Dying from Alcohol Withdrawal: What is Delirium Tremens?

Alcohol withdrawal is notoriously dangerous. In fact, it’s one of the only types of withdrawal that can kill you.

Detoxing from alcohol isn’t dangerous in and of itself. But, the complications of alcohol withdrawal can be deadly.

The most dangerous side effect is known as Delirium Tremens, or “the DT’s”. This is a withdrawal symptom that kicks in a few days after you quit drinking.

Delirium Tremens

Usually, only the most hardcore drinkers are susceptible to it. Casual drinkers and even high-functioning alcoholics aren’t likely to experience it. In order for someone to come down with a case of DT, they must actively maintain a heavy drinking habit for several years. Statistically, only around 5% of alcoholics experience alcohol withdrawal syndrome to this degree during detox.

Fortunately, the DT’s is a curable condition. However, in order for an alcoholic to overcome it and avoid its life-threatening effects, they must seek medical assistance and receive professional treatment.

Understanding Alcohol Detox (and the Risks of Withdrawal)

In order to understand what Delirium Tremens (sometimes mispronounced “delirium tremors”) is and why it occurs, it helps to first comprehend how alcohol withdrawal works. After all, DTs are essentially the worst-case scenario that can occur during detox. It’s important to understand what they are and why they happen.

See, when someone drinks alcohol regularly for a long period of time, they basically trick their brain into believing that the body requires the substance to survive. Alcohol makes us feel good at first. This is because it produces serotonin in the brain. Our brain enjoys when we feel good, so it triggers cravings to remind us to keep drinking.

Of course, most people have the option to abstain, particularly early on in the drinking life. If someone continues to feed their cravings with alcohol, however, they lose the ability to choose whether or not to drink. Their brain and body are reprogrammed to depend on the substance. If they choose not to drink it, they are likely to get sick.

So, if a long-term alcoholic decides to quit drinking, their body responds adversely. As it has grown dependent on alcohol, it doesn’t work correctly without the drug in it. It fails to send out proper signals and, thus, is unable to communicate with the rest of the body. As a result, the alcoholic experiences all kinds of negative side effects. The symptoms of alcohol withdrawal may include nausea, vomiting, shakes, and anxiety. The worst side effect of all, however, is Delirium Tremens.

Why DT’s are Associated with Alcoholism

Long-term alcoholism has a profound effect on the brain’s GABA receptors. These receptors are the part of the brain most closely linked to Delirium Tremens. These receptors normally work to regulate the quantities of chemicals that enter our brain. For example, the GABA receptors ensure that we don’t receive too much serotonin or dopamine. But, drugs like alcohol prohibit these neurotransmitters from working properly.

Part of the problem, however, is that our GABA receptors also control blood pressure, heart rate, and seizure threshold. So, essentially, alcohol inhibits our body’s ability to function properly. This is fine for casual drinkers because the effects aren’t drastic enough to change our body chemistry entirely. But, when someone drinks habitually,  they can completely alter the way their brain functions.

Once the alcoholic ceases to put alcohol into their system, then, the brain and body essentially go haywire. Due to unregulated amounts of GABA, the brain may not be able to moderate a person’s heart rate or seizure threshold. This is how alcohol withdrawal causes DT.

Can You Die from Alcohol Detox?

Yes. Delirium Tremens can be fatal. In a recent report, The Bulletin of the American College of Surgeons reports that 10 alcoholics died of Delirium Tremens during 2013. Nearly 300 other patients were hospitalized for the condition.

Interestingly enough, it is more common to die from alcohol detox than any other type of drug withdrawal. Rarely, a benzodiazepine addict dies during withdrawal. A few people have died during heroin detox, as well. But, these are outstanding cases. Delirium Tremens, on the other hand, is notoriously deadly.

A Closer Look at Alcohol DT’s

DT causes a drastic shift in the brain and nervous system. Doctors and scientists refer to this change as “global confusion”. Essentially, this means that the body slips out of whack to the point that it can no longer send the correct signals to the rest of the body.

Of course, this is a problem because our organs depend on those signals to tell them what to do. If our various organs fail to receive the proper signals, they are unable to operate correctly.

A Closer Look at Alcohol DT's

In the worst-case scenario, this causes a cardiovascular collapse. The heart is unable to pump properly so blood stops flowing and the lungs stop taking in air. This doesn’t happen rapidly, however, Instead, it takes place over several hours or days. In the meantime, the brain, deprived of blood and oxygen, starts to fail. As the brain fails, the alcoholic begins to hallucinate and loses their ability to differentiate the real world from their imagined world.  

As it was pointed out above, alcoholics may also experience seizures during this time. Seizures are associated with alcohol withdrawal because the detox process sends the body into shock.

Are DTs the Same as Hallucinosis?

Although Delirium Tremens may cause seizures, the condition is not the same as hallucinosis. The former is far more deadly than the latter.

In an article on alcoholic hallucinosis published in The Industrial Psychiatry Journal, several doctors define the condition as, “a rare complication of chronic alcohol abuse characterized by predominantly auditory hallucinations”. The authors go on to explain that the symptoms of the condition may include verbal delusions (hearing things that don’t exist) as well as mood disturbances.

Therefore, hallucinosis is similar to schizophrenia. Some doctors even refer to the condition as “alcohol-related psychosis”. While it is a frightening illness, it has no physical symptoms and does not threaten the alcoholic’s life in a direct way.

DT, on the other hand, is life-threatening. This condition can interrupt the alcoholic’s bodily processes and cause them to die during alcohol withdrawal.

Are They the Same as “The Shakes”?

Delirium Tremens are different than alcohol withdrawal “shakes”. However, the two conditions can be tough to distinguish. Shaking may be a side effect of DT, but it is not always a symptom. Plenty of people shake when they withdraw from alcohol, even if they’re a casual drinker (hangover, anyone?).

Alcohol withdrawal shakes are the result of changes in the nervous system. When we drink alcohol, it depresses our brain. This is why booze is referred to as a “depressant”. So, when we’re drunk, our brain slows down. As a result, the nervous system slows down as well. Once we detox and the alcohol leaves our system, the nervous system speeds back up, resulting in a shaky sensation.

As you might imagine, long-term alcoholics experience particularly bad cases of the shakes. If someone has had alcohol in their system for years on end, their nerves are accustomed to operating at a normal speed. So, an alcoholics hands tend to shake uncontrollably when they go through withdrawal.

Ultimately, the shakes can be a symptom of DT. But, the two aren’t always related.

Timeframe of DTs

DTs are fairly predictable when it comes to the connection to alcohol withdrawal in when they will occur and for what reason. The confusion and delirium that occurs with delirium tremens comes on quickly. After your last drink, DTs is expected to occur around three days into withdrawal. It can last for up to three days once it’s begun. Generally, it should taper off 5-7 days later. For this reason, it’s suggested that you seek medical help for the initial stages of alcohol detox. This can be inpatient or outpatient treatment but regardless of what you choose, you’ll want specific medication that will prevent DTs from occurring. Your doctor can prescribe this to you if you want to detox at home. A better option would be to do inpatient detox so you can be monitored throughout the process.

Who is at Risk for Delirium Tremens?

As was pointed out above, this condition usually occurs in those who maintain heavy drinking habits. Specifically, someone must drink excessive amounts of alcohol for at least 30 days before they’re at risk for DT’s.

Who is at Risk for Delirium Tremens?

There are a number of other factors that may increase a person’s risk. These factors include:

Metabolism: The human metabolism is closely linked to liver health. People with healthy livers are able to process food and drugs faster than those with unhealthy livers. If someone drinks heavily, it is likely that their liver is in bad shape. So, their body will have difficulty processing alcohol. They might experience Delirium Tremens due to a buildup of alcohol in their liver and the inability to expel it.

Diet: A healthy diet can help us process drugs faster. By fortifying our digestive system, certain foods can help us to expel toxins. Unfortunately, many severe alcoholics don’t have the healthiest diets. So, those folks who eat poorly may increase their risk of getting the DT’s.

Brain chemistry: This condition is caused by a failure in the connection between the brain and the body. Because the brain can’t send proper signals to the rest of the organs, the individual’s body starts to shut down. If someone has a particularly strong brain, they may not experience DT’s. Those who have sacrificed the plasticity of their brain, however, are at an increased risk.

Age: Typically, younger people tend to have healthier livers and brains. This is particularly the case among hard-drinking alcoholics. An older person who has been drinking for many years is far more likely to experience Delirium Tremens than a younger person with fewer years of alcohol abuse under their belt. Age isn’t always a risk factor but it can be.

Severity of drinking habit: The biggest risk factor is the severity of one’s drinking habit. The longer (and more) you drink, the more likely it is that you’ll contract the DT’s. If you’ve drunken heavily for 10 years or more, for example, you are at a high risk.

DT Symptoms: What are the Side Effects?

Alcohol Withdrawal Delirium has numerous symptoms. They aren’t just confusion, seizures, or death, either. An alcoholic with a bad case of DTs may experience any number of side effects.

Side Effects

The most notorious symptoms include:

  • Nightmares
  • Agitation
  • Global confusion
  • Auditory and visual hallucinations
  • Hypertension (High blood pressure)
  • Profuse sweating
  • General disorientation

Additional mental or psychological symptoms include:

  • Anxiety
  • Panic
  • Psychosis
  • Inability to speak
  • Slowed cognitive function
  • Irrational fear or excitement
  • Sudden bursts of energy
  • Mood swings

Mental Side Effects

Furthermore, an alcoholic with DTs will likely experience some of these physical symptoms:

  • Tremors
  • Shivers
  • Arrhythmias (Irregular heart rate)
  • Heightened pulse
  • Exhaustion
  • Sensitivity to light
  • Deep sleep (several days long)

Long-Term DT Symptoms

Long-Term DT Symptoms

Even if an alcoholic survives Delirium Tremens, the effects may last for years. Some long-term side effects may include:

  • Mood swings
  • Constant exhaustion
  • Insomnia
  • Delirium and/or confusion

The Alcohol Detox Timeline

What happens when you stop drinking suddenly? When does Delirium Tremens occur?

Typically, alcohol detox cases follow a similar timeline. Delirium Tremens usually appear within the same window. This is good, as it allows doctors to plan for treatment. It also enables alcoholics to mentally prepare themselves for the symptoms.

Here’s what a normal alcohol withdrawal time frame looks like:

First 12 hours: During this stage, an alcoholic will feel strong cravings and may experience headaches. Depending on the severity of their habit, they may also vomit or feel painful stomach cramps.

12-48 hours: Heading into the first day, the alcoholic will start to feel feverish. Their body temperature will increase, their heart will pump faster, and they will feel increasingly anxious. It is common for withdrawing alcohols to experience confusion during this time.

48-72 hours: By this point, withdrawal delirium will set in. If the alcoholic is at risk for delirium tremens, the symptoms will begin to appear. They may experience seizures, hallucinations, or strong shakes. This is considered to be the withdrawal “peak” and, if the addict is not treated properly, they may die during this phase.

72 hours+: At this point, only the most severe alcoholics will still experience symptoms. Most folks are able to detox by day 3 or 4. Others, however, feel symptoms for nearly a week. Those who experience Delirium Tremens may not feel the worst pain until day four or five.

Medical Management for Delirium Tremens

Alcohol withdrawal is extremely dangerous and can kill you. It’s worth taking your recovery from alcohol seriously. As symptoms can come on strong very quickly, you won’t be able to get medical help when you need it. Withdrawal symptoms can go from moderate to deadly in a short amount of time with no pre-warning. By getting medical help when you’ve decided to stop drinking, you can help prevent DTs from occurring. It is a part of the inpatient treatment program with any rehabilitation center and can also be part of an outpatient treatment program for alcoholism.

Medical Management for Delirium Tremens

When you decide to get medical management because you’re going to quit drinking, you increase the likelihood of a successful recovery. It is effective enough that you can detox at home without the risk of DTs. You’ll have to see your doctor to get medicated in a clinic but you avoid the dangers of DTs altogether.

How to Prevent the Onset of DT’s

The main way to prevent delirium tremens is to treat withdrawal symptoms. Mortality without treatment while withdrawing from alcohol is 15%-40%. If DTs do occur, aggressive treatments have been shown to improve the outcome. Studies have shown that the most effective treatment should include medical treatment for alcohol in a room that offers the patient sufficient light. Controlling stimuli in a relaxed environment has been shown to reduce stress and visual hallucinations. It’s important for the patient to remain mindful. This may include holistic approaches such as meditation or breathing techniques.

Medical treatment will include giving the person benzodiazepines. They will be administered until the recovering alcoholic is lightly sleeping. To prevent death, it’s possible that high doses of benzodiazepines will need to be given. It depends on the symptoms. Sometimes, the use of antipsychotics are used. For the long-term treatment, medication Acamprosate may be incorporated into alcohol withdrawal treatment. It reduces the risk of relapse, believed to stabilize chemical imbalances in the brain that occur through alcohol withdrawal.

Sometimes, the use of alcohol may be prescribed to prevent DTs. This is not considered to be good practice for most in the addiction treatment industry. What is recommended is thiamine, which may be administered intravenously. A thiamine deficiency in the body along with alcohol can damage the brain further. A thiamine, or Vitamin B1 deficiency can occur through the use of alcohol abuse.  Thiamine deficiency along with alcohol abuse will have high risks of effecting the brain in a dangerous way.

Gauging the Risks of Delirium Tremens

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) is a scale to assess alcohol withdrawal. There are ten components to the test with independent scales of intensity. This helps medical professionals determine when it’s safe for alcoholics to taper off from medication assistance.

Mild alcohol is defined with a score of 15 or less.

Severe alcoholism is 20 or more.

These common symptoms of alcohol withdrawal include:

  • Nausea
  • Tremors
  • Anxiety
  • Random sweating
  • Agitation
  • Anxiety
  • Disturbance in movement.
  • Disturbance in eye movement.
  • Disturbance of hearing.
  • Headaches
  • Problems with orientation and the ability to think clearly.

DT is a medical emergency that can be avoided if the proper medical treatment is administered. This needs to be established before you quit drinking. Casual drinkers may not be at risk but they may wish to consult a doctor or addiction specialist. For those who have been drinking for a long time or heavily, they should get medication to prevent DTs. It is believed that about 50% of people who are alcoholics will develop withdrawal symptoms to some degree with DT affecting 5% of those.

Randomized trials showed that benzodiazepines were more effective to prevent DTs than neuroleptics. The right electrolyte support, monitoring of vital signs, and support of the respiratory system reduces the mortality rate to 3% due to DT. In the medical industry, it’s been proven through studies that if a person is trying to stop drinking, they do need support. They need a reassuring environment that doesn’t cause them to become too anxious or excited. They also need to be constantly monitored for any early signs of DT.

Alcohol DT Treatment: Professional Detox

The best treatment for Delirium Tremens is found in a professional detox facility. These centers are staffed with medical professionals who understand alcohol withdrawal. They can work with you to assess your situation and ensure that the detox process goes as smoothly as possible.

Remember, you can die from alcohol withdrawal. So, it’s not smart to go through the process alone. Medical professionals can help to prevent the risk of DT’s when you detox under their supervision. The understand all possible Delirium Tremens treatments and will choose the one that works best for you.

There is a 35% fatality rate among those who experience the DT’s but fail to seek treatment. Conversely, the fatality rate among those who seek professional treatment is as little as 1%. It is possible to die from alcohol detox, so make sure you get the help you need.

Medical Alcohol Detoxification is The Best Treatment for Delirium Tremens

There are numerous benefits to professional detox. Particularly if you have a severe alcohol habit, it’s important to seek expert treatment.

Some of the biggest benefits include:

Medical expertise: Obviously, this is the #1 benefit of checking in to a professional alcohol detoxification facility before you go through withdrawals. The doctors on-staff will be able to assess your situation. They’ll determine whether you can quit cold turkey or you must wean yourself off. They’ll also prescribe medications for alcohol withdrawal symptoms if necessary.

No triggers: If you’ve gotten to the point that you’re experiencing Delirium Tremens, you most likely suffer from alcohol addiction. Therefore, you will feel strong cravings when you go through withdrawal. The great thing about detox is that there is no alcohol available in the facility. When you’re at home, you’ll still have the opportunity to relapse. But, in a detox center, those opportunities are taken away. Essentially, this helps to prevent you from relapsing before you even get sober.

Peace and quiet: The DT’s are quite uncomfortable. Even in less severe cases, they’re accompanied by headaches, stomach pains, and anxiety. Noise and stress will exacerbate all of these symptoms. In a detox center, you’ll have the peace and quiet you need to get well. You’ll have the chance to rest and to focus on getting sober without having to deal with stress. Therefore, this is a great resource for heavy and mild alcoholic alike.

Alcohol Detox at Home: Can You Wean Yourself Off?

Depending on the nature of your habit, it may be safe to wean yourself off of alcohol. This means that you’ll be able to detox at home. If you are a mild alcoholic (i.e you’re accustomed to taking breaks or you only drink at night), it may be safe to detox on your own.

If you are a full-time alcoholic and you’re accustomed to having booze in your body at all times, however, it is not safe for you to quit by yourself. You’ll need to enlist the help of medical professionals to detox safely. Otherwise, you’ll put yourself at risk of a nasty case of DT’s.

Either way, we recommend that you reach out to a doctor before you try to quit. They’ll take a look at your specific habit and determine the safest route for you to take.

Furthermore, professional detox is always the best option if you have a drinking problem. Between 40% and 60% of folks who attempt an at-home detox end up relapsing. Even if you’re not at risk of dying from Delirium Tremens, a professional detox program could help you get clean and stay that way.

Delirium Tremens: A Dangerous (but Preventable) Condition

Unfortunately, the DTs are a potential reality for some drinkers. After all, alcohol is a powerful drug. No one plans to become addicted to alcohol, but many of us find ourselves slowly slipping into a battle with addiction. Before you know it, you’re unable to withdraw from alcohol without experiencing these life-threatening symptoms.

Luckily, however, Delirium Tremens is both curable and preventable. All you need is the right type of support.

If you’re worried that you’re unfit to go through alcohol withdrawal alone or that doing so will put your life at risk, please call us. We can assess your habit and help you to determine the best course of action. We’ll make sure that you get on the safest and smoothest path to recovery.

Full Infographic:

the risks of mixing alcohol with other drugs

Sources:

The New England Journal of Medicine (Nov, 2014) Recognition and Management of Withdrawal Delirium (Delirium Tremens). Retrieved from,
http://www.nejm.org/doi/full/10.1056/NEJMra1407298#t=article
NIS, Medline Plus. Delirium Tremens. Retrieved from,
https://medlineplus.gov/ency/article/000766.htm
JAMA Network (Oct, 1997) Pharmacologic Treatment of Alcohol Withdrawal. Retrieved from,
http://jamanetwork.com/journals/jama/article-abstract/418432
American Family Physician (Mar, 2004) Alcohol Withdrawal Syndrome. Retrieved from,
http://www.aafp.org/afp/2004/0315/p1443.html
NCBI, CMAJ (Mar, 1999) Diagnosis and management of acute alcohol withdrawal. Retrieved from,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1230114/
NCBI, PubMed (Feb, 2007) Alcohol withdrawal syndrome: how to predict, prevent, diagnose and treat it. Retrieved by,
https://www.ncbi.nlm.nih.gov/pubmed/17323538

2018-10-13T18:46:10+00:00 September 20th, 2018|0 Comments

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