Can alcohol detox cause hallucinations?

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Can alcohol detox cause hallucinations?

Yes. Alcohol detox can sometimes cause hallucinations. This is called alcohol hallucinosis. It is a rare complication of chronic alcohol dependence and alcohol abuse. This condition is characterised by having predominant hallucinations that occur during heavy consumption, or during detox, and when going through withdrawal symptoms.

According to Paul Eugen Bleuler, who was a Swiss humanist and psychiatrist, alcohol withdrawal hallucinations are different from delirium tremens. [1] 

Delirium Tremens is a major ethanol withdrawal that is normally manifested through behavioural abnormalities, and an altered mental status. 

It can progress to a cardiovascular collapse. Minor withdrawal symptoms of this condition are characterized by anxiety, vomiting, insomnia and nausea. 

The major alcohol withdrawal symptoms or major alcohol withdrawal delirium for delirium tremens includes auditory hallucinations as well as visual hallucinations and whole-body vomiting, tremors, hypertension, and diaphoresis. 

On the other hand, alcohol induced hallucinations present with delusions, acoustic verbal hallucinations and mood disturbances that arise in severe alcohol withdrawal when the individual is conscious and can sometimes progress or mimic chronic schizophrenia in adverse cases. 

This is also an alcohol induced psychotic disorder that involves disruptions in the person's perceptions and thoughts in ways that make it extremely challenging for the person to distinguish between what is real and what is not real. 

The concept of psychosis embodies some severe psychological symptoms and characteristics.  

For example: 

Psychosis is thought to be a break from reality due to its perceptual and cognitive changes that are associated with stopping alcohol consumption during treatment for alcohol withdrawal

It can cause the following symptoms: 

  • Disturbing thoughts and perceptions 
  • Alcoholic dementia. 
  • Multimodal hallucinations 
  • Poor functioning. 
  • Troubled thinking  

According to psychiatric evaluation and the famous industrial psychiatry journal, around 3 people out of every 100 usually experience some form of psychosis in their lives with most of the episodes appearing in their later teen years or in their early 20s. 

The causes are not fully understood and there is a likelihood of many factors such as: 

  • severe withdrawal symptoms 
  • alcohol intake 
  • drinking heavily 
  • withdrawal syndrome 
  • alcohol related physical complications 
  • acute alcohol withdrawal 
  • alcohol withdrawal syndrome 
  • alcohol affects 
  • addiction medicine 
  • consuming alcohol in high levels 
  • alcohol detox 
  • and severe symptoms of alcohol dependency. 

Types of Alcohol Induced Psychosis 

Most of the time, people will use the term "Alcohol induced psychosis," or "Alcohol withdrawal hallucinations," as a blanket term. In actual sense, this form of psychosis manifests in three different ways, they include: 

Acute Intoxication 

Any psychosis caused by acute intoxication happens due to a large alcohol intake done at once. It is rare and can be triggered after just one instance of alcohol use on the heavy side.

Once your body fully processes the alcohol and you stop drinking, then the symptoms will stop. 

There is an added danger to this form of intoxication. On the alcohol scale, the amount of alcohol you need for this to happen is like what you would take for alcohol poisoning.

For this reason, anyone experiencing psychosis because of acute intoxication should be treated as a medical emergency and may require treatment in the emergency department.  

Alcohol Withdrawal Psychosis 

As mentioned earlier, it is possible to experience psychosis as a most serious form of alcohol withdrawal symptoms. Though uncommon, alcohol withdrawal hallucinations do occur when you are going through detox. 

In some cases, these hallucinations will pick momentum and transform into full blown psychosis, which is known as alcohol withdrawal delirium (AWD). 

This is one of the most dangerous symptoms of alcohol withdrawal and can spike your breathing and heart rate and also cause full body tremors. 

Chronic Alcoholic Hallucinosis 

This happens over a long period of heavy alcohol consumption. It is a form of psychosis that is very rare, but the most severe.  

People who suffer from this form of hallucination also suffer from schizophrenia which is described as a condition where you hear voices and other form of noises. 

It also causes severe mood swings, which do not help much as they essential trigger more alcohol abuse which increases the intensity of the psychosis.  

Unlike the other two, this form of psychosis lasts longer and has been reported to last hours after the last symptom and could go up to weeks.  

Can Alcohol Induced Psychosis Be Treated? 

Yes, if you are experiencing alcohol withdrawal hallucinations or psychosis because of alcohol withdrawal syndrome, or symptoms of alcohol withdrawal during your addiction treatment, then you need clinical management, and a systematic review to help with this condition. 

Because it has a strong health component, the recommendation is that you should find an addiction treatment centre that deals in dual diagnosis disorders, due to the increased risk of developing into a long-term condition. 

What causes hallucinations in alcoholics? 

Alcoholic hallucinosis, or substance-induced psychosis is caused by excessive alcohol and drug abuse, and it is a condition that wasn't present before the alcohol addiction.

It can happen after your last drink or during alcohol detox when going through withdrawal syndrome. 

Here are other causes for hallucinations in alcoholics: 

  • Thiamine or B1 deficiency. 
  • Addiction treatment. 
  • Drug treatment. 
  • Substance abuse. 
  • Withdrawal phase. 
  • Head injury 
  • Sleep disturbances. 
  • other drugs 
  • lack of proper support groups during treatment. 
  • Having an untreated and prolonged drinking problem. 
  • Impulse control disorder 
  • Onset of alcohol abuse during the early adolescent years. 
  • Binge Drinking. 
  • Heavy drinking 

People who struggle with addiction are at risk of hallucinations when they are trying to quit or suffering from alcohol withdrawal syndrome.  

All kinds of alcohol abuse can lead to this condition, and others such as liver damage, central nervous system problems, alcohol addiction, regional blood flow, acute harm from car accidents and falls, memory problems, chronic health issues such as gastrointestinal damage , cancer, brain damage, etc. 

This condition encompasses some medical problems. For both acute as well as chronic alcohol abuse, alcohol induced psychosis is a common symptom of withdrawal.  

There are many different types of alcohol-induced psychosis, but they are all dangerous and will require clinical management, from mild symptoms to severe symptoms. 

When you stop drinking, and start addiction treatment, the addiction centre will provide medical advice, plus there are some mechanisms involved in the treatment of all these health problems because of alcohol induced psychosis. 

Types of Alcohol-Induced Psychosis 

Some of the most common forms of alcohol-induced psychosis are: 

Alcohol Hallucinosis  

This is rare and mostly involves auditory hallucinations. It usually appears when taking alcohol such as country liquor, or after you've had your last drink. It is prevalent to people who have struggled with Alcohol Use Disorder. 

It is part of severe withdrawal and is characterized by mood disturbances and delusions. 

Alcohol hallucinosis is more likely to form into a chronic form of psychosis compared to other conditions, and according to Bhat, Pookala S, (“Alcoholic hallucinosis.” 

Industrial psychiatry journal vol. 21), among all the people that quit taking alcohol and had had their last drink, 13.5 % of them still hallucinated, even three years after severe withdrawals and abstaining from alcohol. [2] 

In general, however, Alcoholic hallucinosis is most prevalent to people who have been abusing alcohol of between 0.6 and 0.7 percent.

It resembles schizophrenia and there is little consensus of what it is, but it is different from DTs. 

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Wicke-Korsakoff Syndrome (WKS) 

This condition is complex and combines different forms of mental disorders that are associated with thiamine deficiency. They are all caused by alcohol abuse.  

Now, unlike the other conditions, this one can cause long-term brain damage as a result of losing thiamine in the body, and it is associated with drinking too much alcohol. 

These conditions are both forms of psychosis and have similar symptoms, but the most serious are rapid heartbeat, heart palpitations, seizures and high fevers.  

When you quit alcohol cold turkey, you may experience some seizures in the first 12 - 48 hours after your last drink. 

The other symptoms include: 

  • Delirium 
  • Touchiness, edginess, and agitation. 
  • Body tremors, hours after the last drink. 
  • Excessive sleeping. 
  • hallucinations. 
  • Bursts of energy  
  • Sudden excitement, and fear that's too intense. 
  • Light sensitivity. 
  • Mood changes 

The main treatment of these conditions is focused on reducing the symptoms to save the individual's life.

Being admitted for treatment is usually the first step and most medical professionals will try to stabilize the hallucinations and seizures.  

Can alcohol detox cause seizures? 

Yes. Alcohol withdrawal can trigger seizures. People who suffer from chronic alcohol abuse have a high chance of developing seizures when they suddenly stop drinking.  

Alcohol withdrawal seizures usually start just a few hours after you stop drinking. Withdrawal is something that happens whenever your body over relies on alcohol or drugs.

Stopping this substance abuse suddenly is the reason why you end up having seizures.  

It is therefore important to join a detox program that is medically supervised whenever you need to alleviate these risks. 

What happens is that alcohol acts as a stimulating receptor for your brain and causes the brain activities to become suppressed.

The alcohol itself doesn't cause the seizures, but during withdrawal the suppressive activity of the alcohol is normally removed, leaving the brain susceptible to seizures. 

Here are some specific causes and the vital signs that you may suffer from seizures: 

Binge Drinking 

Alcohol withdrawal, together with binge drinking can cause seizures, even for people who have not been diagnosed previously with epilepsy.  

Binge drinking refers to a situation where you drink too much within a short period.

The seizures that are related to the binge drinking are as a result of alcohol withdrawal. Even if you are not a drinker, in most cases, you are likely to experience the seizures after binge drinking. 

Epilepsy 

Long-term use of alcohol can increase your risk of developing epilepsy.

This is a condition that is prone to seizures, and the reason why it is not fully understood is that alcohol creates some changes in the brain receptors which increases the likelihood of seizures. 

Epilepsy can occur on its own in most people who don't even consume alcohol, but long-term alcohol use will increase the risk of developing it in some people. 

If you suspect that you could have epilepsy, you should consult a doctor immediately and stop using alcohol as alcohol can increase the symptoms further.

Alcohol use triggers seizures in people who are already diagnosed with epilepsy.  

If the withdrawal symptoms start to occur, then epilepsy can cause seizures to occur as well, even with mild symptoms of alcohol withdrawal which happens in most people. 

Well, this doesn't mean that everyone should be worried about seizures. Most people can enjoy moderate alcohol levels without being addicted.

The problem is drinking heavily and developing a tolerance for alcohol which eventually causes you to become dependent on it.  

In fact, in most cases, heavy drinking leads to an AUD - Alcohol Use Disorder. 

One of the main symptoms of AUD is withdrawal. It happens whenever an individual stops drinking, hence experiencing symptoms such as nausea, sleep problems and tremors, as the alcohol is leaving the body.  

In the most extreme cases, alcohol withdrawal will lead to seizures, although it is not everyone with a tendency to drink heavily or has a heavy alcohol dependence experience it.  

How prevalent is alcohol withdrawal seizures? 

As we mentioned earlier, not everyone who experiences alcohol withdrawal symptoms will suffer from seizures.

In fact, a report on the NCBI publication showed that 1/10th of patients who undergo withdrawal will have seizures. [3] 

Seizures that are as a result of alcohol withdrawal usually start about one or two days after the person has had their last alcoholic beverage and they usually suffer from tonic-conic seizures. 

These are also called grand mal seizures, and they involve having the muscles stiffening, jerking, and twitching. Anyone suffering from this will soon become unconscious and will have some difficulty breathing. 

Stages of Seizures in the process of Alcohol Withdrawal 

To understand how alcohol withdrawal develops into seizures, you must learn the stages of alcohol withdrawal.

As per the norm, withdrawal symptoms normally start about 6-12 hours after one stop drinking.  

They start off mild and will include a high heart rate, high blood pressure, some tremors, sweating, vomiting and nausea. 

These will then be followed by the patient developing auditory, visual, as well as tactile hallucinations during the twelfth hour of giving up drinking. 

When do seizures start? 

During the third stage of alcohol withdrawal, seizures will start. This should be one or two days after the individual has consumed their last alcoholic drink.  

In the most severe cases, the patient is likely to develop a fatal condition that's called - delirium Tremens, which we have talked about above.  

This will appear around 3-4 days after drinking. It is a condition that involves hallucinations, elevated blood pressures, high body temperatures, and seizures.  

In the worst cases, the patient may go into a coma. According to experts, some of the patients who suffer from this condition are simply having a worsened symptom of alcohol withdrawal. 

So, you are probably worried about all of these stats, but the truth is that, almost half of all patients that suffer from AUD develop withdrawal symptoms although they are mostly mild, and they tend to fade off on their own without the need for medical treatment. 

With that being said however, a patient with Alcohol Use Disorders, whose withdrawal symptoms progress to seizures must seek medical attention immediately, as it may be an early sign of delirium tremens. 

Who is highly at risk for seizures? 

As previously indicated, it’s not everyone that undergoes withdrawal from alcohol experiences seizures. 

Only about 10% of patients will suffer from this condition while going through detox. Most people will not experience seizures. 

Experts say that withdrawal symptoms tend to be severe for people who have had previous alcohol addiction where the nervous system becomes active from repeat withdrawals.  

If you have had a long history of alcohol abuse, it means that you repeatedly go through withdrawal, and it is most likely going to cause you to suffer from seizures the minute you give up drinking. 

According to Science Direct, which is a Journal of Emergency Medicine, for people suffering from alcohol withdrawal seizures, there are additional risk factors such as epilepsy diagnosis, and brain lesions. [4] 

What exactly causes seizures during withdrawal? 

There are certain risk factors that are used to explain who is most likely to suffer from this complication, and neuroscience states that alcohol consumption slows the nervous system's activities thereby increasing the effects of a chemical in the brain called GABA.  

This has a relaxing effect, and while it reduces the actions of the glutamate, it also excites the nervous system. 

With time, the nervous system will then adapt to these new changes, which will result in tolerance. When the individual stops drinking, they become unbalanced, as a result of withdrawal symptoms.  

During repeat withdrawals, the nervous system will become more sensitive, and this is why one goes into multiple rounds of withdrawal, increasing the risk of seizures. 

Treating Alcohol Withdrawal Seizures 

Anyone experiencing seizures as a result of alcohol withdrawal needs immediate medical attention.

This is because seizures can quickly progress into delirium tremens which is a life-threatening condition when not treated. 

According to experts however, a prescription drug called "Benzodiazepines," can be used to prevent the development of seizures.

This drug is a gold standard when treating the withdrawal symptoms as well, and a patient that is going through withdrawal seizures must receive this medication. 

One important point to consider however is that when a patient develops an initial seizure during withdrawal, they are at risk of having more seizures.  

It is highly recommended that this patient receives immediate treatment with benzodiazepines in order to help prevent any further complications and seizures.  

A specific type of the drug known as diazepam is the drug of choice, furthermore, if one is progressing into delirium tremens, the doctor may use a combination of diazepam and clomethiazole for treatment.  

Abbeycare Pricing Bot

Last Updated: November 8, 2021

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.