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Guide to Delirium Tremens: Causes, Symptoms, & Treatment

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Medically Reviewed By: Diana Vo, LMFT

May 2, 2024

Table of Contents

DTs (delirium tremens) is a severe and potentially life-threatening form of alcohol withdrawal. This condition can be mitigated with supervised medical detox. 

What are Delirium Tremens?

Delirium tremens, a severe form of alcohol withdrawal, may emerge when someone discontinues the use of alcohol. Up to 5% of those detoxing from alcohol experience DTs. 

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Delirium tremens most commonly occurs after a period of heavy and often long-term drinking or in people who have previously undergone severe alcohol withdrawal. 

Chronic heavy drinking creates a continuous struggle within the body. Alcohol acts as a CNS depressant, damping down activity in the central nervous system. The CNS is responsible for managing vital autonomic functions like breathing and heart rate. In response, your CNS compensates by ramping up its activity to maintain normal operations. Over time, this heightened activity becomes the new baseline for the CNS. When alcohol is discontinued, the CNS is unable to immediate reduce activity, leading to an overactive state that can trigger delirium tremens. 

Delirium tremens symptoms differ from alcohol withdrawal symptoms and manifest on a different timeline. 

Delirium Tremens Timeline

The progression of delirium tremens usually occurs on a broadly similar timeline. That said, the intensity and duration of symptoms may vary from person to person. Here’s how a person may experience severe alcohol withdrawal: 

  • 6 to 24 hours: Onset of initial withdrawal symptoms after stopping heavy alcohol use.
  • 12 to 48 hours: Emergence of severe symptoms like hallucinations or seizures.
  • 3 to 5 days: Peak of delirium tremens symptoms.

When Do Delirium Tremens Start?

Delirium tremens (DTs) typically begin 2-4 days after stopping or significantly reducing heavy alcohol consumption in individuals with chronic alcohol use disorder. However, the onset can range from 6-10 days after the last drink.


Delirium Tremens Treatment

If you are at risk of severe alcohol withdrawal symptoms, treatment for delirium tremens will begin at a hospital or medical detox center. The condition is treated as a medical emergency. You’ll need 24/7 monitoring. In severe cases, you may require treatment in an ICU while medical professionals treat DTs. 

The symptoms of delirium tremens can emerge rapidly and suddenly worsen. Untreated, delirium tremens can be fatal. 

The main goals of treatment for DTs are: 

  • Stabilizing the person
  • Preventing complications
  • Relieving symptoms 

Medications can be used to mitigate some of the symptoms of DTs. These may include: 

  • Benzos: Benzos like Valium, Librium, and Ativan can all help to manage the symptoms of alcohol withdrawal, delirium tremens included. Benzos can also help reduce the risk of seizures. Large doses of benzodiazepines are required, and they will only be administered short term.
  • Antipsychotics: Low doses of antipsychotics like haloperidol can effectively manage some psychotic symptoms like hallucinations, while also helping you to think more clearly. This class of medication carries a high risk of adverse side effects, though.
  • Barbiturates: If benzos are not enough to manage the symptoms of DTs, barbiturates like phenobarbital may be effective. 

The treatment team will check regularly for the following: 

  • Body fluid levels
  • Electrolyte levels
  • Blood pressure
  • Breathing rate
  • Pulse
  • Temperature

 Medications will ensure that you remain calm until DTs are complete. 

Any long-term preventive treatment can begin after you have recovered from the symptoms of delirium tremens. This could include: 

  • Total lifelong avoidance of alcohol
  • Counseling
  • Psychotherapy
  • 12-step support groups like AA 

You may also need to seek treatment for any of the following adverse outcomes: 

  • Alcoholic neuropathy
  • Alcoholic liver disease
  • Alcoholic cardiomyopathy

While it is essential to receive medical treatment while experiencing the symptoms of DTs, symptoms can still progress and worsen once manifested. 

If you continue to drink alcohol after detoxing, you will be more likely to experience DTs in the future.

How Long Does Delirium Tremens Last?

The core symptoms of DTs usually last 2-3 days, with peak intensity around days 4-5. However, milder symptoms like anxiety or insomnia can linger for weeks in some cases. Early medical intervention can shorten the duration and severity.


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Alcohol Withdrawal Treatment at Renaissance Recovery

If you or a loved one need help with alcohol withdrawal, delirium tremens need not be an issue – reach out to Renaissance Recovery for immediate assistance. 

After detoxing from alcohol under close supervision and with access to medications approved by FDA, you can move into ongoing outpatient treatment at our facilities in Southern California and Florida. This enables you to maintain your everyday commitments while addressing all aspects of alcohol addiction. 

The unique presentation of all alcohol addiction means that treatment programs at Renaissance are personalized. Therapies may include: 

  • Psychotherapies (CBT and DBT) 
  • MAT (medication-assisted treatment)
  • One-to-one counseling
  • Group therapy
  • Family therapy
  • Motivational therapies
  • Holistic treatments
  • Aftercare planning 

Call our friendly recovery specialists today at 866.330.9449.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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