Delirium Tremens: What Is It?


Problem drinking and alcohol use disorder is incredibly common in America, and their prevalence is growing every day. This escalation in alcohol abuse can lead to more significant long-term abuse situations, which result in much more difficult alcohol withdrawal scenarios. The symptoms of alcohol withdrawal can be challenging on their own. For those who have been drinking heavily for a long time, there is the potential for dangerous and even deadly alcohol withdrawal symptoms, such as delirium tremens.

What Is Delirium Tremens?

Delirium tremens are also known as “the DTs” and are one of the most dangerous results of alcohol use disorder (AUD). This form of AUD is accompanied by severe symptoms that may be encountered during the alcohol withdrawal process. 

It is often only seen in individuals that have a history of chronic heavy alcohol use and who have previously attempted the alcohol detox process. It is rare, only being seen in about 5% of those who are at risk, but it is also deadly, being responsible for a fatality rate of nearly one in ten that are diagnosed with it.

Stages of Alcohol Withdrawal

The progression of the alcohol detox process is often unique to each individual that endures it, although there are some commonalities in the timeline. There are generally four stages of alcohol withdrawal syndrome, and most individuals will not see every stage. Many light drinkers will experience at least the first stage, while heavier drinkers will experience other stages of acute alcohol withdrawal. 

Stage 1

The initial alcohol withdrawal symptoms will begin 6 to 12 hours after the last drink. In heavy drinkers, this can be as little as 4 hours without additional alcohol. The symptoms in this stage will include sweating, nausea, vomiting, tremors, hyperthermia, increased respiration, and increased heart rate.

Stage 2

12 to 24 hours after the last drink, more serious and uncomfortable symptoms may present. Most individuals that experience this stage will feel a “pins and needles” sensation in their extremities, similar to having hands and feet that were asleep. Heavier drinkers will sometimes begin to experience hallucinations, hearing and seeing things that are not actually happening.

Stage 3

Drinkers that are still experiencing intense symptom progression 24-48 hours after their last drink should seek medical attention. During this stage, heavier drinkers are at high risk of experiencing seizures. If not medically supervised, these seizures can sometimes be fatal.

Stage 4

The final stage of severe alcohol withdrawal will start 48-72 hours after the last drink. This stage can last an additional five days or up to ten in rare cases. Individuals that make it to stage 4 are at high risk of developing delirium tremens. This will often include hyperactive cardiovascular and autonomic nervous systems, which can result in eventual cardiac collapse and fatal heart failure.

Post-acute withdrawal syndrome is incredibly common for those going through alcohol detox. The acute stage of alcohol detox is largely physical symptoms. The post-acute stage will consist mostly of psychological symptoms, as well as some lingering physical symptoms. Acute alcohol withdrawal will often last between three and five days when the physical symptoms begin to fade, and post-acute symptoms become more prevalent. The symptoms common in this stage include:

  • Reduced concentration and focus
  • Cravings to drink
  • Increased irritability or anger
  • Sleep cycle disruption
  • Low energy and fatigue
  • Reduction in fine motor skills
  • Anxiety
  • Emotional fluctuation

Delirium Tremens Causes & Risk Factors

Alcohol is a powerful depressant that causes significant changes to the nervous system, causing a considerable slowdown in brain activity. This is why those who drink report feeling relaxation and sedation when drinking, as well as lowered anxiety levels. 

As the drinking continues, the brain and nervous system will become used to the effects and develop a tolerance for it. This results in the need for the individual to drink more to achieve the same effect. This tolerance and eventual dependency are the cornerstones for developing a risk for delirium tremens.

There are additional risk factors as well, many related to the circumstances immediately preceding the alcohol detox attempt and subsequent development of delirium tremens. These risk factors include:

  • Larger quantities of alcohol being consumed before a withdrawal attempt are often seen as “ramping up” before going cold turkey
  • Previous attempts to complete alcohol withdrawal and detox
  • Any previous experience of severe alcohol withdrawal symptoms, including prior episodes of delirium tremens or alcohol-related seizures
  • Co-morbidities like heart conditions, liver disease, or traumatic brain injuries
  • Old age
  • History of psychiatric conditions
  • Sub-optimal general health or malnutrition

Symptoms & Signs of Delirium Tremens

The symptoms and signs of delirium tremens won’t just appear out of nowhere. Typically, they will be a natural progression of more mild withdrawal symptoms. One of the more notable traits of delirium tremens is that the symptoms will change over a day and will frequently be accompanied by:

  • Intense confusion
  • Visual or auditory hallucinations
  • Irritability, agitation, anger, or even hostility
  • Slipping in and out of consciousness
  • Nausea & vomiting
  • Sweating uncontrollably
  • Trembling or shaking uncontrollably
  • Tachycardia
  • Experiencing tremors or seizures

Anyone that begins experiencing any of these symptoms while attempting alcohol detox should get to a medical facility immediately and obtain alcohol addiction help. Untreated delirium tremens can easily be fatal, but medical professionals can help minimize the potential danger and damage.

Detoxing the Safe Way

If you or someone you know is at risk for developing delirium tremens during alcohol detox and needs alcohol addiction help, reach out to Agape’s alcohol detox program today. The addiction experts at Agape will be able to help create a treatment program tailored to the individual. They will be able to detox in a welcoming, comfortable environment equipped with round-the-clock medical supervision.

Once the alcohol withdrawal symptoms have begun to fade, the individual will be able to receive additional alcohol addiction help with the post-acute withdrawal stage that often follows. There will be counseling and therapy options made available to them that can help build healthier coping mechanisms for potentially triggering events or situations, giving them the best chance at a successful recovery.

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