Alcohol and Delirium Tremens

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Chronic, heavy drinking will result in withdrawal symptoms if alcohol use is discontinued abruptly or “cold turkey.” Many of these effects, which range from mild-severe, are associated with physical dependence. This condition develops as a result of long-term alcohol misuse, which changes how the brain and body function. Most withdrawal symptoms are not severe, but a dangerous phase of the withdrawal process known as delirium tremens or DTs can occur in extreme cases.

Because the withdrawal process is, at the very least, uncomfortable and potentially life-threatening, individuals attempting to abstain from alcohol use are urged to do this through medical detox. At Guardian Recovery, we offer detox services in a clinical environment where health professionals can supervise clients around the clock. This is the most effective way to ensure those experiencing withdrawals are safe and that medical complications can be addressed if they arise.

While detox is the first important step in recovery, it does not address the underlying factors contributing to alcohol use. These include co-occurring mental health conditions, traumatic experiences, and other psycho-emotional causes of addiction. If you are motivated to break free from alcoholism, contact us today to learn more about our comprehensive programs. We are dedicated to providing our clients with the care and support needed to promote sobriety, prevent relapse, and foster long-term health and wellness.

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What is Delirium Tremens?

Excessive alcohol use followed by sudden cessation can lead to delirium tremens (DTs), a severe form of withdrawal hallmarked by serious and potentially life-threatening symptoms. These typically onset about 72 hours after the last drink a person consumes and can persist for another 48-72 hours. (1) DTs risk factors include a prior history of DTs, seizures, detox, and concurrent illness. (2)

For this reason and others, persons attempting to withdraw from alcohol are urged to seek medical help to prevent dangerous effects, including seizures and heart failure. Many individuals with severe alcohol use disorders will experience some withdrawal symptoms if they stop or significantly reduce their alcohol consumption. Of these, an estimated 3-5% will experience DTs, or “severe symptoms of alcohol withdrawal, including profound confusion, autonomic hyperactivity, and cardiovascular collapse.” (3)

Effects and Complications May Include the Following: (4)

  • Nightmares and sleep disturbances.
  • Agitation, confusion, and disorientation.
  • Hallucinations and environmental illusions.
  • Formication (tactile hallucinations).
  • High blood pressure.
  • Elevated heart rate.
  • Arrhythmia.
  • Chills and sweating.
  • Increased body temperature.
  • Fever and hyperthermia.
  • Excessive sweating.
  • Seizures.
  • Aspiration pneumonitis.
  • Cardiovascular collapse.
  • Respiratory failure.
  • Death.

Delirium tremens is undoubtedly the most dangerous result of alcohol withdrawal. It often includes intense anxiety, fear, paranoia, and feelings of impending doom or imminent death. In addition, individuals may experience uncontrollable tremors and panic attacks. However, respiratory failure and cardiac arrhythmias are the most common causes of death during an episode of DTs. (5)

What Causes DTs?

The precise mechanisms that cause delirium tremens are not entirely understood. Still, it is widely thought that the condition is related to the inhibitory neurochemical GABA, which is responsible for reducing activity in the central nervous system (CNS). Because alcohol is a GABA agonist, excessive drinking reduces GABA levels, especially over a prolonged period. (6)

Abrupt cessation of chronic alcohol use reduces the inhibitory actions of GABA and increases the action of the excitatory chemical glutamate. These two effects result in overactivity in the CNS, causing the extreme and dangerous symptoms associated with DTs. (7)

What is the Treatment for DTs?

DTs is a medical emergency that requires immediate treatment in a clinical setting, including the administration of various prescription medications to prevent DTs and life-threatening complications.

Pharmacological Interventions for DTs May Include:

  • Naltrexone, Suboxone, and acamprosate.
  • Antihypertensives.
  • Anticonvulsants.
  • Anxiolytics (anti-anxiety medications).
  • Muscle relaxers.
  • Antipsychotics.
  • Thiamine (B12).

As noted, the fatality risk is significant without treatment. That said, medically-supervised patients have a much lower likelihood of experiencing lethal complications.

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The Alcohol Detox Timeline

Withdrawal symptoms can onset as early as two hours after an individual’s last drink. Nonetheless, they usually manifest after much more time has passed. While the most unpleasant and painful symptoms subside by the end of the first week, some psychiatric symptoms can persist for several weeks.

The alcohol withdrawal process can vary in duration but typically follows this timeline: (8)

6-12 hours — The initial symptoms of alcohol withdrawal tend to be mild but can rapidly begin to worsen over time. Early withdrawal effects include anxiety, headache, shakiness, nausea, vomiting, and irritability.

24 hours — By the first 24 hours of detox, symptoms may increase in severity. In addition to the effects experienced during the first 12 hours, further symptoms may develop, including tremors, disorientation, and seizures.

48 hours — Like the first 24 hours of withdrawal, the most painful symptoms will persist into the second day. Hallucinations, anxiety, and panic attacks are common during this time as alcohol and its byproducts are purged from the body.

72 hours to one week — Different withdrawal symptoms wax and wane. This is when individuals are at risk for life-threatening effects, such as delirium tremens, and seizures.

After one week — After finishing the first week of detox, many people find that withdrawal symptoms will significantly diminish. However, some emotional symptoms and cravings may last for several weeks, which can often be effectively treated with medication and managed using learned coping mechanisms.

After completing detox, individuals will begin formal addiction treatment, lasting 30-90 days or longer. Residential treatment is often recommended for those with severe alcohol use disorders. When a person experiences DTs, this typically indicates their drinking habits involve chronic, heavy, prolonged use.

Therapeutic Interventions Used During Treatment Typically Include:

Dual Diagnosis Treatment

Alcohol misuse is associated with underlying causes, such as mental health disorders. Common co-occurring conditions include depression, anxiety, bipolar disorder, post-traumatic stress disorder, behavioral addictions, etc. The primary goal of dual diagnosis treatment is to address the underlying physical and emotional difficulties individuals experience that contribute to the need for self-medication through substance misuse. It’s essential to treat these issues simultaneously so relapse is less likely and will not subsequently contribute to further mental health or medical conditions.

Who Needs Comprehensive Addiction Treatment?

Comprehensive treatment for alcohol use disorder can be beneficial for anyone trying to stop drinking. However, for those who’ve experienced delirium tremens, addiction treatment is essential to prevent further excessive drinking leading to life-threatening complications.

The ideal time to begin a recovery program is before alcohol dependence progresses from bad to worse. That said, anyone at any stage of alcoholism can seek an assessment and a level of care for treatment that will meet their individual needs.

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Getting Help for Alcohol Misuse & Addiction

If you are ready to quit drinking and get on the path to recovery, support is available. Guardian Recovery is here to ensure you receive the treatment and tools you need to sustain long-lasting sobriety. We provide our clients with quality clinical care to reduce the risk of relapse and life-threatening complications, such as DTs.

Contact us today for a free, no-obligation assessment and health insurance benefits check. You’ll be connected with a skilled Treatment Advisor who can answer your questions and tell you more about the therapeutic services and levels of care we offer. Our compassionate, professional staff can help you navigate the recovery process, conquer addiction, and reclaim the life you deserve.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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