Alcohol withdrawal is an incredibly serious undertaking, much more so than other substances. Regular symptoms of alcohol detox can include anxiety, sweating, headaches, and mood swings. However, alcohol affects many different parts of the body, most notably the nervous system. If someone is physically addicted to alcohol and wants to detox, they’re in for much more than a hangover.
People who are chronic heavy drinkers are at serious risk for serious risk for delirium tremens, a condition that can lead to serious bodily harm or death if not treated properly by a medical professional. This is much more severe than just getting “the shakes.” It’s important to know the delirium tremens timeline so that you can tell the signs of delirium tremens, how long to expect each sign to last, and when things are starting to go dangerously wrong.
What Are Delirium Tremens?
Delirium tremens (DTs) is a severe and potentially life-threatening complication of alcohol detox and withdrawal, characterized by sudden and intense changes in mental status and autonomic nervous system dysfunction. Alcohol works as a depressant, and thus this condition (in a very simplified explanation) is the nervous system “restarting” without these depressant effects.
DTs typically occur in individuals with a history of heavy and chronic alcohol use who abruptly stop or significantly reduce their alcohol intake. Prompt medical attention is essential to manage DTs, as untreated cases can lead to complications such as seizures, dehydration, and even death. If left completely untreated, delirium tremens can have up to a 37% chance of fatality. But if symptoms are caught early and the person receives treatment, this can drop all the way down to 5%.
What Causes Delirium Tremens?
Delirium tremens is a symptom of alcohol withdrawal. It directly correlates to how alcohol affects the nervous system and is a reaction by the nervous system readjusting to functioning without the presence of alcohol. Because of the vital function of the nervous system within the body, DTs can be life-threatening and even fatal if not treated in a timely manner.
What Are the Risk Factors For Delirium Tremens?
Not everyone with a substance use disorder will suffer from delirium tremens. But there are a few risk factors that make someone more inclined to experience it:
Chronic and excessive alcohol use, especially if it takes place over many years, significantly increases the risk of developing delirium tremens during withdrawal.
Individuals who have experienced DTs during alcohol withdrawal in the past are at higher risk of experiencing it again.
Older adults are at increased risk of delirium tremens due to age-related changes in metabolism and their increased vulnerability to alcohol’s effects.
Certain medical conditions, such as liver disease, cardiovascular disease, electrolyte imbalances, and infections, can increase risk and severity.
Individuals with a long history of heavy and chronic alcohol use, as well as those with a high tolerance to alcohol (such as functional alcoholics), are at greater risk of developing delirium tremens.
Suddenly stopping or reducing alcohol consumption after prolonged and heavy use can trigger withdrawal symptoms, including delirium tremens.
Malnutrition or deficiencies in essential nutrients, commonly associated with chronic alcohol use, can exacerbate the risk and severity of delirium tremens.
Coexisting psychiatric disorders, such as depression, anxiety, or post-traumatic stress disorder (PTSD), may increase susceptibility to delirium tremens.
Certain medications, including sedatives, antidepressants, antipsychotics, and antihypertensives, can interact with alcohol and increase the risk of DTs during withdrawal.
Genetic predisposition may play a role in an individual’s susceptibility to developing delirium tremens, although the specific genetic factors involved are not fully understood.
Statistically, only about 3-5% of all people undergoing alcohol withdrawal experience delirium tremens. But the older a person is and the longer they have been drinking heavily, the more likely they are to experience delirium tremens.
Is Delirium Tremens Reversible?
Yes, delirium tremens is reversible with prompt and appropriate medical treatment. Treatment typically involves supportive care (including administration of benzodiazepines and/or other medications to manage symptoms) as well as addressing any underlying medical issues. With proper medical intervention, most individuals with delirium tremens recover fully within several days to a week. However, without treatment, DTs can be fatal. This is why it’s important to undergo alcohol detoxification in a medically assisted setting.
How to Prevent Delirium Tremens
To prevent delirium tremens, individuals with alcohol dependence should seek medical supervision and support when they want to stop using alcohol. Gradual tapering of alcohol consumption under medical guidance can reduce the risk of severe withdrawal symptoms, including DTs.
Additionally, individuals should make sure they’re receiving adequate nutrition, hydration, and electrolyte replacement during withdrawal to support their body’s recovery. Medications such as benzodiazepines may be prescribed to manage withdrawal symptoms and prevent the onset of DTs. Seeking professional help for alcohol dependence and participating in a comprehensive treatment program (that includes monitoring from medical professionals as well as relapse prevention) can also reduce the risk of experiencing DTs.
Timeline of Delirium Tremens Symptoms
This is a general guide to delirium tremens and a description of what someone may expect if they are experiencing delirium tremens. However, individuals may vary and not all cases will display exactly the same symptoms. This is one more reason why it’s important to complete detoxification under medical supervision.
Symptoms of delirium tremens will typically present in this order:
Six to 24 Hours After The Last Drink (Symptoms Related to Alcohol Withdrawal)
- Insomnia
- Headaches
- Nausea
- Sweating
- Gastrointestinal problems
- Anxiety
- Insomnia
- Heart palpitations
Severe withdrawal symptoms (as evaluated by a medical professional) may signal that the patient may experience symptoms of delirium tremens as the detox goes on. A person is also more at risk of experiencing delirium tremens if they are dehydrated.
48 Hours After The Last Drink (Start of Symptoms Specific to Delirium Tremens)
- Profound confusion
- Visual hallucinations
- Elevated temperature
- Seizures
- Tremors
- Hypertension
Symptoms of delirium tremens usually conclude after five days. But depending on the severity of the addiction, symptoms may be prolonged for up to 8 to 10 days after a person’s last drink.
If incorrectly treated or untreated, the following complications may occur:
- Altered mental state
- Aspiration pneumonitis
- Abnormal heart rate
- Respiratory failure
- Death
How Long Does Delirium Tremens Last?
The duration of delirium tremens depends on factors such as the individual’s overall health, severity of alcohol dependence, and promptness of medical intervention. In most cases, delirium tremens typically peaks within two to four days after stopping alcohol consumption, with symptoms gradually improving over the course of several days to a week.
However, some individuals may experience prolonged or recurring symptoms, which will require extended medical monitoring and treatment. Early recognition and appropriate management of delirium tremens are crucial for minimizing complications and promoting a quick recovery. Someone looking to stop drinking alcohol after a long time of chronic drinking should not attempt to do so without medical advice and/or supervision.
What is The Treatment for Delirium Tremens?
Medications commonly used to manage delirium tremens (DTs) include benzodiazepines, such as diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium). These help to control agitation, anxiety, and seizures. These medications work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that helps calm the brain.
Additionally, antipsychotic medications like haloperidol (Haldol) may be used to manage severe agitation and hallucinations in some cases. Medical professionals will administer these medications in a controlled setting to ensure the safety and effective treatment of acute symptoms of delirium tremens. It’s essential for individuals experiencing delirium tremens to receive prompt medical attention and appropriate pharmacological intervention to prevent complications and promote a healthy recovery.
Westwind Recovery® Can Assist with Alcohol Addiction
If you’re looking to detox from alcohol addiction, there are safe and healthy ways to do it that don’t put your health at risk. Everyone’s health is different. However, the risk of adverse health effects drops dramatically when it is conducted in the presence of health professionals and under direct medical supervision.
At Westwind Recovery®, we’re committed to helping you start off your life of sobriety on the right foot. Our partial hospitalization program can help you work through your treatment while still retaining the freedom to go home on a regular basis. If you’re working through a dual diagnosis, our program will help you work toward a place of healing from a holistic point of view. Our multiple sober living home options help to support the process of recovery as people move from active treatment back to (a much healthier version of) everyday life.
Contact us today to learn more about how to start your journey to a healthier, sober lifestyle.
Dr. Deena is the Chief Clinical Officer of Westwind Recovery®, an award-winning outpatient treatment center in Los Angeles where she oversees the clinical and administrative program and treatment methods. Dr. Deena is a doctor of psychology and licensed clinical social worker since 1993. LCSW #20628. Originally from the East Coast, Dr. Deena has worked running treatment centers, worked as a therapist in psychiatric hospitals as well as school settings and currently has a thriving private practice in the LA area. Dr. Deena has appeared regularly on the Dr. Phil Show as an expert since 2003. She has also been featured on many other TV shows, podcasts and has contributed to written publications as well as podcasts.
