Blog - Beach House Rehab Center
November 28, 2018

Alcohol Withdrawal Hallucinations

Even though it’s legal throughout most of the United States, alcohol is incredibly addictive. Too often, people don’t realize that they’ve become addicted until it’s too late. Predisposed individuals ignore telltale warning signs, like family members struggling with alcoholism, and often end up down the same path.

Because alcohol is so accessible, people of all age groups abuse it. Even though the federally mandated age limit is 21, children as young as 12 have reported symptoms of Alcohol Use Disorder (AUD) and in some places, there have been reports of addicted children even younger than that. According to a recent National Survey on Drug Use and Health (HSDUH), 86.4 percent of US citizens over the age of 18 reported that they drank in their lifetime. 56 percent reported that they drank in the past month.

When people become affected by Alcohol Use Disorder, their drinking often takes over their lives. They prioritize it over almost all else, at the cost of their personal relationships, dignity, and health. When the condition is bad enough, attempts to quit can prove harmful or even fatal, and induce unpleasant and intense alcohol detox and withdrawal symptoms like hallucinations. There are several medical terms for this condition, including alcoholic hallucinosis, alcohol-related psychosis, and alcohol-induced psychotic disorder. 

What is Psychosis?

Psychosis is a medical condition that can be induced by either an external substance such as alcohol or psychoactive drugs, or by mental illness in people who are biologically vulnerable. Psychosis has also been reported by survivors of sexual assault, individuals who have suffered traumatic brain injuries, stroke survivors, brain tumors, and diseases like Alzheimer’s and Parkinson’s.

It’s important to note that psychosis is not itself an illness—it is a symptom of an illness. When psychosis is diagnosed, it’s treated as a clue that leads medical professionals towards a diagnosis. In general, psychosis is used as an umbrella term that captures an array of auditory and visual hallucinations or delusions.

Some symptoms of psychosis include:

  • Losing touch with reality
  • Seeing, hearing, and believing things that are not real
  • Intense delusions in which the patient believes strange or untrue things
  • Auditory and visual hallucinations
  • Strange behavior not typical of the patient
  • Disorganized speech

Often, when powerful drugs like hallucinogenics induce psychosis, the effects are temporary. However, if the patient is suffering from psychosis as a result of a mental condition like schizophrenia or as a result of withdrawal from alcohol, the symptoms may last much longer.

Alcohol-Induced Psychotic Disorder

Individuals who suffer from Alcohol-Induced Psychotic Disorder (AIPD) are typically longtime users of alcohol. It’s incredibly rare that an individual who does not have a serious alcohol addiction will experience these symptoms. In almost all cases, symptoms will occur when a user is either consuming a large amount of alcohol or shortly thereafter. In other cases, AIPD symptoms strike when heavy users abruptly stop drinking, which can induce alcohol withdrawal hallucinations.

Medical professionals recognize three different forms of Alcohol-Induced Psychotic Disorder:

  • Alcohol poisoning or acute intoxication, which occurs when a user consumes a significant amount of alcohol very quickly
  • Long-term, chronic alcohol use disorder
  • Alcohol withdrawal symptoms

In the United States, 15.1 million adults over the age of 18 struggle with alcohol use disorder (9.8 million men and 5.3 million women), and around 623,000 minors between the age of 12 and 17 also struggle with AUD. Of these people, only about 4 percent of them will experience AIPD. Even though it’s rare, if you believe you recognize the symptoms of psychosis in a person who has heavily abused or used alcohol, it’s important to get in touch with a medical professional as soon as possible.

Once AIPD has begun, symptoms can last for a long time. Depending on the manner in which it was induced, patients can expect to experience AIPD from anywhere between several days to six months. Again, it’s vital that the person suffering from AIPD be under the supervision of a health care professional, because psychosis greatly increases the risk of self-harm and can prove fatal.

Alcoholic Hallucinosis

Although alcoholic hallucinations have occurred throughout history, they weren’t documented until the early 20th century. It has been categorized as a psychotic disorder, though a rare one, and is only seen in a small percentage of alcohol withdrawal patients. Those at risk for developing the symptoms of alcoholic hallucinosis are almost exclusively long-term users of alcohol, although the risk is even higher for those who have also used other drugs in the past.

Alcohol withdrawal hallucinations are intense. Because they’re so difficult to measure, scientists have trouble determining exactly what causes them. However, there is a widespread belief that it is related to the spread of dopamine through the limbic system—a network of nerves in the brain that controls instincts and mood—and possibly other related bodily systems. In most cases, symptoms develop quickly. The sudden onset contributes to the overwhelming sense of delirium experienced by patients.

Just before the hallucinations begin, several symptoms may arise including:

  • Dizziness
  • Insomnia
  • Intense headaches

The hallucinations manifest in several forms. While most reported cases involve auditory hallucinations, in which the sufferer believes that they are hearing voices from both inside and outside of their mind, some experience intense visual hallucinations. The visual hallucinations are often disturbing and vary from person to person.

Delirium Tremens (DTs)

People commonly confuse the symptoms of hallucinations with those of Delirium Tremens, a related but different effect of alcohol withdrawal hallucinations that are much more dangerous. While the symptoms are different, it’s believed that both DTs and hallucinations are caused by the same physiological process.

Unlike hallucinations, which manifest suddenly and send the user into a rapid delirium, DTs take a little longer to develop. Usually, the first signs take at least 48 hours to begin. Symptoms of DTs include:

  • Irregular heart rate
  • Violent shaking and shivering, usually beginning in the hands
  • High body temperature
  • Seizures
  • Intense sweating

It’s possible to treat someone suffering from DTs. However, if treatment isn’t commenced quickly, the mortality rate is high—between 15 and 40 percent. However, with treatment, the mortality rate is significantly lowered to around 1 to 4 percent.

Because DTs have been documented for much longer than hallucinations, it is the subject of medical lore and has acquired various nicknames:

  • Barrel-fever
  • Drunken horrors
  • Elephants
  • Quart mania
  • Pink spiders
  • Blue horrors
  • Bottleache
  • The shakes

Treating Alcoholic Hallucinosis

Abruptly ceasing alcohol after sustained heavy use is the catalyst for hallucinations. However, when hallucinations occur it’s often the case that users have already weakened their bodies through the sustained intake. Deficiencies in magnesium, folate, phosphate, zinc, thiamine and low blood sugar intensify the symptoms of hallucinosis.

When medical professionals treat individuals suffering from hallucinosis, the first step is often to provide nutritional supplements that attempt to restore balance to vitamin and mineral deficiencies. However, prescription drugs are often administered. Doctors have found that neuroleptics—drugs that depress nerve function and reduce nervous tension—have been effective in suppressing hallucinations. Benzodiazepines like Lorazepam and Chlordiazepoxide are often prescribed. Finally, and perhaps most importantly, it’s necessary to abstain from alcohol use in order to bring hallucinations to an end.

It’s possible to preemptively treat hallucinations. If a heavy user is attempting to rapidly reduce intake or abruptly stop, medical professionals will often prescribe diazepam and chlordiazepoxide in anticipation of withdrawal symptoms and hallucinations.

Alcohol Withdrawal Delirium

When users suffer from alcohol withdrawal hallucinations, it’s almost always within the context of alcohol withdrawal delirium (AWD). Of all the types of withdrawal related to alcohol, AWD is the most serious. Among serious drinkers who suffer from AUD, around 50 percent will experience general withdrawal symptoms while 3 and 5 percent will experience intense AWD symptoms like hallucinations.

What Causes AWD?

Alcohol withdrawal delirium is only experienced by heavy alcohol users with a long history of drinking. In these cases, the central nervous systems of longtime users have established dependencies on alcohol, and to deprive their systems of the substance produces intense chemical reactions. These chemical reactions often result in the hallucinations we associate with AWD. It’s important to note that while withdrawal is the main cause of AWD symptoms, it is not the only cause. A comprehensive list includes:

  • Ceasing alcohol consumption after long periods of daily use (aka cold turkey)
  • Physical trauma, e.g. head injuries
  • Reducing alcohol use quickly
  • Reducing alcohol use quickly without eating
  • Sickness and infection

It’s not only the central nervous system that is affected by and causes the symptoms we recognize as AWD. When alcohol enters the system, it suppresses neurotransmitters in the brain—chemical substances that act as little messengers and carry the brain’s orders to the rest of the body—and produces the feeling of relaxation that many associate with alcohol consumption. For longtime users, neurotransmitters are used to working hard to overcome that suppression, and when alcohol is removed from the system those neurotransmitters are kicked into overdrive. The resulting chemical reaction causes withdrawal symptoms that include hallucinations.

Alcohol Withdrawal Delirium Symptoms

When AWD sets in after heavy alcohol users abruptly stop using or attempt to drastically reduce intake, they may start to experience symptoms anywhere within a few hours to a few weeks. It’s difficult to predict from case to case when symptoms may set in, but it’s correlated to the level of intake and biological factors that are unique from person to person.

  • Agitation, anxiety, and irritability
  • Chest pain
  • Confusion, delirium, and delusions
  • Intense sweating
  • Uncontrolled eye movements and issues with motor control
  • Intense fatigue
  • Fever
  • Hallucinations that are auditory, visual, or both
  • Intense nausea
  • Nightmares and nighttime restlessness
  • Seizures
  • Stomach pain
  • Sensitivity to sound, touch, or light

Withdrawal Timeline

You may be wondering how long alcohol withdrawal takes . While everyone who experiences AWD will pass through the following stages of the withdrawal timeline, it’s virtually impossible to predict the exact moment when symptoms will set in. Unique biological factors and the user’s consumption history affect the timeline, but enough cases have been reported and studied that professionals have confirmed a general pattern.

Withdrawal symptoms are usually divided into three stages. After the user’s final drink, the symptoms usually set in between two to six hours.

Stage One

Stage one begins very quickly after the user’s final drink. Symptoms usually set in within two to six hours, but can sometimes be delayed eight to 12 hours. This is the mildest of the three stages, as withdrawal ramps up in intensity over time. The symptoms of this stage include:

  • Anxiety
  • Insomnia
  • Nausea and vomiting
  • Depression
  • Mood swings
  • Fatigue
  • Tremors
  • Foggy thinking
  • Loss of appetite

Stage Two

In most patients, stage two sets in somewhere between 24 and 72 hours after the user’s last drink. The symptoms are more intense than those experienced in stage one and are described as moderate by medical professionals. The primary symptoms of stage two include:

  • Increased body temperature
  • Hyperventilation and irregular heart rate
  • Mental confusion and irritability
  • Mood swings
  • Sweating and shaking

Stage Three

The third stage of alcohol withdrawals usually takes between five and seven days to set in. Medical professionals describe this phase as severe—it’s the most intense time for patients suffering from alcohol withdrawals. During the course of stage three hallucinations are most likely to occur, along with delirium tremens. Symptoms include:

  • Tactile hallucinations, in which patients experience phantom symptoms of burning, numbness, or itching
  • Visual hallucinations, in which patients see disturbing images that don’t exist
  • Auditory hallucinations, in which patients hear sounds—typically voices which are often threatening—that don’t exist
  • Intense fever
  • Shaking
  • Severe confusion
  • Seizures
  • Intense agitation and irritability

Just as it’s difficult to predict exactly when an individual might enter a stage of withdrawal during their drug detox, it’s also possible that not all stages of withdrawal are experienced. The main factor is the level of the user’s dependency on alcohol, which usually correlates to longer, more intense symptoms.

If you or someone you know is experiencing withdrawal symptoms or experiencing hallucinations, it’s vital to call a doctor immediately. Depending on the severity of the case, withdrawal can prove fatal. If you are ready to overcome your alcohol addiction, our Florida drug treatment center is here to help. Contact us today to learn more about our inpatient drug rehab services.


How Long Does Alcohol Withdrawal Take