Delirium Tremens (DTs): Recognizing a Medical Emergency

Alcohol can be very dangerous, causing a host of symptoms, the most serious of which is delirium tremens, commonly known as DTs. DTs can be fatal and require immediate medical attention. If you or someone you know is stopping alcohol use, it’s important to know the signs of DTs so that you can get help quickly.

What Is Delirium Tremens (DTs)?

DTs are the most serious form of alcohol withdrawal. Alcohol slows down the activity of your central nervous system (CNS), making your CNS work harder to do its job.  After drinking heavily for a long time, your CNS becomes accustomed to working at that level, but when you stop drinking suddenly, it can’t return to its normal level fast enough. This overactivity of the CNS is what causes DTs.

Signs of DTs

Signs of DTs include:

• Tremors, particularly in the hands
• Confusion
• Agitation, sometimes with aggressive behavior
• Hallucinations
• Paranoia
• Reduced awareness of what is going on around you
• Heavy sweating
• Seizures
• High body temperature
• Headache
• Nausea and vomiting
• Rapid heart rate

It’s important to note that if you are experiencing DTs, you may not be in a condition to call for help. It’s important for those around you to know the warning signs and to understand that they signal a medical emergency.

Risk Factors for DTs

Not everyone withdrawing from alcohol will experience DTs, but several factors can increase the risk.

• A history of heavy alcohol consumption
• A history of seizures or DTs during withdrawal
• Having detoxed from heavy drinking multiple times
• Having another substance use disorder (i.e. benzodiazepines or opioids)
• Age
• Other medical conditions such as liver disease or cardiovascular disease

Treatment for the DTs

Treating the DTs requires slowing down the central nervous system, which is usually done with sedatives like benzodiazepines. Rarely, general anesthesia is used to fully sedate the person. Often, people experiencing DTs also suffer from dehydration, mineral deficiencies, and electrolyte imbalances. Treatment of these conditions includes IV infusions of fluids, vitamins and minerals, and electrolytes.

It usually takes three to seven days for DTs to subside, but it can take longer.

Without quick treatment, the DTs can be fatal. About 15% of people who experience DTs do not survive.

Preventing the DTs

If you are going to stop drinking after heavy and prolonged use, it’s highly recommended that you attend an inpatient, medically supervised detox program. In detox, you’ll likely be given benzodiazepines like Ativan or Valium to prevent DTs and seizures. You may also be given other medications to ease the withdrawal symptoms.

While in detox, you’ll be closely monitored by medical professionals to detect signs of DTs. If you experience seizures or other signs, you’ll be taken to the hospital for treatment.

Stopping alcohol use on your own is not recommended because of the dangers, but if you do so, it’s best to taper your use slowly, reducing your consumption daily for a period of time before you stop completely. This may help to prevent serious withdrawal symptoms. However, it cannot be stressed enough how dangerous withdrawing on your own can be.

Treatment for Alcohol Use Disorder

Inpatient detox, while necessary, does not treat your addiction. Treating alcohol use disorder involves intensive therapy in a structured treatment program. Most treatment facilities offer three options.

Inpatient Treatment

A 30 to 90 day inpatient treatment program includes medically supervised detox as well as intensive individual and group therapy. You may also be treated for any co-occurring mental health disorders that you may have, such as anxiety or depression.

Most of your time will be spent in group therapy, which is critical to the treatment process. You’ll learn about the nature of addiction, healthy coping strategies, and strategies to prevent relapse, all while having the opportunity to interact with people who are facing similar struggles.  You’ll likely form mutually supportive relationships with some of these peers which may last beyond treatment.

The type of therapy most commonly used in alcohol addiction treatment is cognitive behavioral therapy (CBT). CBT teaches you to recognize your irrational and negative though patterns, and to challenge them with more reasonable, realistic thoughts. It also focuses on tangible ways to cope with problems without turning to alcohol.

Partial Hospitalization Programs (PHPs)

A partial hospitalization program (PHP) allows you to live at home while attending treatment for four to six hours per day, five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually.

Often, a PHP program is a transitional step that occurs after a medically supervised detox program or inpatient treatment, although it can be an alternative to inpatient treatment if you do not need medically supervised detox.

Intensive Outpatient Programs (IOPs)

An intensive outpatient program (IOP) consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held at convenient times so that you can still go to work or attend school. Treatment, again, involves individual and group cognitive behavioral therapy.

IOPs can be standalone treatments, or they can be attended after inpatient treatment, PHPs, or both.

Comprehensive Treatment

The most effective treatment for an alcohol use disorder, particularly if it is severe, is a comprehensive treatment program that consists of an inpatient program, a PHP, and an IOP. Research has shown that success rates increase the longer you stay in treatment. Even after IOP, it’s important to receive ongoing support through a program like Alcoholics Anonymous (AA).  Recovery from alcohol addiction is a lifelong process that requires dedication and a strong support network.

In Closing

Delirium tremens is a serious condition requiring immediate medical treatment. If you are struggling with alcohol use disorder and attempting to detox, it’s important for you and the people around you to know the warning signs of the DTs. However, it’s far safer to attend an inpatient detox program where you will be medically supervised.

At Bridges of Hope we offer several treatment options including medically supervised detox. We are committed to providing comprehensive, personalized care so that you can move on to live a healthier, more fulfilling life. Give us a call today to learn more.