Alcohol is a widely used and generally socially accepted drug, but it can be extremely harmful.

Alcohol misuse is known to be a causal factor in more than 60 medical conditions and can also be extremely addictive. There are estimated to be more than 600,000 dependent drinkers in England alone, less than a fifth of whom are receiving any sort of treatment for their problem.

Excessive or chronic drinking can lead to both psychological addiction and physical dependency. Regular drinking can see you build up a tolerance to alcohol, meaning you need more or more for the same effect – and sometimes just to feel normal. At the same time, your brain and central nervous system come to rely on the presence of alcohol and adjust to compensate for its effects.

When the alcohol is reduced or removed, this can lead to a wide range of physical and psychological withdrawal symptoms. The most severe form of alcohol withdrawal is known as delirium tremens, sometimes referred to as DT or ‘the DTs’.

How Common is Delirium Tremens?

Alcohol has a number of effects, but in general, it acts as a depressant, meaning it suppresses the central nervous system. With prolonged drinking, the system compensates for this suppression, and when the alcohol is removed, you are essentially flooded with more stimulatory chemicals. This can lead to alcohol withdrawal symptoms associated with a heightened nervous system, including:

  • Rapid or irregular heartbeat
  • Increased blood pressure
  • Excessive sweating
  • Shaking or tremors
  • Aches and pains
  • Headache
  • Nausea

There can also be a range of related psychological symptoms, including:

  • Anxiety and agitation
  • Dysphoria or intense unease
  • Sleep disturbance
  • Anhedonia – an inability to feel pleasure

Delirium tremens usually develop alongside ‘regular’ alcohol withdrawal symptoms. Existing withdrawal symptoms may be more severe and new symptoms may appear, including:

  • Hallucinations
  • Changes in mental function
  • Deep sleep lasting for more than 24 hours
  • Sensitivity to light, sound and touch
  • Seizures

Symptoms of delirium tremens will most often occur within 48 to 96 hours after the last drink, but in some cases, they may occur up to 7 to 10 days after the last drink. Delirium tremens is always extremely serious and is considered a medical emergency. It can prove fatal if not managed and treated properly.

So, how common is delirium tremens?

It is estimated that more than half of people with a history of alcohol use disorder will experience some form of alcohol withdrawal symptoms at stopping or significantly reducing their alcohol use. However, only around one in 20 (3-5%) will exhibit the symptoms of severe alcohol withdrawal known as delirium tremens.

Risk Factors for Delirium Tremens

The most obvious risk factor for delirium tremens is a continued history of alcohol misuse -i.e. persistent or heavy drinking. Anyone can develop an alcohol dependency, and it can often ‘creep up’ on you, developing over time without you necessarily recognising it as a problem.

Some other specific risk factors include:

  • A previous history of delirium tremens
  • A prior history of alcohol withdrawal symptoms in general
  • Age – with older people being more at risk
  • Suffering from some other illnesses
  • Hypokalemia or low potassium count

Potassium is an electrolyte that your cells need to function properly. Hypokalemia can have a number of causes but is often associated with alcoholics and heavy drinkers.

There is also some evidence that the presence of structural brain lesions – such as from a severe head injury – could increase the risk of delirium tremens.

Treatment and Management of Delirium Tremens

As already mentioned, delirium tremens is always very serious and can be fatal. It is always best for people with severe alcohol problems to undergo supervised detoxification and withdrawal symptoms if possible – at a dedicated detox clinic, rehab centre or under medical supervision. Whatever the situation, you should always seek medical help immediately if withdrawal symptoms become severe or suggest that delirium tremens is developing.

There are a number of treatments that medical professionals might use with a person suffering from delirium tremens. Drugs such as benzodiazepines (including diazepam and chlordiazepoxide) can be used to manage many of the symptoms. Monitoring and replacing fluids and substances like thiamine, magnesium and potassium can also help recovery. Co-morbidities (other illnesses or health conditions) are extremely common with delirium tremens, and these must also be assessed and treated.

The immediate goal of DT treatment is to reduce the most serious symptoms of agitation and delirium, which can be dangerous. Beyond that, however, a long-term programme of treatment for alcohol addiction recovery should also be drawn up and followed.

Prevention and Support

The best way to prevent or lower the risk of delirium tremens is to manage a drinking problem before it gets to that stage. There are a number of steps you can take to reduce your alcohol intake, such as:

  • Keeping an alcohol diary or log
  • Setting limits on any drinking session
  • Committing to alcohol-free days
  • Switching to a lower alcohol option
  • Alternating alcoholic drinks with soft drinks or water

It can be difficult to cut down or stop without expert help, however, especially if you have developed an alcohol dependency. Alcohol can be very addictive, and both the physical and psychological aspects of any addiction will need to be addressed.

There are several support groups, helplines, charities, and other organisations you can contact for confidential help and advice, including Alcoholics Anonymous (AA), Drinkaware, and FRANK.

You can also access NHS alcohol services. Your GP will be a good first point of contact as they can signpost you to relevant local groups and resources. You might also want to consider private rehab, as this is the single most effective way of treating a serious alcohol addiction.


Reach Out for Help

If you or someone you know is at risk of severe alcohol withdrawal symptoms up to and including delirium tremens, Addiction Advocates can find the right place for you to manage your withdrawal safely and effectively.

We can also help you take control of your drinking and find a rehab programme that can let you make a full and long-lasting recovery. Reach out to us today on 0800 012 6088.


  • [1] may occur up to 7 to 10 days after the last drink -
  • [2] will exhibit the symptoms of severe alcohol withdrawal known as delirium tremens -
  • [3] Hypokalemia can have a number of causes -
  • [4] could increase the risk of delirium tremens -
  • [5] Co-morbidities (other illnesses or health conditions) are extremely common with delirium tremens -