Excessive alcohol use followed by abrupt discontinuation of use can lead to a condition known as delirium tremens (DTs). It is characterized by severe and potentially life-threatening symptoms. These usually onset, on average, about 72 hours after the last drink and can persist for another 48-72 hours.
For this reason and others, persons attempting to withdraw from alcohol must seek medical help to prevent potentially lethal effects, including seizures and heart failure.
Severe alcoholics will experience some withdrawal symptoms if they stop or significantly reduce their alcohol consumption. Of these, up to 5 percent will have seizures or other problems associated with DTs if they stop drinking and do not have access to emergency medical intervention.
Effects may include the following:
- Shaking and chills
- Irregular heartbeat
- Increased body temperature
In some instances, an elevated body temperature or seizures can prove lethal. Alcohol is one of few substances that may induce life-threatening withdrawal effects. Barbiturate and benzodiazepine withdrawals can incite similar symptoms, however.
DTs usually manifest only in those who have consumed alcohol excessively for more than 30 days, and symptoms are often worse at night.
Signs and Symptoms of DTs
The main symptoms of DTs include the following:
- Tactile hallucinations
- High blood pressure
- Excessive sweating
- Elevated heart rate
Moreover, delirium tremens is the most severe result of alcohol withdrawal syndrome. DTs often include intense feelings of anxiety, fear, paranoia, impending doom, and imminent death. DTs can also induce uncontrollable tremors and panic attacks. The most common cause of death during an episode of DTs is cardiac failure.
What Causes DTs?
The precise mechanisms that cause delirium tremens is not entirely understood. However, it is widely thought that the condition is related to the neurotransmitter GABA, a chemical responsible for inducing peace and relaxation. Moreover, drinking excessive amounts of alcohol, especially over a prolonged period, impairs the body’s ability to regulate the neurochemical GABA.
To elaborate, when an individual drinks excessively, experts contend that the body begins to mistake alcohol for GABA and, for this reason, reduces production. So when a chronic alcohol user stops drinking suddenly or “cold turkey,” alcohol levels decline, and the body interprets this as having insufficient GABA to function correctly.
Is DTs the Same as Alcoholic Hallucinosis?
DTs are different from alcoholic hallucinosis (AH). AH is rarely lethal and occurs in about 20 percent of alcoholics admitted to a hospital. DTs, conversely, is less common and occurs in up to 10 percent of alcoholics, yet is fatal 15-40 percent of the time, depending on whether the individual receives treatment.
Finally, the DTs are often hallmarked by a condition known as “altered sensorium” or a complete hallucinogenic experience without any real-world perception. AH is rarer and is typically limited to intense auditory hallucinations.
Treatment for DTs
DTs often require intensive inpatient treatment and high doses of benzodiazepines (benzos) to avoid seizures or death. Through the worst of DTs, the individual is usually placed under sedation using benzos such as lorazepam (Ativan) or diazepam (Valium).
Other pharmaceutical treatments include the following:
- Antihypertensive medication, such as clonidine
- Anticovulsant medications, such as gabapentin
- Baclofen, a muscle relaxer
- Barbiturates, such as phenobarbital
- Haloperidol, an antipsychotic
- Thiamine (B12) (intravenous delivery preferred)
As noted, the fatality rate without treatment is about 15-40 percent, but individuals who are medically monitored have a lower incidence of fatality and die in approximately 1-4 percent of cases.
Alcohol Detox Timeline
Withdrawal symptoms can onset as early as two hours after a person’s last drink. However, they usually manifest later after much more time has passed. While the most unpleasant and painful symptoms typically wane during the first week, some psychiatric symptoms can persist for several weeks. The alcohol withdrawal process, in general, follows this timeline:
6-12 hours: The initial symptoms of alcohol withdrawal tend to be mild but can rapidly begin to worsen over time. Early withdrawal symptoms include headaches, anxiety, shakiness, nausea and vomiting, and irritability.
24 hours: By around the first 24 hours of detox, symptoms may increase in severity. In addition to the effects experienced during the first 12 hours, additional symptoms may develop, including disorientation, tremors, and seizures.
48 hours: Like the first 24 hours of withdrawal, the most painful symptoms will continue into the second day. Hallucinations, anxiety, and panic attacks are common during this time as the body eliminates alcohol from its system.
72 hours to one week: Different withdrawal symptoms wax and wane. This is the timeframe when a person is at risk for life-threatening symptoms such as delirium tremens and seizures.
After one week: By the time you’ve completed your first full week of detox, many withdrawal symptoms should have subsided. While some symptoms may last for several weeks, most of them are emotional in nature and can be treated with medication.
Getting Help for Alcohol Abuse and Addiction
Persons who are attempting to quit drinking are urged to seek medical detox, followed by a comprehensive treatment program, as soon as possible. Detoxing at home is never advised and places an individual at an increased risk of relapse or life-threatening complications such as seizures.
Just Believe Detox and Just Believe Recovery offer addiction treatment that includes a wide variety of clinically-proven methodologies, including the following:
- 12 step and group meetings
- Individual and family counseling
- Substance abuse education
- Health and wellness education
- Relapse prevention
- Art and music therapy
- Aftercare planning