Substance Withdrawal Delirium

Substance withdrawal delirium is a mental health condition that occurs when diminishing levels of alcohol, drugs, or medications in the body lead to the onset of an incoherent, unbalanced state of mind. Along with a related condition called substance intoxication delirium, it belongs to a group of disorders that also includes various forms of dementia and amnesia. While a variety of substances can potentially produce delirium during the withdrawal process, alcohol has an especially well-deserved reputation for its delirium-inducing potential. Alcohol withdrawal-related delirium, known as delirium tremens, is a potentially fatal condition.

Withdrawal Basics

A variety of substances achieve their effects in the body by altering normal chemistry in the central nervous system (brain and spinal cord). Over time, a repeat and/or heavy user of one of these substances can undergo involuntary changes in his or her brain chemistry that are designed to compensate for the effects of the substance in question. If a user then stops taking the substance that triggered these changes, he or she will enter a state of withdrawal, during which the brain and body react negatively to the absence of the discontinued substance. Common symptoms of normal withdrawal vary from substance to substance. For example, people undergoing alcohol withdrawal may experience insomnia, tremors, gastrointestinal distress, and anxiety. People undergoing withdrawal from sedative-hypnotic medications may experience problems with their autonomic (involuntary) nervous systems or muscle control.

Delirium Basics

Delirium is characterized by a number of mental and emotional states that significantly disorient the affected individual. Typically, it involves fluctuations between abnormally exaggerated and subdued levels of excitability, alertness, wakefulness and body mobility, as well as problems such as short-term amnesia, loss of the ability to concentrate or control one’s behaviors, and loss of the ability to organize one’s thoughts and carry on a normal conversation. People affected by delirium also experience a number of fluctuating emotional states that can include agitation, confusion, depression, anxiety, euphoria, irritability, and anger. The American Psychiatric Association, which acts as the chief authority on mental health issues in the United States, classifies delirium as a mental disorder that belongs to a larger category of conditions known collectively as “delirium, dementia, and amnestic and other cognitive disorders.”

Substance Withdrawal Delirium Basics

According to guidelines established by the American Psychiatric Association, people with substance withdrawal delirium experience delirium-related symptoms either during the active phase of withdrawal from alcohol, drugs or medications, or during the period of time that directly follows withdrawal. In order to qualify as substance withdrawal delirium, these symptoms must be harmful enough to trigger intervention by medical personnel; in addition, they must cause problems more severe than the problems normally associated with withdrawal from the substance in question.

In addition to alcohol and sedative-hypnotic medications, specifically identified potential causes of substance withdrawal delirium belong to a class of anti-anxiety medications known as anxiolytics. All other drugs and medications capable of producing the condition are grouped into a single catchall category. Generally speaking, delirium that stems from substance withdrawal begins within hours or days after the withdrawal process begins; rather than remaining constant throughout the day, the symptoms of this type of delirium alternate between relatively intense and relatively moderate levels.

Delirium Tremens

As indicated previously, delirium tremens (the DTs) is a condition associated with withdrawal from heavy, sustained alcohol use. While all drinkers who use alcohol in this way will go through some form of withdrawal when their alcohol intake stops, only about 5 percent of heavy, sustained drinkers will experience a bout of delirium tremens. Symptoms commonly produced by the DTs include intense confusion or disorientation, hallucinations, seizures, dramatically altered breathing, severe heart rate escalations, severe blood pressure escalations, advanced body dehydration, dangerous reductions in the brain’s normal blood supply, and dangerous alterations in the body’s baseline temperature. Delirium tremens can result in death when the affected individual experiences a complete stoppage of his or her heartbeat (cardiac arrest) or a complete stoppage in breathing (respiratory arrest), or chokes on accidentally inhaled vomit.

Known risk factors for the onset of delirium tremens during the withdrawal process include alcoholic drinking patterns that go back at least 10 years, daily consumption of at least a pint of 80 proof liquor or an equivalent alcohol amount, development of seizures during the normal withdrawal process, an ethnic classification as “white,” the presence of unusually strong alcohol cravings during withdrawal, and a prior history of the DTs in the aftermath of drinking cessation. Most people affected by the condition first develop symptoms within two to three days after quitting drinking, although some don’t develop symptoms for as long as 10 days. All people experiencing the DTs are in a state of medical emergency and require immediate treatment from qualified medical personnel.