Delirium Tremens: Severe consequence of alcoholism

Delirium tremens is a withdrawal disorder that happens in alcoholic people as a result of an interruption in alcohol consumption. It happens to 5% of alcoholic people after suddenly stopping ingestion of alcohol. For a long time, we have known that excessive alcohol intake can lead to acute or chronic mental disorders. Many of you may have heard of delirium tremens on occasion and may have different questions. In this article, we try to solve your doubts about this disorder: from what is delirium tremens, differences with the withdrawal syndrome, symptoms, risk factors to how to treat it.

What is Delirium Tremens?

Delirium tremens can be defined as an alcohol-induced disorder, considered to be acute and life-threatening in nature. Its appearance is abrupt, as a severe form of alcohol withdrawal. It involves sudden and intense changes in the nervous system and brain.

Delirium tremens happens after having consumed alcohol excessively for long periods of time, in which the alcoholic person generates a dependence to the alcohol. When the subject abruptly stops habitual alcohol consumption, symptoms of alcohol withdrawal appear. In most cases, delirium tremens symptoms usually appear between the second and fourth day of withdrawal.

It is important to differentiate delirium tremens from other diseases related to alcoholism, such as Korsakoff’s Syndrome or Wernicke’s Encephalopathy, which, unlike delirium tremens, are chronic: they progress slowly and are prone to irreversibility.

Difference between delirium tremens and withdrawal syndrome

It’s important to know that not all people suffering from withdrawal syndrome, reach the peak of their symptoms, that is, not all of them have delirium tremens.

Delirium tremens is a disorder that happens within the same withdrawal syndrome but only in a small percentage of people suffer from this. It is the most severe form of withdrawal syndrome.

Symptoms of withdrawal syndrome often happen within a few hours after stopping alcohol consumption, while delirium tremens appears between the second and fourth day. Delirium tremens is worse at night when there is less light and more absence of stimuli. 

Delirium Tremens: Risk Factors

Even though we don’t know why delirium tremens happens to some alcoholics and not others, we can affirm some risk factors of delirium tremens:

• Research by Kopelman states that in 90% of cases, delirium tremens happens in people with a serious hepatic injury, and 50% is related to infectious or traumatic processes.
• It usually appears in people whose alcohol consumption is high (several liters a day, every day), and have been drinking for more than 10 years.
• Delirium tremens is also associated with an interruption of medicine or a suspension of other drugs in patients with high dependence.
• Finally, poor diet in alcoholic patients after having consumed excessive amounts of alcohol over a long period is a high-risk factor. This can lead to malnutrition and consequently worsen the alcoholics situation.

Delirium Tremens- Symptoms

Symptoms begin between the second and fourth days of withdrawal and if death does not occur, a prolonged sleep episode takes place. The syndrome begins with anxiety symptoms, strong breathing, insomnia, and tachycardia. The next phase of delirium tremens has these symptoms:

• Alteration in consciousness and disorientation.
• Visual, auditory and tactile hallucinations may happen. Alcoholics in this phase often see small animals, insects or other small objects that move quickly. Auditory hallucinations during delirium tremens are sometimes characterized by coarse sounds associated with contractions of the middle ear muscles. There are also complex sounds, such as voices with threatening content, or music.
• When there are delusions, these are paranoid in nature and are related to the patient attempts to make sense of the hallucinations.
• All this leads to an intense fear and causes palpitation.
• Sweating and tachycardia also take place and may lead to dehydration.
• Severe tremors and motor agitation. The term tremens refers to these motor symptoms.
• In some cases, although less frequent, big epileptic crisis might happen, even one after another without giving the person time to regain consciousness.
• Occasionally, if the patient is not intervened in time by specialized personnel, it can cause the death.

Delirium Tremens: Treatment in alcoholic patients

Before delirium tremens happens, the patient has to have had moderate to severe symptoms of alcoholism, all of which were followed by the withdrawal syndrome. Therefore, it is logical that a person does not become alcoholic from one day to another, but that the evolutionary course of alcoholism reflects a progressive deterioration in physiological, psychological and social aspects.

Alcohol tolerance already develops in the pre-alcoholic phase, in which the person needs to drink more and more frequently to obtain the desired effects of alcohol. In later stages, the opposite will happen, the person will have “reduced tolerance”, therefore intoxication will happen with fewer amounts of alcohol. By this time it is when people will begin to notice more the personality and emotional changes in the alcoholic person. In addition, the person’s main objective will be to consume any alcoholic beverage, sometimes with sudden explosions of anger. It is also often that they will hide money or other objects, such as alcohol, to be able to buy or drink it in secret. It’s common to have amnesia episodes and not remember anything the next day.  

If we witness a person with any of the symptoms mentioned or losing control with alcohol consumption it is important to seek help. 

• If there are signs of abstinence or withdrawal symptoms, and to a greater extent, of delirium tremens, hospital admission is necessary, since in many cases if not attended to it can cause mortality.
• There are rehabilitation centers, in which the patient will be taken care of for 24 hours, being able to intervene in case the person has hallucinations or other symptoms of delirium tremens.
• Withdrawal symptoms are not always present but if there are behaviors associated with alcoholism the sooner it can be diagnosed, the more likely it is to prevent future complications.
• Especially at the beginning of alcoholism and as it gets worse, the person denies that he has a problem, so it is important to look at the family, work and social context that surrounds him. Treatment success is going to be greater if the support network is present and helps the patient deal with the problem properly.
• Alcohol abuse accelerates cognitive impairment. There are currently clinical neuropsychological assessment programs that allow professionals to assess brain damage in an alcoholic patient. There are also clinical rehabilitation programs and cognitive stimulation that can improve deteriorated cognitive abilities.

Recently alcohol consumption starts in adolescence or even at younger ages. Problems related to alcohol dependence, however, will depend largely on individual differences. We can’t know why some people have more dependence than others or why withdrawal symptoms happen in some but not others, however, it is better to be safe than sorry. 

Alcoholism is progressive, the person can start drinking only at night with friends and then start during the day, so it’s important to catch the problem in time before the problem escalates. It is essential to keep in mind that alcoholism, like many other addictions, can escape the willpower of the subject, who in the first stage, will not want to assume that he has a problem, and in later stages can relapse even if he is aware that he has a problem.

On the other hand, when the withdrawal syndrome starts, the patient often wants to re-use alcohol to avoid the symptoms. Therefore, it is important to explain to the alcoholic that even if these symptoms are present they will eventually recede and they will be able to recover completely if they receive the necessary help. In addition, there are psychological aids not only for the alcoholic patient but also for their relatives.

It is important to drink responsibly and know that this can become a problem without us even noticing. Finally, especially for younger people, it is important to offer information about alcohol and help raise awareness to prevent alcoholism or dangerous behaviors. 

Hope you enjoyed the article and remember to never drink and drive!

This article is originally in Spanish written by Eva Rodríguez translated by Alejandra Salazar.

Alejandra Salazar

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.