Apart from withdrawal symptoms such as sweating, shaky hands, vomiting, nausea, and insomnia, alcohol addicts who are trying to stop drinking can experience a condition known as delirium tremens, which can be life-threatening. Its symptoms begin to appear from 6 to 96 hours after the last drink, sometimes more. They are a result of nervous system changes that occur as the body tries to adapt without alcohol. Typically, people who experience it have been drinking heavily for years.
What Is Delirium Tremens? How Long Does It Last?
Broadly speaking, the definition of delirium tremens is as follows: a psychotic condition involving tremors, hallucinations, anxiety, and disorientation, which alcoholics can suffer from. The question of “how long does delirium tremens last” is common among people who are worried about having it after stopping alcohol consumption. In fact, this is sometimes the reason they are afraid to stop. It can last just 24 hours for some and up to five days for other people. The amount of time generally depends on how long the person has been abusing alcohol and in what amounts. What causes delirium tremens? It is commonly believed that excessive alcohol consumption interferes with the body’s ability to regulate the neurotransmitter GABA. The brain starts to mistake alcohol for GABA and limits the production of the neurotransmitter. As the alcohol levels in the body drop, the brain compensates by producing more excitatory neurons (GABA is an inhibitor). The brain then goes into an overexcited state, leading to the symptoms described above, as well as further complications, such as seizures.
Delirium Tremens: Signs and Symptoms
Common signs of delirium tremens include nausea and vomiting, body tremors, high blood pressure, a fast, irregular heartbeat (tachycardia), sensitivity to light and noise, intense anxiety, fear, or paranoia, overexcitement and agitation, decreased focus, visual or auditory hallucinations (delirium tremens hallucinations are very frequent – seeing, hearing or feeling things that aren’t there), disorientation, confusion, and sleeplessness. There can be stupor or inresponsiveness to touch. These symptoms are scary both to the person experiencing them and those around him or her if they don’t recognize them as indications of delirium tremens and alcohol withdrawal. We’ll elaborate further below.
Delirium Tremens and Death
People witnessing or experiencing these symptoms may think they are dying or worry about sustaining permanent brain damage. Neither of these is true. It is important to understand what DT is and prevent its onset or recognize its symptoms, stay calm and do what is necessary at that moment. Sometimes symptoms may appear even a week after the last drink. Heavy drinkers face the highest risk. According to the National Institutes of Health, a heavy user is defined as someone who has been having more than 4 (women) or 5 (men) drinks a day for more than a few months. Seizures are another symptom of DT, and these can be mistaken for epilepsy even if the person doesn’t have a history of it. These can occur between 6 and 48 hours of ceasing alcohol consumption. As alcohol affects the prefrontal cortex of the brain severely, the region responsible for analysis and perception, confusion and clouded thinking can be a common symptom of delirium tremens that intensifies with time. So can fear, anxiousness, and paranoia. Sufferers report a conviction that doom is impending.
Risk Factors for Delirium Tremens
A person who has experienced DTs before faces a higher risk of developing it every time he or she tries to stop drinking, as is a person exhibiting severe withdrawal symptoms. Chronic drinkers or alcohol addicts also tend to suffer from certain medical conditions, such as underlying infections, hepatitis, and pancreatitis. The existence of these conditions may exacerbate the effects of DT symptoms or make delirium tremens treatment problematic. Common comorbid conditions include:
Cirrhosis: Also referred to (mistakenly) as alcohol liver disease, this can occur after years of heavy alcohol abuse.
Alcoholic cardiomyopathy: Long-term alcohol abuse can lead to heart problems. Treatment may include prescribing beta-blockers, reducing sodium intake, and taking ACE inhibitors. If cardiomyopathy isn’t treated or cannot be treated effectively, serious complications can arise, such as heart failure.
Alcoholic neuropathy: This involves nerve damage from excessive alcohol consumption. Symptoms can include tingling in the arms and legs, numbness, pain, and cramps and other muscle problems. Treatment may involve physical therapy and other symptom management. Nerve damage can be permanent.
The presence of some co-occurring mental disorders may intensify symptoms like fear and anxiety and cause aggressive behavior. Also, elderly people face a higher risk of developing DTs, and their symptoms are usually more severe.
Stopping Alcohol and Delirium Tremens
Ultimately, stopping one will eventually lead to cessation of the other, and this will be elucidated at the end of the article. This section is about the timeline of withdrawal. Withdrawal symptoms can start as early as a few hours after the last drink. The four stages of withdrawal are listed below, including the possible complications. Please keep in mind that this data is based on statistics and there may be exceptions.
6 to 12 hours
The first stage of withdrawal includes minor symptoms, typically occurring less than 12 hours after the last drink. Among them are anxiety, sleeplessness, nausea, headaches, loss of appetite, sweating, and a rapid or irregular heartbeat.
12 to 24 hours
Tactile, auditory, and/or visual hallucinations can occur in this time frame. Visual hallucinations are most common. For example, someone might be taking a shower and imagine something coming at them through the bathroom window, strike out to protect themselves, break the glass and cut themselves, adding to the anxiety of the whole situation. There may be a sense of burning, itching, or numbness that has no physical cause. Auditory hallucinations are when one hears non-existent sounds. People rarely experience hallucinations more than 48 hours after having their last drink.
24 to 48 hours
Withdrawal seizures occur most often in this period. These can be very dangerous as one of several complications can arise. Typically, most symptoms will peak five days after they start and will begin to decrease up to seven days later.
Delirium Tremens: Treatment at Home?
When the person passes out, they can hit their head and sustain a concussion, which can be fatal. They might swallow their tongue during the seizure. The heart rate is very high and can spiral into cardiac arrest i.e. a heart attack. They will start foaming at the mouth – the foam is sometimes mixed with blood – and they can choke to death on it. If someone is having a seizure, don’t try to stop them from shaking, because you can’t. Try to turn their head to the side so they don’t choke and remove dangerous objects from the vicinity, like sharp items. Move any pieces of furniture away from them. Seizures are the most dangerous part of alcohol withdrawal and this is why treatment at home is not encouraged. The symptoms of delirium tremens can worsen if they are not controlled and treated promptly. They need to be managed with medication to prevent exacerbation and fatal complications.
Call 911 immediately. A seizure typically lasts less than a minute and it will be over by the time the medical emergency team arrives. The person might come to. While you wait for help, watch them closely to make sure they don’t sustain further injuries, like falling and hurting themselves if they try to stand up too fast. Remove items they might perceive as threatening and dim the lights – bright light will aggravate them. They won’t be able to speak coherently or think clearly, so be prepared to answer the following questions from doctors or other medical staff:
- When did the person last have a drink?
- How much does the person typically drink per day?
- Since when does he or she drink?
- Has he or she ever had delirium tremens before, including a seizure?
- Has he or she tried to stop drinking before. If so, were there any withdrawal symptoms?
- Does the person have a mental or physical disorder? Are they getting treatment for it?
- Do they take illegal drugs or prescription medication?
Diagnosing Delirium Tremens
If symptoms are still mild, it may not always be obvious that DT is occurring. In the context of alcohol withdrawal, delirium tremens is best diagnosed by a doctor. A physician will perform a toxicology screen to see how much alcohol is in the blood or urine. This can also show if there are other substances in the body. If a recovering addict is receiving inpatient treatment, the doctor will perform toxicology screens several times. Other tests that may be ordered to assess alcohol addiction or withdrawal severity include blood phosphate levels, blood magnesium levels, an electrocardiograph, an electroencephalogram, and questionnaires such as the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar).
Delirium Tremens – Treatment
DT is best treated in a hospital setting for a variety of reasons. The person may need to be sedated until the symptoms go away. Being sedated will keep them safe and injury-free. Doctors sometimes give benzodiazepine medications like lorazepam or diazepam (Valium). Delirium tremens treatments may also include intravenous fluids, antipsychotic medications to prevent hallucinations, anticonvulsants to prevent or stop seizures, medication to reduce body pain and fever, and approaches to heal other alcohol-related conditions. After the person undergoes detox, they will need rehabilitation to help them stop drinking. A qualified alcohol addiction expert will devise a long-term treatment plan to this end. Alcohol withdrawal disorder has a very low death rate – less than 2% – if there is timely medical intervention. If not, it can reach 35%. All symptoms subside with proper delirium tremens treatment.
Delirium tremens and its meaning in the life of an addict are not to be taken lightly. Symptoms like fatigue, insomnia, and mood swings can persist for years after someone has stopped using, and support groups for alcohol withdrawal can be crucial to long-term sobriety. These include Alcoholics Anonymous (AA) and SMART Recovery, both of which have local meetings and online resources. Apart from support groups, a long-term prevention treatment program is usually built around lifelong abstinence and psychological counselling.