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Delirium Tremens: Causes, Symptoms, and Treatment

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Withdrawal from alcohol can be an uncomfortable, and potentially dangerous, process. People with a history of alcohol misuse are more than 50% more likely to experience alcohol withdrawal symptoms after stopping or lowering their alcohol intake.1 Of these individuals, 3–5% experience severe alcohol withdrawal, or alcohol withdrawal delirium (delirium tremens).1

This article will provide an overview of a syndrome known as delirium tremens that can develop in instances of severe alcohol withdrawal, including the signs and symptoms of delirium tremens, the risks and dangers associated with delirium tremens, how long delirium tremens last, and ways to prevent them from occurring.

This article will also provide you with information on how to get help, such as medical detox or substance use disorder treatment, if you are struggling with alcohol misuse.

What Is Delirium Tremens?

Commonly referred to as DTs, delirium tremens is a cluster of relatively severe alcohol withdrawal symptoms that may gradually develop in some people after abrupt discontinuation of alcohol use.1 DTs was first acknowledged as a disorder in 1813 and believed to be a result of excessive alcohol use.1 Each person’s experience with withdrawal symptoms is different, and not everyone who stops drinking alcohol will experience alcohol withdrawal symptoms or DTs.

Research on alcohol withdrawal and DTs are listed below.1

  • As much as 20% of the United States population has misused alcohol during their lifetime.
  • Lifetime and 12-month prevalence of DTs is highest among men.
  • Prevalence of DTs is highest among young adult Caucasian men who have been previously married or have never been married.
  • In young adult Caucasian men with alcohol misuse, the lifetime risk of developing DTs is 5% to 10%.

Certain risk factors may make you more likely to experience severe symptoms of withdrawal. Risk factors for DTs include:1

  • Having a previous history of seizures.
  • Having experienced DTs in the past.
  • Prior history of alcohol detoxification.
  • Pre-existing conditions and the presence of concurrent illnesses.

Delirium Tremens Symptoms

DTs are considered the most severe progression of alcohol withdrawal.2 Though they may vary from one person to the next, potential signs and symptoms of DTs include:2

  • Delirium (rapid progression of disturbances related to cognition, levels of consciousness, psychomotor activity, and sleep-wake cycle).
  • Severe alcohol withdrawal (tremors, hallucinations, psychomotor agitation, and seizures).

Individuals who experience severe DTs will require medical intervention, which will usually involve hospitalization and, in some cases, a stay in the intensive care unit (ICU).3 Detoxification interventions can include the use of medications like benzodiazepines, the correction of fluids and electrolytes in the body, and the monitoring of vitals.3

Delirium Tremens Risks and Dangers

Without proper medical care, DTs can lead to devastating outcomes, including seizures, death, and permanent disability.3 Preventing DTs is possible with adequate medical supervision and pharmacological intervention. Early medical intervention can reduce the risk of experiencing complications related to DTs.3 Medications such as benzodiazepines, and other medical interventions may be used as prevention efforts to help minimize the severity and reduce the likelihood of DT symptoms.3

Delirium Tremens Timeline

Each person’s timeline for alcohol withdrawal may be different, and as stated previously, not everyone who stops drinking alcohol will experience alcohol withdrawal symptoms or DTs. In general, alcohol withdrawal symptoms usually begin within 6–24 hours after the last drink was consumed.3 DTs usually develop 48–72 hours after a person stops heavy drinking.2 Delirium tremens are not sudden, and typically present according to the following alcohol withdrawal timeline:2

  • 1–Tremor (within 6 hours of alcohol cessation).
  • 2–Hallucination (usually 12–24 hours after alcohol cessation).
  • 3–Withdrawal seizure, usually grand mal (any time after 24 hours of cessation).
  • 4–DTs (48–72 hours after alcohol cessation).

Delirium Tremens Treatment

Due to the severity of DTs, immediate medical attention is needed. Medication is usually administered upon diagnosis to help mitigate and reduce the severity of DTs. Medications can help prevent DTs, and usually high doses of intravenous benzodiazepines and other symptom-specific medications can help prevent and regulate DT symptoms.3 The administration of vitamins and thiamine should be administered along with benzodiazepines, and individuals with severe DTs require hospitalization.3

Research shows that it is recommended to over-medicate rather than to under-medicate to prevent the emergence of DTs.3 Under medical supervision, you can be monitored for other withdrawal symptoms, reduce suffering, and stabilize your medical status so you can enter a rehabilitation program. Early medical intervention can help reduce the complications that can arise because of DTs.3 Intravenous benzodiazepines such as diazepam and lorazepam may be used; in certain instances, intramuscular or intravenous antipsychotic medications may also be administered to manage severe agitation and hallucinations.3

Preventing Alcohol Withdrawal and Delirium Tremens

Prevention is crucial, and alcohol prevention strategies can help reduce your risk of misusing alcohol and experiencing DTs.

Prevention strategies include:4

  • Practice safe drinking practices by avoiding binge drinking and heavy alcohol consumption.
  • Don’t start drinking at an early age, as studies show that individuals who began drinking alcohol before 15 years old are five times more likely to develop an alcohol use disorder than those who wait until 21 to drink alcohol.
  • Seek help for any underlying mental health disorder, including trauma.
  • Seek professional help for alcohol use disorder as soon as possible.

For many people, especially those at risk of developing DTs, medical detoxification is the first step in the recovery process. Detoxification is an essential step that seeks to medically stabilize you so you may enter a substance use treatment facility.5 During the detox phase, medications are often administered under medical supervision to help reduce the severity and risks of withdrawal symptoms.5

Regarding alcohol withdrawal, detoxing at home is not recommended due to the risks associated with withdrawal symptoms such as:3

  • Seizures.
  • Paranoia and other delusions.
  • Auditory and visual hallucinations.
  • Impaired judgment, memory, and poor concentration.
  • Increased heart rate and blood pressure.

Medication and other medical interventions can decrease these symptoms and strengthen your ability to end your substance misuse.5 Alcohol rehab programs often begin with a formal evaluation by a licensed medical or addiction professional.

During your evaluation, a treatment plan will be developed based on your unique needs and goals in recovery. Substance use treatment programs offer many different interventions and levels of care to ensure you get the services and support you need to not only end your addiction but to learn how to live your life without the use of drugs and alcohol.

After an initial intake evaluation, your rehabilitation process may include:6

Common behavioral therapies used in the treatment of substance use disorders (SUDs) include:5

  • Cognitive-behavioral therapy–Helps you learn skills in how to deal with stress and triggers without using drugs or alcohol.
  • Motivational interviewing–Makes the most out of your motivation to change to help you engage with treatment efforts to achieve and sustain sobriety.
  • Contingency management–Uses privileges and rewards to help motivate you to remain sober and work towards your recovery goals.

12-Step and other mutual support groups may be an integral component of your treatment plan. 12-Step groups like Alcoholics Anonymous (AA) are a source of social support and serve as supplemental supports to other interventions like behavioral therapy and medication.5 If you are struggling with alcohol or drug use, don’t wait to get the help you need. Treatment has many benefits, including:5

  • Lessening and effectively managing your withdrawal symptoms.
  • Assisting you in developing the skills necessary to learn how to live life without drugs and alcohol and prevent future relapse.
  • Helping improve overall family functioning.
  • Strengthening your social support system.

American Addiction Centers (AAC) offers rehab locations across the country. Call to speak with an admissions navigator who can help verify your insurance and answer questions you may have about the treatment process. We are available 24 hours a day, 7 days a week. You can also locate a treatment center using the online directory. Don’t live another day in addiction. Get the help you need today.

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Senior Medical Editor
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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