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Delirium Tremens

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People who drink heavily and have for a long time might have experienced delirium tremens. Most commonly known as “the DTs,” this period of alcohol withdrawal is serious, difficult, and dangerous. 

Without treatment, delirium tremens can be fatal. Despite this direness, only 3 to 5 percent of people going through alcohol withdrawal experience the symptoms of delirium tremens, which can include grand mal seizures and severe confusion.

What Is Delirium Tremens?

Individuals who have become addicted to alcohol must overcome physical dependency during detoxification as the first step in the treatment process. Sometimes referred to as “DTs” or “the shakes,” delirium tremens is a dangerous condition that can manifest in up to 10 percent of people addicted to alcohol—often the most severe or long-term cases of alcoholism—as their bodies struggle to adapt to the abrupt cessation of alcohol.

However, delirium tremens has also been documented in individuals who were in withdrawal after ceasing consumption of benzodiazepines or barbiturates. When an individual is dealing with delirium tremens, the situation is treated as a medical emergency.

When Does Delirium Tremens Start?

After the last alcoholic drink, it takes between 48 and 72 hours for delirium tremens to develop, says Everyday Health. Although the cause of delirium tremens is debated, a recent explanation that seems probable is that alcohol interferes with the body’s regulation of GABA (gamma-Aminobutyric acid), a neurotransmitter that’s essential for the central nervous system to work properly.

It is thought that the body mistakes alcohol for GABA, resulting in the decreased natural production of the neurotransmitter to compensate. When a person addicted to alcohol stops drinking, the body is suddenly deprived of this essential neurochemical, which regulates excitability in the nervous system.

Symptoms of Delirium Tremens

Individuals who experience delirium tremens struggle with various dangerous symptoms, such as epileptic seizures, confusion, agitation and/or increased levels of excitement, hallucinations, anxiety, and elevated blood pressure and pulse. Healthline lists the additional symptoms of alcohol withdrawal delirium as:

  • Chest pain
  • Delirium (an extremely disturbed state of mind)
  • Delusions (irrationally believing things that are untrue)
  • Excessive sweating
  • Excitement
  • Eye and muscle movement problems
  • Fatigue
  • Fear
  • Fever
  • Increased heart rate or breathing rate
  • Increased startle reflex (an exaggerated reaction to unexpected stimuli)
  • Involuntary muscle contractions
  • Nausea
  • Nightmares
  • Restlessness
  • Sensitivity to light, sound, or touch
  • Stomach pain
  • Sudden mood changes

After the onset of these symptoms—often treated by physicians with sedatives and benzodiazepines—it typically takes about three days before they begin to subside.

The onset of delirium tremens is more gradual, with symptoms slow to appear before peaking. Delirium tremens is often accompanied by paranoia, making the hallucinatory experience especially frightening.

Additionally, the sensorium—the areas in the brain that interpret sensory stimuli and distinguish between reality from hallucination—is altered when an individual is suffering from delirium tremens. This makes the individual unable to separate hallucinations from what’s real.

According to Science Direct, “Delirium tremens is the last stage of alcohol withdrawal; it occurs in 5 percent  to 10 percent of alcohol-dependent individuals, with a mortality rate of 5 percent to 15 percent when left untreated.” 

The mortality rate for delirium tremens has been estimated as high as 35 percent when not medically treated, but as low as 10 percent or less when the patient is detoxing under medical supervision.

How Is Delirium Tremens Treated?

Medical Detox

Because of delirium tremens’ severe nature, it is critical for someone going through it to be medically observed. One of the best facilities for this is a certified substance abuse treatment center. Here, the individual will be monitored around the clock, given medication to ease symptoms, and be in a safe environment as their body works to remove all of the toxins from it.

Medical detox is the first and more challenging step in alcohol addiction treatment. It is the stepping-stone for the rest of treatment. If someone can get through this step, it is likely they will be able to reach and maintain long-term sobriety.

Medical detox usually lasts from five to seven days. When it is complete, the individual graduates to an inpatient/residential treatment program or an outpatient program.

Inpatient and Residential Treatment

Inpatient treatment is the next step where a person lives on-site for the rest of their recommended recovery program. A person with a high risk of relapse should consider entering an inpatient treatment program. Due to the nature of alcohol and the ease of obtaining alcohol almost anywhere, inpatient therapy is encouraged.

Residential treatment specifically explores the psychological reasons for alcohol use. It usually lasts longer than the inpatient treatment program. People are placed under medical supervision twenty-four hours per day and seven days per week while residing at the treatment center.

Outpatient Treatment

Outpatient treatment is best for people who cannot take time away from work or family. It is also good for people who have graduated from inpatient or residential care and are ready to be on their own. This therapy program teaches people how to identify their triggers and find ways to master them. It also helps people learn new skills and techniques to prevent relapse and helps forge a path to long-term sobriety.

Sources

Medline Plus. Delirium tremens. from https://medlineplus.gov/ency/article/000766.htm

Everyday Health. Alcohol Withdrawal. Joseph Bennington-Castro. Medically Reviewed by Robert Jasmer, MD. September 13, 2016 from https://www.everydayhealth.com/alcoholism/guide/withdrawal/

Healthline. Alcohol Withdrawal Delirium. Timothy J. Legg, PhD, CRNP Rose Kivi, Elizabeth Boskey, PhD, and Ana Gotter. May 12, 2017. from https://www.healthline.com/health/alcoholism/delirium-tremens

Science Direct. Delirium Tremens. Medical Conditions. Editors: Shahrokh C. Bagheri. Mehran Mehrabi, in Clinical Review of Oral and Maxillofacial Surgery (Second Edition), 2014 from https://www.sciencedirect.com/topics/neuroscience/delirium-tremens

Delirium Tremens (DT).Pathophysiology. SUNY Upstate. SUNY Upstate Medical University Abdul Rahman; Manju Paul. November 18, 2018. from https://www.ncbi.nlm.nih.gov/books/NBK482134/

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