What It's Like to Go Through the DTs

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People who drink alcohol heavily experience a variety of physical and mental withdrawal symptoms when they cut back or stop drinking. People who stop drinking cold turkey can experience a variety of symptoms ranging from mild to severe. The most severe alcohol withdrawal is called delirium tremens, otherwise known as the DTs.

The experience of going through delirium tremens can vary from person to person depending on the duration and frequency of their previous alcohol consumption.

Causes

Alcohol is a depressant, which means that it slows down the central nervous system. Chronic, heavy alcohol use can create changes in how the brain works, including how the brain's chemical messengers function. When alcohol consumption suddenly stops, the brain continues working in the state it has become used to, leading to symptoms of alcohol withdrawal. 

Signs and Symptoms

DTs typically begin after a person decides to give up alcohol after a binge, period of heavy drinking, or when they realize that they need to quit drinking. While people sometimes go through this process at home, it is also common for people to choose to go through alcohol withdrawal and detoxification at a medical facility.

DTs usually don't begin right away. A person who stops drinking will often experience a period of milder alcohol withdrawal symptoms that become increasingly severe.

Only about five percent of people going through withdrawal experience DTs. Heavy, long-term alcohol users are more likely to experience delirium tremens during withdrawal.

Early Alcohol Withdrawal

Early symptoms of alcohol withdrawal typically begin within the first 8 to 12 hours following a person's last drink. 

Early symptoms are often mild and can include:

  • Headaches
  • Nausea
  • Vomiting
  • Clammy skin
  • Lack of energy
  • Trembling
  • Restlessness
  • Sweating
  • Anxiety
  • Irritability
  • Mood swings

These early-stage symptoms of withdrawal typically last for between one to three days, although they may last longer for some individuals.

Later Withdrawal Symptoms

As alcohol withdrawal progresses, people often begin to experience more severe symptoms which may include:

  • Hallucinations
  • Changes in blood pressure
  • Breathing changes or difficulties
  • Seizures

These symptoms may begin around 12 to 24 hours after a person has stopped drinking. Such symptoms may also be experienced in addition to the symptoms that characterize early withdrawal.

Delirium Tremens (DTs)

It is during the later stages of alcohol withdrawal, around 48 to 96 hours after the last alcohol use, that people may experience delirium tremens (DTs). However, they may also begin as long as 7 to 10 days after a person quits drinking.

Symptoms of the DTs include:

  • Delirium
  • Tremors
  • Deep sleep
  • Fear or excitement
  • Fatigue or stupor
  • Seizures
  • Disorientation
  • Rapid mood changes
  • Sensitivity to light, sound, and touch
  • Changes in heart rate

While going through DTs, people may experience feelings of severe agitation. Feelings of panic or even a sense of impending doom are not uncommon. Some people may also experience changes in heart rate or breathing that are potentially fatal. 

Symptoms of DTs typically resolve in a few days, but they are serious and should receive medical attention. If you or someone you know has signs of delirium tremens, contact medical services immediately.

Treatments

DTs are a medical emergency that requires hospitalization. Doctors may conduct a variety of tests including electrocardiograms (ECGs), toxicology screens, blood magnesium levels, metabolic panels, and blood phosphate levels.

Treatment is focused first and foremost on saving the individual's life, preventing complications, and minimizing symptoms.

Treatment may include the use of benzodiazepines to reduce the symptoms of alcohol withdrawal. Some of the medications that are used to treat DTs include lorazepam (Ativan) and chlordiazepoxide (Librium). Such medications may help relieve the anxiety that is associated with severe, acute alcohol withdrawal.

Because heavy alcohol use can also result in nutritional deficiencies, doctors may also recommend vitamins and minerals including thiamine, zinc, phosphate, magnesium, and folate. 

With medical treatment, mortality rates for DTs are around five percent. Without appropriate treatment, between 15 to 35 percent of cases may be fatal. The most common causes of death for patients with DTs are attributed to cardiac arrhythmias and respiratory failure.

Before You Stop Drinking

While not everyone who goes through alcohol withdrawal experiences DTs, you should still inform your doctor about your plan to stop drinking. Alcohol withdrawal can be dangerous and potentially fatal, so you should always go through this process under the supervision of a medical professional.

The problem is that no one knows until they quit how severe their withdrawal symptoms will be. If you're a longtime drinker or a heavy drinker and you plan to quit, consult with your healthcare provider or seek treatment from a professional detoxification facility.

How to Get Help

If you need help to stop drinking, there are resources available. Support groups such as Alcoholics Anonymous and Al-Anon can provide information and social support as you go through this process. You can even attend meetings online.

If you need help to stop drinking, talk to your doctor or contact the SAMHSA national helpline at 1-800-662-4357 to find treatment services in your area.

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