Delirium Tremens: What It Is and How To Treat It

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When long-term heavy drinkers suddenly quit, they generally experience withdrawal symptoms. That’s because, over time, the central nervous system (CNS) adjusts to the presence of alcohol. If alcohol is suddenly removed, the CNS can take some time to rebalance itself. This causes a variety of alcohol withdrawal symptoms, ranging from mild to severe.

Delirium tremens (DTs) is one of the most severe and notorious symptoms of alcohol withdrawal. And although it only occurs in around two percent of people with alcohol dependence, it can be life-threatening if it goes untreated. Below, we’ll discuss what delirium tremens is, the risks associated with it, how to prevent DTs, and the best ways to treat it.

What Is Delirium Tremens?

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Delirium tremens is a serious form of alcohol withdrawal involving severe mental confusion and disturbance of the nervous system. DTs most often occurs within two to four days of a person’s last drink, but symptoms can appear up to 10 days after quitting alcohol.

How Long Does Delirium Tremens Last?

DTs usually lasts for three to four days. In extreme cases, it can continue for up to eight days. Symptoms may fluctuate, appearing to resolve before returning.

Typical precursors of DTs include tremors, followed by hallucinations, and then seizures. DTs is the last and most serious symptom of severe withdrawal.

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Who Is at Risk for Delirium Tremens?

People with severe alcohol dependence are most at risk for DTs. It’s also especially common among people with a drinking history of 10 years or longer.

Additional risk factors include a history of DTs, seizures, or detoxification; a prolonged period prior to last drink; and having an additional illness, such as a mental health disorder. Old age and poor general health may also impact the severity of alcohol withdrawal.

Delirium Tremens Symptoms

Delirium tremens symptoms may include:

  • Shaking hands
  • Severe confusion
  • Reduced cognitive abilities (e.g., focus, attention, and awareness)
  • Visual hallucinations, often involving animals
  • Less commonly, tactile or auditory hallucinations
  • Rapid heart rate
  • High blood pressure
  • Agitation
  • Hyperthermia (overheating)
  • Unusual sweating
  • Nausea and vomiting
  • Headache
  • Sleep disturbances or disturbances of the sleep-wake cycle
  • Fatigue/sleepiness
  • Prolonged sleep (typically at the end of DTs)

Rapid changes in cognition, breathing, blood circulation, or temperature are extremely dangerous. If you recognize these symptoms in yourself or a loved one, seek immediate emergency medical treatment.

What Are the Risks of Delirium Tremens?

Delirium tremens can lead to major complications such as:

  • Rhabdomyolysis (potentially life-threatening breakdown of muscle tissue)
  • Hypertension
  • Respiratory failure
  • Lasting changes to the brain
  • Arrhythmia (may lead to cardiac arrest and heart failure)
  • Death

Without treatment, DTs can be fatal in up to 37 percent of cases. But with early treatment, the delirium tremens mortality rate is less than 5 percent. It’s important to pay attention to the early signs of DTs to improve your prognosis.

Prevention and Management of Delirium Tremens

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How is DTs treated, and how can you prevent it from occurring in the first place?

Management of Delirium Tremens

The most common and effective treatment for DTs is benzodiazepines. These include lorazepam (Ativan), diazepam (Valium), and chlordiazepoxide (Librium), typically administered intravenously. Sometimes, it’s administered only when symptoms are present. Other times, it’s administered according to a fixed schedule, with additional doses given as needed.

Intravenous fluids are sometimes necessary to treat dehydration and rebalance electrolytes. Depending on your symptoms, you may also require blood pressure medication, anticonvulsants, pain medication, antipsychotic drugs for hallucinations, or medications to regulate your heartbeat. Some people with DTs may need to stay in the hospital for up to a week to stabilize.

Afterward, it’s important to get treated for alcohol dependence to avoid experiencing DTs again in the future. Remember that the risk of DTs increases when you have a history of delirium tremens.

Effective management of delirium tremens requires early intervention. If you cut back on alcohol and notice troubling symptoms, call a doctor right away. Other, less severe symptoms of withdrawal occur before delirium tremens, so early intervention can prevent DTs or reduce its severity. In addition, it’s best for heavy drinkers to quit or cut back on drinking in consultation with a medical professional.

How to Prevent DTs

Because DTs is most common among heavy drinkers, the best prevention strategy is to drink in moderation or not at all. According to the Centers for Disease Control and Prevention (CDC), heavy drinking is 15 or more weekly drinks for men and eight or more drinks per week for women. Moderate drinking means two or fewer drinks per day for men and one daily drink for women.

If you already drink heavily, and are concerned about experiencing delirium tremens if you quit, try tapering off alcohol first. Quitting cold turkey puts you at higher risk for withdrawal symptoms, including DTs. That said, cutting back gradually takes a lot of discipline, and you may still experience some level of withdrawal. Getting medical assistance is the surest way to prevent DTs.

Support for Limiting Your Drinking

If you are expecting severe withdrawal symptoms, it’s best to check into a medical detox facility, or find some other form of professional medical support to ensure your safety. Delirium tremens and other severe alcohol withdrawal symptoms can be dangerous, and even deadly. If you drink heavily, and plan to quit abruptly, make sure you’re safe.

However, there are many other aspects of cutting back or quitting drinking aside from medical detox. Tapering off before stopping completely is much easier with the support of peers, or a recovery program. And avoiding DTs in the future means avoiding relapse once you’ve quit. This is also much easier with some professional support.

Ria Health offers an online program to help you establish lasting change. Our recovery coaches can help you develop new skills for coping with the challenges of sobriety, and our medical team can prescribe medication to limit alcohol cravings. If you want to quit gradually, we can help you create a plan and stick with your goals.

While you should seek in-person medical care for withdrawal symptoms like delirium tremens, online programs may be the most convenient way to establish long-term change. Get in touch with a member of our team to learn more about how we can support you in giving up alcohol for good.

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Written By:
Ashley Cullins
Ashley Cullins is a writer with a passion for creating engaging, understandable content on complex topics like addiction and mental health. She has over five years of experience writing for healthcare websites and publications. Having experienced addiction first-hand in her family, Ashley deeply connects with Ria Health’s mission to make treatment easier and more accessible. In her spare time, she enjoys spending time with her daughter, reading, and cooking.
Reviewed By:
Evan O'Donnell
Evan O’Donnell is an NYC-based content strategist with four years’ experience writing and editing in the recovery space. He has conducted research in sound, cognition, and community building, has a background in independent music marketing, and continues to work as a composer. Evan is a deep believer in fact-based, empathic communication—within business, arts, academia, or any space where words drive action or change lives.

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