People experience alcohol withdrawal differently. For some, it’s mild, with a bit of headache, anxiety, insomnia, and maybe an upset stomach.
For others, however, things get particularly intense, with symptoms ranging from hallucinations to seizure fits. That’s what the experts refer to as delirium tremens (DT) or alcohol withdrawal delirium (AWD).
How can you stop the unpleasant symptoms of DT? Does this level of withdrawal warrant a visit to the emergency room?
The short answer is that DT is a very serious, potentially fatal condition that requires medical attention right away.
This post explores DT in more detail, going over the risk factors, complications, management options, and overall prognosis.
Alcohol Withdrawal Delirium at a Glance
Before we get to the dangers of DT and how it’s treated, let’s cover some basics.
Causes: Why Do Some People Experience DT?
Alcohol itself is a central nervous system depressant. It interacts with a type of inhibitory receptor in the brain called gamma-aminobutyric acid (GABA) and enhances its activity, helping the body relax.
Over time, alcohol use can turn into a full-blown substance abuse problem. This long-term use forces the brain to change its chemistry to adapt to the boost in inhibitory activity. It does so by downregulating GABA receptors, which in turn creates a state of overactivity.
Chronic alcohol users and heavy drinkers feel the need to cut down on their drinking to calm down this overactivity.
But of course, not every brain is the same. In some cases, when the person stops drinking alcohol suddenly, the brain isn’t able to readjust its chemical balance smoothly or quickly enough.
The result is automatic hyperactivity, which means that functions like heart rate and blood pressure become dangerously overactive. That’s when symptoms of DT or AWD start showing.
Timeline: How Quickly Does DT Start and How Long Does It Last?
Delirium tremens (DT) typically starts around 2–3 days after stopping alcohol abruptly, and it shows up as both physical and psychological issues.
The symptoms can last up to 5 days or linger for months in severe cases.
Side Note:This is the usual timeline. That said, DT can differ from one person to another. In fact, some might not experience symptoms at all until the 10th day after cessation.
Manifestation: What Does DT Look Like?
As the name implies, DT is characterized by a sudden state of confusion/disorientation (delirium) and tremors/shaking (tremens). But there are other symptoms to expect as well, including:
- Irritability
- Profuse sweating
- Hyperthermia
- Rapid heartbeat (tachycardia)
- High blood pressure (hypertension)
- Light sensitivity
- Seizures
- Tactile hallucinations
- Auditory hallucinations
Prevalence: How Common Is DT Among People Who Abuse Alcohol?
Let’s just clarify that there’s a difference between DT and alcohol withdrawal syndrome. DT is much more severe but less common.
Studies show that over 50% of those suffering from alcohol use disorder (AUD) experience alcohol withdrawal syndrome when they stop drinking. DT, however, happens in 3% to 5% of cases.
Risk Factors: Who Is More Likely to Experience DT?
Certain segments of the population are more likely to experience DT, and young men are at the top of the list.
You’re at a higher risk if:
- You have gone through alcohol detoxification before.
- You’ve experienced DT before.
- You have a history of seizures.
- You have a history of cardiovascular diseases or chronic liver damage.
- You have a heavy drinking pattern.
- You’ve been using alcohol for a long period (think 10+ years).
Why You Must Seek Emergency Care for DT
As we’ve mentioned earlier, DT is a serious condition that requires immediate medical interventions.
Here’s why you should call 911 if you suspect someone is going through DT:
1. DT Can Be Fatal, and Treatment Reduces the Mortality Rate
Without proper treatment, DT has an anticipated mortality rate of 37%! Remember that the autonomic hyperactivity caused by abrupt cessation disrupts normal breathing and cardiac functions.
Seeking help doesn’t exactly guarantee a full elimination of the risk of death from DT. Still, early medical intervention can make a significant difference. It can actually reduce the mortality rate to about 5%.
2. Lots of Serious Complications Are to Be Expected With DT
Even cases of DT that don’t result in a fatality might include intense complications, including:
- Cardiac arrhythmias
- Lung injury from aspiration pneumonia
- Rhabdomyolysis (breaking down of muscles)
- Respiratory depression
Unfortunately, these complications may require hospitalization and round-the-clock monitoring.
3. A Proper DT Diagnosis Is Essential for Treatment
Another compelling reason to seek help is to make sure that this is actually a case of DT. After all, the list of conditions that may be confused with DT is long.
If it’s not DT, it could be Wernicke encephalopathy, a brain disorder caused by vitamin B1/thiamine deficiency. Alternatively, it could be thyrotoxicosis (a toxic rise in the level of thyroid hormones), meningitis, sepsis, a stroke, rare adrenal gland tumors, or even a brain abscess.
Health professionals can identify the culprit and evaluate the severity of the alcohol withdrawal. To do that, they need to consider the history and the clinical presentations. In many facilities, care teams rely on the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar).
The CIWA-Ar is a short 10-item questionnaire that healthcare professionals fill out as they assess the patient. Anything above 15 on the CIWA-Ar scale indicates that the patient is at high risk for DT. A score between 9 and 15, however, corresponds to moderate alcohol withdrawal.
Besides the CIWA-A, doctors might request laboratory tests to check the magnesium, potassium, and electrolyte levels. They might also resort to an MRI to help them figure out if any seizures are withdrawal seizures or some sort of head injury.
4. DT Treatment Options Often Require a Medical Setting
The medications (antipsychotics, anticonvulsants, etc.) that doctors use to manage the symptoms aren’t without their risks, either. Patients need to be monitored in intensive care units and receive controlled doses.
Note that certain treatment paths require mechanical ventilation. So, overall, this isn’t the sort of condition that can be safely treated at home.
How Doctors Manage and Stop Symptoms of Delirium Tremens
Despite the complications, there are still ways to manage DT. Treatment is mainly built around three goals:
- Controlling the agitation
- Managing/preventing seizures
- Saving the patient’s life
Treatment often follows a symptom-based, case-by-case approach. Depending on when and how the withdrawals present, doctors can prescribe medications (such as sedatives) to control the symptoms.
One common class of medications used in managing DT is the benzodiazepine class (diazepam, lorazepam, etc.). If the patient is unresponsive to benzos, doctors might add doses of barbiturates (phenobarbital) to the treatment plan.
A dose of propofol (a fast-acting sedative) could be used with benzos, too. That being said, this is a valid option mainly for patients on mechanical ventilation. It definitely requires strict monitoring as well.
The concept here is to sedate the patient until the DT symptoms pass. Of course, this also means supplying the patient with all the vitamins, minerals, and fluids they need in the meantime.
Sedatives aside, doctors might also use blood pressure and heart medication to rebalance the patient’s hyperactive system.
The Role of Supervised Detox for Alcohol Withdrawal
So, we’ve clarified that DT is a medical emergency. If you or a loved one is experiencing concerning symptoms after quitting alcohol, make sure to seek help immediately.
But what if you haven’t stopped consuming alcohol yet? In this case, contacting a detox facility is highly recommended.
Quitting in a supervised medical detox setting is a safer option than quitting on your own for several reasons.
For one, addiction treatment professionals can help you taper your alcohol intake. This would be much trickier to do at home, surrounded by triggers and temptations. You’d likely end up quitting cold turkey, which can be quite dangerous in certain cases.
Plus, detox facilities typically offer 24/7 supportive care, with in-house clinicians and counselors. They monitor the symptoms, manage what they can, and refer the patient to a hospital when needed.
Quitting Alcohol Is Possible. Do It Safely.
To recap, DT is a serious condition that can lead to death. People going through DT may experience hallucinations, rapid heartbeats, high blood pressure, agitation, confusion, and overheating only a few days after sipping their last drink.
Symptoms of DT can be managed, though. You just need the right medical interventions, be it medications or round-the-clock monitoring. And the earlier the medical care starts, the better.
The number one way of avoiding DT is avoiding alcohol abuse from the get-go. But if you or a loved one is already suffering from alcoholism, you shouldn’t let the risk of developing DT deter you from quitting. Many people can and do quit drinking alcohol safely.
For more information on alcohol dependence detox and treatment programs, contact the team at Illinois Recovery Center. Our experts are here to provide clarity and support people suffering from substance use disorder and their family members.
