Alcohol Withdrawal Delirium: Causes, Symptoms, And Treatments

Alcohol withdrawal delirium (AWD) may occur after a period of heavy drinking and is one of the most severe side effects of alcohol withdrawal. AWS symptoms may be mental and physical in nature.

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Dr. Manish Mishra, MBBS

Medically Reviewed By: Manish Mishra, MBBS


Heavy drinkers who abruptly quit drinking alcohol are at a higher risk for developing a dangerous condition called alcohol withdrawal delirium (AWD), also known as delirium tremens (DTs).

AWD symptoms may begin mere hours after your last drink and may include increased heart rate, nausea, auditory and visual hallucinations, disorientation, itching, and more.

When AWD occurs, it is considered a medical emergency, and people are highly encouraged to call the emergency department promptly to avoid potentially life-threatening consequences.

Causes Of Alcohol Withdrawal Delirium

Nearly half of people who are addicted to alcohol will experience withdrawal symptoms, and of those only five percent will exhibit symptoms of delirium tremens.

It remains unclear what precisely triggers alcohol withdrawal delirium, but research shows that it’s related to ethanol’s effect on receptors in the brain and central nervous system.

Changes To Neurotransmitters

Alcohol has a depressant effect on the body. This means brain functioning slows down and a person will experience feelings of sedation and decreased anxiety.

Over time, the brain will compensate for this by increasing activity between neurotransmitters. Eventually, a heavy drinker will develop a dependence on alcohol, and any attempt to reduce alcohol intake will arouse withdrawal symptoms.

Alcohol Dependency

Alcohol dependency occurs when a person craves drinks that contain alcohol and is unable to control their drinking. Dependence means a person must drink higher amounts to get the same euphoric effect.

When somebody has a physical and psychological dependence on alcohol, they will experience withdrawal symptoms up to and including delirium if they attempt to quit drinking cold turkey.

Poor Diet While Detoxing From Alcohol

Drinking alcohol may change the effectiveness of the digestive system and impact the absorption of vitamins and minerals that are essential for bodily function.

During alcohol detox, many people have issues with malnutrition due to ailments such as nausea, vomiting, and diarrhea.

To combat this, most detox centers provide IV fluids infused with electrolytes and vitamin supplementation.

Symptoms Of Alcohol Withdrawal Delirium

Symptoms of AWD will vary based on several factors, such as the severity of the alcohol addiction, duration of heavy drinking, and other underlying physical or mental health conditions.

Physical Symptoms Of Alcohol Withdrawal Delirium

The first physical symptoms of AWD may begin a few hours after the last drink. They may include increased heart rate, high blood pressure, sweating, and intense itching or burning.

Many of these physical symptoms are present in a mild to moderate alcohol withdrawal syndrome and should be monitored closely to avoid further risks to safety.

In extreme cases of AWD, people may experience alcohol withdrawal seizures. This is one of the most dangerous side effects of AWD and is considered a medical emergency.

Mental Symptoms Of Alcohol Withdrawal Delirium

Mental symptoms of alcohol withdrawal may include irrationality, confusion, disorientation, auditory hallucinations, nightmares, and more.

Typically, severe mental symptoms of AWD don’t start to appear until 12 to 24 into the detoxification process, peaking around the 72-hour mark.

How Alcohol Withdrawal Delirium Is Treated

Withdrawal delirium can pose serious health risks if not addressed promptly by a medical professional. Below are some of the most common treatments for AWD.

Medications To Reduce Fever And Aches

Medications to control itching, fever, and aches are often administered to help alleviate physical discomfort. Drugs may include over-the-counter medications such as ibuprofen or acetaminophen.

Antipsychotic Medications To Treat Hallucinations

To help alleviate the vivid hallucinations during AWD, many people are given benzodiazepines to calm the brain and central nervous system. These medications may include diazepam, lorazepam, haloperidol, and others.

Learn more about medications for alcohol withdrawal.

Intravenous Fluids

IV fluids are an important treatment for AWD to avoid dehydration and other health complications. Fluids may be infused with vitamins such as thiamine and minerals such as magnesium.

Anticonvulsants To Prevent Seizures

Anticonvulsant medications are also commonplace in the treatment of AWD. Common anticonvulsants include chlordiazepoxide (Librium) to help prevent the onset of seizures.

Complications Of Alcohol Withdrawal Delirium

If medical attention is not sought for AWD, several harmful conditions may arise that can cause permanent physical damage.

Wernicke-Korsakoff Syndrome

Wernick-Korsakoff syndrome (WKS), also called wet brain, is a brain disorder caused by a lack of thiamine in the body. Symptoms of WKS include vision abnormalities, confusion, and grandiose storytelling.

Medical treatment is possible for WKS when caught early. When left untreated, it may eventually lead to permanent cognitive decline, loss of muscle coordination, and amnesia.

Learn more about Wernicke-Korsakoff syndrome.

Alcoholic Cardiomyopathy

Alcoholic cardiomyopathy refers to alcohol abuse that eventually damages the heart tissue and weakens the muscle. This eventually leads to reducing the body’s available oxygen supply.

This condition is relatively uncommon, only affecting one to two percent of people who drink more than is recommended on a weekly basis.

Symptoms of cardiomyopathy may include tachycardia (fast heart rate), palpitations (irregular heart beat), and intense fatigue.

Alcoholic Neuropathy

Alcoholic neuropathy occurs in people who drink heavily and start to feel pain or tingling in their limbs. This is typically due to a lack of essential vitamins in the body from prolonged alcohol abuse.

Alcoholic neuropathy can be treated by completely abstaining from drinking and entering a detox or inpatient treatment program.

Over time, much of the nerve damage may be repaired with proper diet and vitamin supplementation.

Treatment Programs For Alcohol Addiction

If you or someone you know is addicted to alcohol or is at risk for severe alcohol withdrawal, evidence-based treatment services for substance abuse may help get you on track to sobriety.

Treatment options may include:

Inpatient and outpatient treatment of alcohol withdrawal is the best way to avoid potentially dangerous side effects such as delirium tremens (DTS).

Find Treatment For Alcohol Use Disorder At Bedrock Recovery Center

Call Bedrock Recovery Center today for more information on the health risks of chronic alcohol consumption and treatment options for substance use disorders.

Our residential treatment program can assist you in management of alcohol withdrawal, and help you achieve long-term recovery from heavy alcohol use.

  1. National Institute on Alcohol Abuse and Alcoholism (NIAAA)
  2. National Institute of Health (NIH)
  3. National Institute of Neurological Disorders and Stroke (NINDS)
  4. U.S. National Library of Medicine: PubMed

Written by Bedrock Recovery Center Editorial Team

© 2024 Bedrock Recovery Center | All Rights Reserved

* This page does not provide medical advice.

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