Alcohol Withdrawal Delirium: Symptoms, Causes, and Treatment

More than half of people with a history of alcohol misuse may experience symptoms of alcohol withdrawal when they stop drinking or reduce their alcohol intake.¹

Alcohol withdrawal can be unpleasant and, in some cases, have potentially fatal complications. While rare, up to 5% of people experience certain severe alcohol withdrawal symptoms, including altered levels of consciousness, confusion, and marked autonomic hyperactivity. This dangerous constellation of symptoms comprises what’s known as alcohol withdrawal delirium, which is commonly referred to as delirium tremens (DTs).¹

Alcohol withdrawal delirium is a medical emergency that can be fatal if not treated immediately. This is one reason why it is important that you do not attempt to detox on your own or at home if you are at risk of experiencing severe alcohol withdrawal symptoms.²

This article will help you learn more about:

• What alcohol withdrawal delirium is
• Symptoms of alcohol withdrawal delirium
• Causes and risk factors
• How long alcohol withdrawal delirium lasts
• Delirium tremens treatment
• How to get help

What Is Alcohol Withdrawal Delirium?

Alcohol withdrawal delirium or delirium tremens is a severe manifestation of alcohol withdrawal that can occur when a person who has been drinking heavily for a long period of time stops drinking or reduces their alcohol intake.²

DTs typically appear within 1 to 4 days after acute alcohol withdrawal symptoms begin.² Hallmark symptoms of DTs include extreme autonomic nervous system hyperactivity (e.g., irregular heartbeat, sweating), agitation, hallucinations, and profound confusion.^{1, 2}

Symptoms of Alcohol Withdrawal Delirium

Alcohol withdrawal delirium does not develop suddenly and instead progresses from relatively minor symptoms such as anxiety, headache, insomnia, and irregular heartbeat from alcohol withdrawal among others.^{1, 3} Minor alcohol withdrawal can progress to severe alcohol withdrawal, which is characterized by hallucinations, seizures, tremors, and more.^{1, 4} If these symptoms are left untreated, a person may develop DTs, which is marked by a combination of delirium and severe alcohol withdrawal symptoms.^{1, 4}

Delirium tremens symptoms may include:^{1, 4, 5}

• Profound confusion
• Cognitive disturbances
• Hallucinations
• Nausea
• Fever
• Sweating
• Rapid heartbeat
• High blood pressure
• Severe agitation
• Tremors
• Seizures

Causes and Risk Factors of Alcohol Withdrawal Delirium

Alcohol is a central nervous system (CNS) depressant that, with heavy or prolonged use, can upset the balance of inhibitory and excitatory neurotransmitters in the brain.^{1, 4} Alcohol facilitates the function of GABA, an inhibitory neurotransmitter that helps regulate brain function, and inhibits the activity of glutamate, an excitatory amino acid that plays a role in regulating cognition, memory, and mood.²

When a person drinks heavily over a long period of time, physical dependence can develop as the body naturally adapts to regular exposure to alcohol.⁶ At such a point, when they cut back or abruptly stop drinking, they may experience a relative deficit in the once artificially elevated inhibitory effects of GABA, which manifests as overactivity throughout the CNS.² This imbalance is made even more pronounced by the relative increase in excitatory glutamate activity, and can ultimately result in a spectrum of adverse symptoms including agitation, irregular heartbeat, high blood pressure, and tremors, among others.^{1, 4}

A person who is physically dependent on alcohol may experience withdrawal symptoms when they cut back or abruptly stop drinking. However, as mentioned, most people do not experience alcohol withdrawal delirium.¹

Certain factors that can increase the risk of developing alcohol withdrawal delirium include:^{1, 2, 3, 5}

• Having a prior history of detoxification, severe withdrawal symptoms, DTs, or seizures.
• Drinking heavily during the weeks prior to withdrawal.
• Having a co-occurring psychiatric or medical disorder (e.g., abnormal liver functioning).
• Being of advanced age.
• Overall health and nutrition status.
• Using additional substances, including prescription medications or illicit substances.

How Is Alcohol Withdrawal Delirium Treated?

Because alcohol withdrawal can be life-threatening, attempts to manage it without medical detoxification—including close patient supervision and pharmacological withdrawal management—are not recommended. People at risk of experiencing severe withdrawal, seizures, and/or delirium tremens are not good candidates for non-medical alcohol detoxification.³

Alcohol withdrawal delirium is a medical emergency that should be treated as early as possible, ideally in an inpatient hospital setting.^{1, 3} Studies suggest that DTs can result in death up to 15% of the time even with treatment. Untreated DTs can result in death up to 37% of the time.¹ Early treatment of withdrawal symptoms can reduce the risk of developing DTs and other complications and improve patient outcomes.^{3, 5}

Appropriate delirium tremens treatment involves the use of medications. Medication for delirium tremens are:

• Benzodiazepines, such as lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium), can help manage withdrawal symptoms and reduce the risk of seizures. Benzodiazepines are the most commonly used type of medication for the treatment of alcohol withdrawal and DTs.^{3, 5}
• Barbiturates, such as phenobarbital, may be used in combination with benzodiazepines to help patients who don’t respond to benzodiazepines alone.^{1, 4}

How Long Does Delirium Tremens Last?

Delirium tremens can begin 1 to 4 days after acute alcohol withdrawal begins.² Should they arise, DTs usually last for 3 to 4 days, although symptoms can last for more than 1 week. ⁴ As mentioned previously, delirium tremens doesn’t develop suddenly, but instead slowly progresses over the course of alcohol withdrawal.³ After initial alcohol withdrawal symptoms arise, tremors, hallucinations, and seizures can emerge, followed by DTs, if symptoms aren’t addressed earlier.^{3, 4} Nothing has been shown to shorten the length of DTs once it has developed.³

Preventing Alcohol Withdrawal Delirium

Avoiding alcohol is the best way to prevent delirium tremens. If you are at risk of experiencing severe symptoms of alcohol withdrawal, you should contact a medical professional or an alcohol treatment center before you stop or significantly reduce your alcohol intake. Doing so without the help of medical professionals can be dangerous and detoxing in a non-medical setting is not recommended, especially if you are likely to experience severe withdrawal symptoms and complications such as DTs.³

If you or someone you care about are struggling with alcohol use, you don’t have to go through it alone. An alcohol detox center can help you comfortably and safely withdraw from alcohol as well as assist in the transition into ongoing care. Our rehab directory lets you easily search for an alcohol detox center near you when you filter by “detox services,” and location.

If you are unsure about where to start when it comes to choosing a local or out-of-state rehab, contact one of our admission navigators at and they can help you figure out which program will be the right fit for you. You can also look at some of the facilities listed below to see if they provide the program you are looking for:

• California: Laguna Treatment Center
• Florida: Recovery First Treatment Center
• Florida: River Oaks Treatment Center
• Nevada: Desert Hope Treatment Center
• Mississippi: Oxford Treatment Center
• Texas: Greenhouse Treatment Center

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