Delirium Tremens

Delirium Tremens (DTs) is a severe, life-threatening condition characterized by violent delirium, tremors, and autonomic instability. DTs most commonly occur in people with a history of excessive and/or prolonged alcohol use, especially in those who suddenly stop drinking. The condition typically develops within two to four days after the last drink and can last up to five days.

What is Delirium Tremens?

Delirium tremens, also called DTs, is one of the most severe and potentially life-threatening symptoms of alcohol withdrawal. It is most commonly seen in individuals drinking heavily for a long time. 

If someone who fits these criteria suddenly stops drinking, they may experience delirium tremens. If so, it is considered a medical emergency. Failing to seek help can lead to potentially fatal outcomes. 

Delirium tremens often start about two or three days after complete cessation of drinking, which can be long enough that some people may think they won’t get them. The symptoms of delirium tremens can be intense and will often include severe forms of confusion, hallucinations, agitation, elevated blood pressure, increased heart rate, and seizures. 

The most likely cause of DTs is a significant disruption in the electrical activity of the individual quitting drinking. Since the brain becomes highly dependent on alcohol over time, the neurotransmitter disruption will be severe enough to lead to delirium tremens during acute withdrawals. The DTs are preventable and treatable with medical help, but they can be deadly if attempted solo.

How Much Do You Have to Drink to Get Delirium Tremens?

There are specific amounts that an individual needs to drink over a particular time to put them at greater risk for experiencing delirium tremens during alcohol withdrawal. In one study, of 200 consecutive hospital admissions for alcohol-related problems, about one-quarter of the patients eventually developed delirium tremens. Of those, nearly one-tenth were fatal. Even still, only approximately three to five percent of all patients are treated for alcohol use disorder or other issues related to heavy drinking.

Delirium Tremens Signs and Symptoms

The symptoms of delirium tremens won’t generally display in the first few days of alcohol withdrawal. They will take 2 or 3 days to start, possibly because the brain needs that long to react to the drastic changes in neurotransmitter levels and central nervous system activity. The main symptoms of DTs will begin after the acute withdrawal stage has begun and will often change and shift without notice. This includes:

  • Significant irritability, anger, agitation, and hostility
  • Confusion about their location, activities, and more
  • Hyperactivity of the autonomic nervous system, leading to trembling, sweating, irregular heart rate, and vomiting
  • Complete impairment, occasional loss of consciousness
  • Whole body shaking and tremors
  • Seizures

If you or someone you care about has stopped drinking and is experiencing any of these symptoms, emergency medical assistance must be obtained immediately. This emergency medical situation may result in seizures or death if medical intervention is not accepted. 

Delirium Tremens Timeline and Stages

While each individual’s recovery journey will be unique, there will be some commonalities. Depending on the severity of the drinking and the period that the heavy drinking occurred over the withdrawal process, the DTs may be shorter or longer in comparison. The general appearance of delirium tremens isn’t even seen until a few days into the alcohol withdrawal. For those thinking about entering treatment for alcohol use, here is a basic timeline that you can use for general expectations.

Stage 1

Stage 1 is the first handful of hours after the last drink was consumed, where the alcohol has worn off, but withdrawals haven’t started yet. Headaches, tremors, and nausea are common here.

Stage 2

Stage 2 will start about 24 hours after the last drink and begin the withdrawals with a sense of agitation and confusion while nausea and headaches continue. For those who will experience delirium tremens, this stage marks the beginning of the peak seizure risk.

Stage 3

This stage starts about 48 hours after the last drink and features seizures, inability to sleep, increased blood pressure and heart rate, uncontrollable sweating, hallucinations of vision and hearing, and the bulk of the delirium tremens symptoms. 

Stage 4

Stage 4 will start about 72 hours after the last drink and will signal the peak of intensity for most of the uncomfortable or painful symptoms of the early stages of alcohol withdrawal. 

Can Delirium Tremens Cause Brain Damage?

Delirium tremens don’t directly cause brain damage. It is essential to note the commitment to heavy drinking that makes DTs a risk that can result in brain damage. In milder forms, there is damage to the memory and the pleasure and reward centers. In more severe cases, it can be a disorder known as “wet brain.”

How Long Does Delirium Tremens Last?

It’s important to remember that one person’s recovery journey can be worlds different from others, even with incredibly similar addiction profiles. Countless variables can factor into it, but generally speaking, there are some guidelines you can use if you expect them. 

DTs generally start about 2-3 days after the last drink. It will become more intense until it peaks and then begin to subside. In some cases, it can be over in 4 or 5 days. It may last for a week or longer in the most severe cases. 

Treatment for Delirium Tremens

The treatment for delirium tremens is the same for alcohol use disorder, finding a professional alcoholism treatment center and working with them on a recovery plan. Common approaches include medication-assisted treatment, psychotherapy, counseling, and support groups like Alcoholics Anonymous. 

Treatment will often begin as an inpatient detox program that allows you to focus on drying out, then a residential program to help you learn coping and relapse prevention skills. When ready, you can move on to partial care programs, outpatient programs, and even sober living facilities when you are ready.