Throughout history, society has assimilated the consumption of alcoholic beverages , becoming characteristic of some cultures. It is something that can be observed in parties, concerts and discos, traditions, as part of the leisure habits of youth and even in the popularity of phenomena such as the botellones .

However, it must be taken into account that alcohol consumption can generate addiction, with the drinker losing control of his or her intake, thus generating dependence on the substance. And this dependence is not only expressed through the abuse of the substance, but also through signs and symptoms that appear when you stop drinking alcohol. Among the most serious phenomena of abstinence from alcohol is delirium tremens . Let’s see what it is.

The mechanics of abstinence

Once a dependency has been generated, the fact of removing the object to which one is dependent causes abstinence syndrome , that is, the absence of the substance in the body causes symptomatic reactions. That is why in many cases ending alcoholism is not as simple as removing the possibility of consuming this type of drink once and for all. The lack of this substance also produces a series of symptoms that can sometimes be dangerous in themselves.

This means that for a depressant substance (such as alcohol) there will be manic-like symptoms, while for a stimulant the withdrawal will be a drop in the body’s overall activity. In any case , the withdrawal of the desired substance must be controlled , as too abrupt a stop in the supply can cause these syndromes.

Among the abstinence syndromes related to alcohol abuse, the one considered to be the most serious is the one called delirium tremens .

What is delirium tremens?

The acute confusional picture produced by alcoholic deprivation is called delirium tremens. It is caused by the interruption of alcohol intake in chronic drinkers who have developed a physical dependency, and often appears after 4-72 hours of abstinence.

While DTs often occur in patients who stop drinking after heavy alcohol consumption, it is possible to find cases where DTs have been caused by illness, trauma, or infection in individuals with heavy alcohol consumption in the past.

The symptoms of delirium tremens

The main symptoms of this syndrome are a disintegration of consciousness in which visual hallucinations, delusions, emotional lability and stupor appear . Tremors, psychomotor agitation and convulsions are also frequent.

Delirium tremens is usually short lived, but regardless of this it is a dangerous syndrome, as 20% of cases are fatal if not treated, and even with medical care 5% of cases end in death.

Phases of delirium tremens

In the first phase, vegetative symptoms such as anxiety, tachycardia, dizziness, restlessness and insomnia, caused by a rise in noradrenaline in the blood, are observed. If the second phase is reached, around 24 hours after its appearance, the intensity of the previous symptoms increases, with uncontrollable tremors and intense sweating . Seizures may also occur.

Finally, in the third phase (defining delirium tremens), a state of altered consciousness called obnubilation appears. This is defined by a propensity for distraction and confusion, along with profound disorientation. Most characteristic of this phase is the appearance of visual hallucinations (usually microzoopsies) and delusions, along with a heightened sense of distress. Agitation, tachypnea, hyperthermia and tachycardia also occur.

Possible treatments

Bearing in mind that delirium tremens is a problem that can lead to the death of the patient, immediate hospitalization is required for those who present the described symptoms, and it may be necessary to admit them to the ICU.

The treatment to be applied will have as basic objectives to keep the patient alive, avoid complications and relieve the symptoms. Thus, the monitoring of the affected will be constant, observing their hydroelectric balance and vital signs.

Although the specific measures will depend on the case, the administration of diazepam, loracepam and dipotassium chloracepate are frequently applied to achieve the sedation of the patient, the hydroelectrolytic control in order to maintain the hydration of the affected person and the administration of vitamins to maintain the correct functionality of the organism. Likewise, haloperidol is also usually applied to control the psychotic process and hallucinations .

One final consideration

While excessive consumption of alcohol is a dangerous phenomenon, and those who stop drinking do so for good reasons, it is necessary for those who decide to stop drinking to take into account the physical dependence their bodies have on the substance.

It is essential in cases of addiction or prolonged consumption of substances (including medicines such as tranquillizers or antidepressants), that the withdrawal of the substance is gradual, since in the initial stages the body needs a certain dose of the substance to continue to function properly.

In addition, it should be remembered that the type of health hazards associated with delirium tremens can be avoided by early detection of cases of alcohol addiction , which allows early closure to alcoholism. The use of this type of drink is socially accepted and widespread in all kinds of contexts, and that is why detecting its first signs can be complicated, given the degree of normalisation of the abuse of these substances.

For some of the signs that indicate the presence of early alcoholism, you can read this article: “The 8 Signs of Alcohol Addiction”.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Correas, J.;Ramírez, A. & Chinchilla, A. (2003). Manual de Urgencias Psiquiátricas. Masson.
  • Ferri, F.F. (2015). Delirium tremens. Ferri’s Clinical Advisor. Philadelphia: PA Elsevier Mosby; p. 357.
  • Golberg, D. & Murray, R. (2002). The Maudsley handbook of practical psychiatry. Oxford.
  • Marta, J. (2004). Practical approach to delirium. Masson.
  • O’Connor, P.G. (2016). Alcohol use disorders. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. Philadelphia, PA: Elsevier Saunders; chap 33.