Delirium Tremens: Symptoms, Causes, & Treatments

What Are Delirium Tremens?

Delirium tremens, also known as DTs or referred to as “stage 3,” are among the most severe symptoms of alcohol withdrawal. Those with alcoholism, now known as alcohol use disorder, have a much higher risk of experiencing delirium treatments when attempting to stop drinking.

Although about 20% of the population abuses alcohol at some point during their lifetime, only 3-5% of people withdrawing exhibit delirium tremens. DTs should always be considered a medical emergency, and research shows that about 37% of people with DTs die if they don’t receive adequate treatment.²

Delirium Tremens Symptoms

Delirium tremens are not random. They are part of the significant progression of alcohol withdrawal. Such symptoms can occur as early as six hours after the last drink, though they may take several days to appear. However, symptoms can rapidly worsen.

Mild symptoms of DTs may include:

• Sensitivity to senses of light, touch, and sound
• Sleepiness
• Bursts of energy
• Agitation and irritability
• Excitement or anxiety
• Restlessness

Life-threatening symptoms of DTs that require immediate attention include:

• Delirium (severe confusion)
• Fever
• Hallucinations
• Fast heartbeat
• Extreme agitation
• Seizures

Research shows that seizures can occur in more than 5% of untreated people experiencing acute alcohol withdrawal. More than 90% of alcohol-related seizures occur within two days after the last drink. Someone is at a greater risk of having a seizure if they’ve had one in the past or had multiple experiences of past withdrawals.³ Such seizures may look like alcohol poisoning. Regardless of what you believe the origin of a seizure might be, seek immediate medical attention.

Delirium Tremens Stages & Timeline

DTs are a side effect of alcohol withdrawal syndrome, and there can generally be an expected duration of time for symptoms to appear and develop. Symptoms can last several days, usually occurring within the first two days after the last drink.

The usual timeline of delirium tremens symptoms will likely follow these three stages:³

• Early stage: This stage generally happens within the first 1-2 days, and it may include symptoms of depression, anxiety, irritability, nausea, and sleepiness.
• Acute stage: This stage typically peaks within 2-4 days after the last drink and can last for another 2-4 days. The key symptoms include disorientation, fever, high blood pressure, rapid heartbeat, and (in some cases) withdrawal seizures.
• Recovery stage: This stage can linger for several weeks after acute withdrawal. Some main symptoms include anxiety, cravings for alcohol, depression, and irritability.

Risk Factors & Causes of Delirium Tremens

Prolonged alcohol use can result in dependence (needing to drink alcohol to feel like you can function) and tolerance (habituating to the effects of alcohol and needing more to achieve a desired and intended effect). Over time, the body adapts to chronic alcohol and relies on it to “feel normal.” Once you stop drinking, it disrupts brain communication, and the body responds to this dramatic change through a withdrawal process.

Risk factors that can increase the chances of withdrawal and delirium tremens include:⁴

• Increasing alcohol consumption before stopping
• Number of previous withdrawal episodes
• Preexisting brain dysfunction
• Past delirium episodes
• Vision or hearing loss
• Preexisting levels of high blood pressure
• Being unemployed
• Being middle-aged (one study found the mean age was 41.9 years)
• Being male

Medication Treatment for Delirium Tremens

If someone is at a heightened risk of experiencing alcohol withdrawal, they should seek professional medical attention. Detoxing alone can be fatal, particularly if they have multiple health risk factors. However, medications can help with DTs and may save someone’s life.

The following are medications commonly used to treat DTs and withdrawal⁵:

• Benzodiazepines: Benzodiazepines slow down the central nervous system and are the most commonly-prescribed medications for DTS and withdrawal.
• Barbiturates: Barbiturates may be effective in benzodiazepine-resistant cases. They may be used in emergency department and intensive care unit settings.
• Magnesium: Many people experiencing alcohol withdrawal have a magnesium deficiency, which can exacerbate depression and anxiety⁶
  .
• Beta-blockers: Beta-blockers can help reduce intense withdrawal symptoms by decreasing the heart rate and reducing anxiety symptoms.
• Antipsychotics: Antipsychotics may also be used with other medications like benzodiazepines.

How to Avoid Withdrawals & Prevent DTs

There is no guaranteed way to avoid withdrawal or prevent DTs. If you struggle with an alcohol use disorder, even if it seems mild, you may be at risk of experiencing withdrawal. The most proactive decision you can make is to seek professional help for how to reduce or stop drinking altogether. Although it may be tempting to quit cold turkey on your own, if you have a history of chronic or long-term drinking, it’s advised to seek medical attention.

Long-Term Treatment After Detox

Detox is the first step toward stabilizing acute withdrawal symptoms. However, detox alone should not be considered substance abuse treatment.⁷
If you struggle with alcohol or other drugs, it’s essential to consider more long-term support. This may include residential or inpatient therapy, intensive outpatient therapy, attending addiction-based support groups, or individual psychotherapy.

Some people also benefit from medication management. For example, the FDA has approved disulfiram, naltrexone, and acamprosate for treating alcohol use disorder.⁸ If you have co-occurring mental health issues like depression or anxiety, taking psychiatric medication that specifically treats those symptoms may reduce the likelihood of an alcohol relapse.

Treatment is often multifaceted and may include addressing trauma, family dynamics, and alcohol-related triggers. It’s important to find a therapist that helps you feel safe and supported in your recovery. Several online therapy options can allow you to receive the help you need to start from home.

Final Thoughts

Delirium tremens are a severe, life-threatening condition that should never be taken lightly. Taking preventative measures and looking after your emotional and physical health is critical. If you struggle with drinking too much- or worry that you can’t stop on your own- you’re not alone. Seeking help from a trusted medical professional can help you overcome alcohol abuse.