What is Delirium Tremens?

Delirium tremens is a hallucinatory and delusional state often induced by cessation of heavy daily drinking or during recovery from alcoholism. It can also occur when people rapidly withdraw from regular use of benzodiazepines like Xanax® or Valium®. Sudden withdrawal from barbiturates like Phenobarbital can also produce this condition.

Recovering alcoholics often refer to that rough period of alcohol withdrawal as the DTs. Delirium tremens usually occurs within a day after one’s last drink or dose of medication, but may happen several days after cessation of drinking. The condition, if left untreated, can be fatal in approximately 30% of those ceasing heavy long-term drinking.

Delirium tremens immediately affects the brain, causing it to secrete in high quantities several hormones like GABA and serotonin to attempt to find balance in the non-drinking state. These hormones may also decrease rapidly. The neurological effects cause confusion, great anxiety, and sometimes visual and auditory hallucinations. However, their primary dangerous effect is that the body responds to the upshifts and downshifts of neural chemicals by causing breathing difficulties, rapid heart rate, and severe arrhythmias, as well as abnormally high blood pressure. A single arrhythmia can cause death if left unaddressed.

Since most alcoholics are usually in poor health, and may be suffering from nutritional deficits as well as liver disease, the body has a particularly hard time adjusting to this state, and this may increase fatality rates when untreated. Treatment of delirium tremens consists of administration of low dose sedatives, ironic perhaps for those addicted to benzodiazepines. Extreme emotional disturbance may also warrant treatment with an anti-psychotic medication like Haldol®. The person experiencing the condition may be violent making monitoring and medical interventions difficult without an anti-psychotic.

Delirium tremens is a medical emergency, and its effects are the reason why chronic alcoholics should not attempt a “cold turkey” approach to ceasing drinking. With medical intervention, the fatality rate from delirium tremens drops to 5%. Most medical experts feel that recovery from alcoholism is best undertaken at either a hospital or an alcohol treatment center. Additional participation in programs like Alcoholics Anonymous is encouraged to support and maintain recovery.

Long-term benzodiazepine use should never be ended with cessation of all benzodiazepines. Instead, most doctors feel that gradually decreasing amounts of benzodiazepines taken is the best way to cease such use, and can help people avoid delirium tremens. Under the guidance of a doctor or psychiatrist, levels are reduced very gradually, often by quarters of a milligram per week. Narcotics Anonymous and programs like it can provide support during and after the reduction process.