming majority experienced no clinically significant withdrawal symptoms during their weeks of strict abstinence, and not a single participant developed moderate or severe withdrawal.
The study, published in the Bulletin of Faculty of Physical Therapy, was conducted by Kaviya Muralidharan, Ramya Arasar and Rajkumar Murugan, who assessed devotees during the fasting period that runs from November to January. Using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-AR), a validated instrument covering ten symptom domains including nausea, tremor, sweating, anxiety, agitation, sensory disturbances and orientation, the researchers interviewed participants about symptoms they experienced during the fasting phase while also noting observable signs such as tremors and agitation.
The headline result is striking. According to the paper, 88.5 percent of participants experienced no withdrawal symptoms at all, and every symptom that did appear remained within the mild severity range, with no participant exceeding a CIWA-AR score of 10. Agitation was the most commonly reported symptom, affecting 7.3 percent of the sample, followed by anxiety at 4.2 percent. Paroxysmal sweats and headache each affected 2.9 percent of participants. Physical manifestations were rare: nausea and vomiting occurred in 1.3 percent, and tremors in just 0.8 percent, described as transient fingertip tremors that were clinically insignificant and caused no functional impairment.
This profile stands in sharp contrast to figures reported in clinical settings. The authors note that studies in medical and addiction treatment populations report moderate-to-severe withdrawal symptoms in 20 to 40 percent of cases, delirium tremens in 5 to 15 percent of patients, and tremors in 50 to 70 percent of individuals undergoing medically supervised detoxification. Against an expected withdrawal prevalence of 50 to 70 percent cited from general population studies of alcohol cessation, the near-absence of symptoms in this cohort represents what the authors describe as an approximately 80 to 85 percent reduction. They caution, however, that the comparison is between very different populations and settings, and that their study was not designed to test causal explanations.
The cohort itself was carefully screened. To be eligible, devotees had to be male, aged 18 or older, and to have consumed alcohol at least twice weekly for a minimum of six months before the fasting period, ensuring the sample reflected established drinking patterns rather than casual use. People with infrequent or light consumption, substance use disorders other than alcohol, pre-existing neurological or mental illnesses, ongoing psychiatric therapy, or chronic medical conditions requiring frequent medication were excluded, as were anyone who drank during the fast. One third of the final sample reported drinking daily before the fast, so the benign outcome cannot simply be attributed to light drinking.
The study did identify some patterns within the mild symptom burden. Younger devotees aged 18 to 40 reported significantly more agitation than those aged 41 to 60, with 8.9 percent versus 2.9 percent affected, an odds ratio of 3.24, although the confidence interval of 0.96 to 10.98 just crossed unity. Several symptoms, including tremors and various perceptual disturbances, were entirely absent in the older group, though the authors stress that the low absolute frequencies limited definitive conclusions for most symptoms.
Comorbidities also appeared to shape the symptom picture. Participants with diabetes showed significantly more agitation than those without the condition, 14.5 percent versus 5.9 percent, and a markedly higher rate of headache or fullness in the head, 9.7 percent versus 1.6 percent, an odds ratio of 6.79. The authors suggest that alcohol cessation can affect glucose homeostasis, potentially triggering glycaemic fluctuations and headaches, but they are careful to note that after applying Bonferroni correction for multiple comparisons, these associations would not retain statistical significance and should be treated as hypothesis-generating. Hypertension showed a non-significant trend toward increased tremor risk, while coronary heart disease showed no significant associations with any measured symptom.
Perhaps the most biologically telling finding concerned drinking frequency. Tremors occurred exclusively among the heaviest drinkers, those consuming alcohol five to seven days per week, at a rate of 2.4 percent, with zero cases in the lower-frequency groups. A Cochran-Armitage trend test confirmed a statistically significant linear dose-response relationship for tremors, consistent with the neurobiological model in which chronic daily exposure produces the GABAergic and glutamatergic adaptations that underlie physical dependence. Paroxysmal sweating, by contrast, showed a U-shaped distribution, most prevalent in the lightest drinkers and absent in moderate-frequency drinkers, without a significant linear trend, which the authors interpret as possibly reflecting distinct consumption phenotypes such as binge-pattern drinking. Psychological symptoms like agitation and anxiety showed no consistent dose-response relationship, suggesting they were driven more by contextual and individual factors than by physiological dependence.
Why was withdrawal so mild in this population? The authors offer several non-exclusive explanations, all framed as hypotheses rather than demonstrated mechanisms. Religious motivation may act as a psychological buffer: the fast is not mere abstinence but a comprehensive spiritual practice involving daily prayers, dietary restrictions and behavioural modifications, and research on substance use suggests that abstinence perceived as freely chosen and personally meaningful is associated with less subjective distress. Social support embedded in the pilgrimage, with community prayers and continuous reinforcement from fellow devotees, may also play a role. The accompanying lifestyle changes, including simplified diet, regular sleep and reduced sensory stimulation, could plausibly dampen the central nervous system hyperexcitability that characterises withdrawal. The authors also raise a more mundane possibility: despite regular consumption, many devotees may simply not have developed severe physiological dependence, since even among daily drinkers tremors appeared in only 2.4 percent. Finally, they note that weeks of mental and spiritual preparation precede the fast, so while the physical cessation is abrupt, the psychological transition may be gradual.
The findings come with important caveats. The study used convenience sampling, which the authors acknowledge may have introduced selection bias and limits generalizability. Reliance on self-reported alcohol use and symptoms raises the possibility of recall and social desirability bias, particularly in a context where abstinence is a sacred commitment. The cross-sectional design precludes causal inference and says nothing about long-term abstinence or relapse after the fasting period ends. Only male participants were included, and the culturally specific religious context may restrict transferability to other settings. The authors also emphasise that their comparison with clinical populations is indirect, since clinical cohorts typically include people with comorbid medical and psychiatric conditions that this study deliberately excluded.
Nevertheless, the authors argue the results carry practical implications. They suggest that healthcare providers serving communities that observe the Sabarimala pilgrimage could identify higher-risk devotees, such as younger individuals, diabetic patients and daily drinkers, and offer anticipatory guidance during the fasting period. More broadly, they propose that elements observed in this context, including strong personal motivation, clear behavioural structure, social support networks and meaningful purpose, might inform community-based cessation programmes, while stressing that current clinical guidelines recommending supervised tapering or pharmacological support remain appropriate for many clinical populations. They call for longitudinal and cross-cultural research to determine whether the benign withdrawal profile observed here persists beyond the fasting period and whether similar mechanisms operate in other traditions of temporary abstinence, from Ramadan to Dry January. For now, the study documents a remarkable natural experiment: hundreds of regular drinkers stopped drinking at once, and almost nothing happened to them.
Subject of Research: Alcohol withdrawal symptoms among Ayyappa devotees during the Vrischika fasting period
Article Title: Prevalence of alcohol withdrawal symptoms during the Vrischika month among Ayyappa devotees
Article References: Muralidharan, K., Arasar, R., & Murugan, R. (2026). Prevalence of alcohol withdrawal symptoms during the Vrischika month among Ayyappa devotees. Bulletin of Faculty of Physical Therapy, 31(1), Article 43. https://doi.org/10.1186/s43161-026-00380-9
Image Credits: AI Generated
DOI: 10.1186/s43161-026-00380-9
Keywords: alcohol withdrawal, Ayyappa devotees, Sabarimala pilgrimage, Vrischika fasting, CIWA-AR, alcohol abstinence, observational study, religious fasting, agitation, tremors, diabetes, drinking frequency
News Source: Ophelia Keating. (October 28, 2026). Fasting Ayyappa Devotees Show Almost No Alcohol Withdrawal Symptoms in New Study. Scienmag.
