What Is Alcohol Withdrawal Delirium?

Imagine waking up in a whirlwind of disorientation where reality blurs and shadows dance in your periphery. You get up but your room warps into a puzzling landscape, familiar faces morph into strangers, and even the simplest actions become daunting. You’re hoping to snap out of it, but this isn't a scene from a nightmare. It’s the stark reality of alcohol withdrawal delirium, also referred to as delirium tremens (DTs).

DTs is a severe and potentially life-threatening condition that can arise after abruptly stopping heavy alcohol consumption. This form of alcohol withdrawal can plunge us into a state of intense confusion, vivid hallucinations, and erratic physical symptoms. For those looking to quit or cut back on alcohol, understanding DTs is crucial in managing safe detox and recovery. Let's dive into all things DTs to equip you with the tools to confront this challenging aspect of alcohol withdrawal.

Delirium Tremens (DTs): Alcohol Withdrawal’s Most Severe Form

Delirium tremens (DTs), also known as alcohol withdrawal delirium (AWD), is the most extreme form of alcohol withdrawal. It causes severe problems in our brain and nervous system that can be potentially fatal. In those with alcohol use disorder (AUD), about 50% of people experience withdrawal symptoms, and out of those people, 3% to 5% percent experience severe symptoms of delirium tremens. How can we tell DTs from general alcohol withdrawal?

Recognizing Delirium Tremens Symptoms

Symptoms of alcohol withdrawal appear between 6 to 24 hours after drinking, but symptoms of DTs often occur a bit later. They typically appear within three days to a week or more after stopping drinking. Symptoms of DTs include general symptoms of alcohol withdrawal:

• Agitation and anxiety
• Fatigue
• Fever and excessive sweating
• Nausea and stomach pain
• Chest pain
• Sensitivity to light/sound
• Increased heart or breathing rate

Symptoms more indicative of DTs (and not regular withdrawal) include the following:

• Delirium (severe confusion and disorientation)
• Delusions (irrational thoughts)
• Uncontrolled eye and muscle movements
• Hallucinations
• Sensitive startle reflex
• Seizures
• Sudden mood changes

If experiencing any severe symptoms, consult a physician and call 9-1-1 for emergency medical treatment. Now that we’ve learned to identify DTs, let’s examine why we experience withdrawal when we quit drinking.

Causes and Risk Factors for Delirium Tremens

To understand the risk factors for DTs, let’s first take a look at why alcohol withdrawal occurs. When we drink, alcohol excites and aggravates our nervous system, and our body becomes dependent on it over time.

The two main culprits? Gamma-aminobutyric acid (GABA) and glutamate — two neurotransmitters or chemical messengers in our brain. GABA decreases nerve cell signaling (producing a calming effect) and glutamate increases cell signaling (optimizing brain function for learning and memory). When we drink, alcohol increases GABA and suppresses glutamate, producing the calm, pleasurable feeling we may experience from alcohol. When we stop drinking, GABA levels drop and glutamate is no longer suppressed — prompting our brain to go into a state of overexcitement, causing withdrawal symptoms. 

Since DTs is the most severe form of alcohol withdrawal, it only affects those of us with a history of heavy and prolonged alcohol use. We may develop DTs when we stop drinking or reduce our alcohol consumption too quickly. Certain risk factors can increase our risk of developing DTs, for example if we:

• Have co-occurring psychiatric conditions
• Have poor overall health
• Have a family history of DTs
• Are older in age
• Have a head injury
• Experienced previous withdrawal episodes

While these factors may increase our risk of developing DTs, all heavy, long-term drinkers are at risk. According to the CDC, heavy drinking refers to having 15 or more drinks in a week for men and 8 or more drinks in a week for women. But that’s not all! The CDC also classifies binge drinking as excessive drinking, and it’s actually the most common form of heavy drinking. Binge drinking means having 5 or more drinks in one sitting for men and 4 or more drinks in one sitting for women. 

So, if we do develop delirium tremens, can it be treated? 

Types of Delirium Tremens Treatments 

DTs can be dangerous and even fatal. In most cases, hospitalization is recommended to ensure our safety and manage any complications. Treatment for DTs requires an extensive approach that involves the following methods:

• Pharmacological treatments. There are no specific delirium tremens medications, but some types of drugs, including sedatives, anticonvulsants, and antipsychotics, are used to treat common symptoms of DTs.
• Intravenous fluids. This can help ensure hydration during alcohol detox and provide nutritional support. 
• Treatment for other alcohol-related conditions. Excessive drinking is associated with many health conditions. These include liver disease, cardiovascular disease, GI issues, diabetes, cancer, and more. While DTs is being treated, other alcohol-related conditions may also require management. 
• Long-term care. DTs occurs after prolonged, excessive drinking, which may indicate alcohol dependence or AUD. Aside from medical stabilization, long-term care including rehabilitation programs and psychological support may be recommended.

There are effective treatments for DTs, but what about complications that may arise?

Transitioning From Active Addiction to Active Recovery

Active addiction, more aptly referred to as alcohol use disorder (AUD), is actively drinking and not being able to quit or cut back despite negative consequences. It differs from active recovery because recovery refers to taking steps to improve our relationship with alcohol even though we may not be sober or completely abstinent. The transition from active addiction to active recovery through these strategies is the first step in developing a healthier relationship with alcohol:

• Practice self-honesty. The first hurdle is recognizing that we have negative drinking habits. To get a clearer picture, we can track our alcohol consumption and practice self-honesty to make that first step towards change.
• Find your purpose. One of the main aspects of active recovery is having the mindset to back up our actions. Determining our purpose for recovery can help motivate us to start and maintain recovery.
• Set realistic goals. Quitting alcohol cold turkey may not be effective and can even be dangerous. Setting small realistic milestones helps make reaching our goals to quit or cut back seem less daunting and more attainable. 
• Seek support. Recovery isn’t all sunshine and rainbows like sobriety promises to be. However, we don’t have to do it alone. There are many treatment options including behavioral therapies, rehab programs, and peer support groups that we can explore if we need extra support.
• Actively participate. While we can passively attend treatment programs and support groups, we’ll get the most out of them by actively participating. Ask questions, connect with others, and take initiative for your own recovery! 
• Build a support network. Professional treatment is beneficial, but so is social support. Reach out to close family and friends and join communities like Reframe to receive and share support from like-minded individuals. 

If we notice that we’re taking more of a passive approach, we can use these same strategies to transition from passive to active recovery.

Complications and Outlook of Delirium Tremens 

Since DTs is caused by heavy alcohol consumption, other complications that are associated with excessive drinking can also occur. Additional conditions that may co-occur and require treatment include the following:

• Increased risk of falling or injury. DTs manifests in dangerous symptoms such as seizures, hallucinations, and delirium. This greatly increases our risk of falling or injury.
• Alcoholic cardiomyopathy. This type of heart disease known as alcoholic cardiomyopathy occurs when prolonged alcohol use weakens the heart muscles, affecting their ability to pump blood. It can lead to an irregular pulse, shortness of breath, and disruption of major bodily functions, leading to heart failure and other serious health issues.
• Alcohol-related liver disease. This is one of the most common conditions associated with excessive alcohol consumption, since our liver is in charge of breaking down and eliminating the toxins from alcohol. Alcohol causes scarring and damage (cirrhosis), which can lead to liver failure and cancer.
• Alcoholic neuropathy. Prolonged drinking can cause permanent damage to our nerves known as alcoholic neuropathy. Symptoms can include tingling, pain, numbness, and muscle impairments.
• Wernicke-Korsakoff syndrome. This disorder is linked to AUD and involves damage to certain parts of the brain. Symptoms include memory impairments, behavioral changes, disorientation, and mobility challenges. 

These additional risks and co-occurring conditions make navigating DTs even more challenging. While DTs can be fatal, luckily there’s a low mortality rate with timely intervention and early medical treatment. 

DTs can be treated, but some symptoms can linger far beyond medical stabilization. Symptoms such as fatigue, insomnia, and mood swings can remain for up to a year or more, a condition known as post-acute withdrawal syndrome. Going through alcohol withdrawal or DTs is no easy feat, to say the least. So, how can we better prevent it from happening?

Tips for Preventing Delirium Tremens and Alcohol Withdrawal

We’ve already completed the first step in preventing DTs — learning about what it is. We can further increase our health and safety by implementing these strategies: 

• Learn more. Understanding what causes alcohol withdrawal and signs to look out for increases our chances of early intervention. This prevents continued excessive drinking, which can lead to DTs. 
• Quit or cut back before it becomes heavy drinking. It may go without saying but alcohol withdrawal occurs due to excessive drinking. Quitting or cutting back on alcohol before it becomes heavy drinking not only helps prevent alcohol withdrawal and DTs down the road but also other detrimental health and social effects. 
• Avoid quitting cold turkey. Suddenly quitting or significantly cutting back can be dangerous. Consult a healthcare provider to find the best course of treatment. It may be a more gradual approach to quitting!
• Explore supported alcohol detox. Alcohol detox can be done at home (when appropriate and done correctly) but monitored alcohol detox (done in a rehab facility) can more effectively ensure our safety. We’ll receive support with detoxing slowly, be monitored for any complications, and receive other supporting treatments as needed.
• Seek treatment. We don’t have to wait until we experience withdrawal symptoms to seek support. If we’re concerned about our drinking habits or simply want to develop a healthier relationship with alcohol, there are treatment options that help us intervene early and prevent the dangers of alcohol withdrawal and DTs. 

Early intervention and timely medical treatment are key when it comes to managing and preventing DTs. Developing a better relationship with alcohol can be challenging, but we don’t have to do it alone. Join Reframe’s welcoming community to connect with others who may be going through a similar experience.

Staying on Top of It

Symptoms of delirium tremens can seem like a scene taken right out of a nightmare, but it’s a real occurrence that is caused by stopping alcohol consumption after prolonged, excessive use. Learning to identify symptoms of DTs can ensure we obtain timely medical treatment, greatly increasing our chances of successful recovery. To further improve our health and safety, we can quit or cut back on alcohol. With this knowledge of DTs, we’re better equipped to tackle it!