Delirium tremens is a hallucinatory and delusional state, often induced by discontinuation of daily heavy drinking or during recovery from alcoholism. It can also happen when people quickly stop using regular benzodiazepines like Xanax® or Valium®. Sudden withdrawal from barbiturates such as phenobarbital can also cause delirium tremens.
Recovering alcoholics often refer to that difficult period of alcohol withdrawal as DTs. Delirium tremens usually occurs within a day after the last drink or dose of medication, but can occur several days after stopping drinking. The condition, if left untreated, can be fatal in about 30% of long-term heavy drinkers.
Delirium tremens immediately affects the brain, causing it to secrete various hormones such as GABA and serotonin in large amounts in an attempt to find equilibrium in the non-consuming state. These hormones can also decline rapidly. The neurological effects cause confusion, great anxiety, and sometimes visual and auditory hallucinations. However, its main dangerous effect is that the body responds to the up-and-down changes in neural chemicals by causing shortness of breath, rapid heart rate and serious arrhythmias, as well as abnormally high blood pressure. A single arrhythmia can be fatal if not addressed.
Because most alcoholics are generally in poor health and can suffer from nutritional deficiencies and liver disease, the body has a hard time adjusting to this state, and this can increase mortality rates when left untreated. Treatment of delirium tremens involves the administration of low-dose sedatives, which can be ironic for those addicted to benzodiazepines. Extreme emotional disturbance may also warrant treatment with an antipsychotic medication such as Haldol®. The person experiencing delirium tremens may be violent, making monitoring and medical interventions difficult without an antipsychotic.
Delirium tremens is a medical emergency, and its effects are the reason chronic alcoholics shouldn't try a "cold turkey" approach to quitting drinking. With medical intervention, the mortality rate from delirium tremens drops to 5%. Most medical experts believe that recovery from alcoholism is best done in a hospital or alcohol treatment center. Additional participation in programs such as Alcoholics Anonymous is encouraged to support and maintain recovery.
Long-term use of benzodiazepines should never end with the cessation of all benzodiazepines. Instead, most doctors believe that gradually reducing the amounts of benzodiazepines taken is the best way to stop use and can help people avoid delirium tremens. Under the guidance of a doctor or psychiatrist, levels are lowered very gradually, often by quarter milligrams per week. Narcotics Anonymous and similar programs can provide support during and after the reduction process.