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For those that have struggled with considerable alcohol abuse over a long period, detox may not be as easy as simply abstaining from drinking for a few weeks to “dry out.” Doing this can result in some of the most severe and potentially deadly side effects of alcohol withdrawal.

These side effects are known as delirium tremens, or “the DTs,” and the chance of seizure represents the biggest and most dangerous alcohol withdrawal challenge for long-time abusers to overcome on their road to recovery.

Understanding Delirium Tremens?

Delirium tremens, often called DTs, is the more common term for alcohol withdrawal delirium or AWD. It is one of the most severe withdrawal symptoms of a long-term or extremely heavy alcohol addiction. It will generally start between 48 and 72 hours after the last drink, but it can stretch on for a week or so in some extreme cases. It will generally only occur in about 5% of all individuals enduring alcohol withdrawal, but it can be deadly if the individual attempts alcohol detox solo and the condition goes untreated.

Alcohol Withdrawal Stages

The stages of alcohol withdrawal will vary from one individual to another, particularly when the level and severity of the drinking habit can fluctuate so wildly. Here are the most common stages, the average length of time it will take them to begin, and what to expect during each.

  • Stage 1 – The first stage of alcohol detox will start 6 to 12 hours after the last drink. This stage is generally marked by increased anxiety, agitation or irritation, headaches, tremors, nausea, and vomiting.
  • Stage 2 – The second stage of alcohol withdrawal will begin 12 to 24 hours after the last drink. Common symptoms during this stage include disorientation and the continuation of tremors. This is also the stage where seizures will start to become a risk.
  • Stage 3 – Stage 3 will begin 24-48 hours after the last drink and include seizures, sleep disruption or insomnia, elevated blood pressure, uncontrollable sweating, fever, auditory or visual hallucinations, and delirium tremens.
  • Stage 4 – The final stage will occur 48-72 hours after the last drink and will mark the peak of most physical and mental symptoms, after which they will begin to subside. Once this stage has been completed, the individual will be left with mostly lingering psychological symptoms, such as irritability or emotional instability, low energy levels, ongoing sleep issues, memory problems, and more.

Following the main stages of alcohol detox, the post-acute withdrawal syndrome will begin. This stage will be common for heavy drinkers that have had a drinking problem for many years. The symptoms of post-acute withdrawal symptoms, or PAWS, can last anywhere from a few weeks to a year or more. In many cases, they may require additional medication to help treat.

Some of the symptoms commonly associated with PAWS include:

  • Low energy
  • Anxiety
  • Depression
  • Mood swings and emotional instability
  • Irritability or aggression
  • Chronic sleep cycle disruption, including insomnia
  • Trouble forming, storing, or retrieving memories
  • A higher incidence of accidents or low coordination side effects
  • Slower reflexes
  • Dizziness

It’s important to remember that even though these symptoms may persist for a long time, they will eventually fade. Enduring the challenges of PAWS is one of the leading causes of relapse since the individual is often desperate to reduce or eliminate the symptoms. This is why professional help can be crucial to recovery, since it can help the individual more effectively cope with the temptation to relapse, which helps prevent them from having to start all over from the beginning, with the potential for the next detox to be even more difficult.

Delirium Tremens Risk Factors and Causes

Significant risks are associated with developing an alcohol addiction that leads to delirium tremens. Research has shown that nearly one-quarter of 200 consecutive alcohol-related hospital admissions are likely to develop delirium tremens. One study even showed that 8% were statistically likely to be fatal.

With that in mind, only an estimated 3%-5% of all patients would be at risk for developing delirium tremens or similar withdrawal symptoms such as profound confusion, autonomic hyperactivity, and cardiovascular collapse. Failure to have delirium tremens treated appropriately can result in stroke, cardiac arrest, and even death, arguably making it the most serious side effect of quitting alcohol after long-standing abuse.

The most common groups to display delirium tremens upon alcohol detox include:

  • Younger caucasian adults
  • Unmarried men
  • Individuals with an existing history of seizure
  • Individuals that have experienced alcohol withdrawal before
  • Long-term, heavy drinkers (heavy in this case means more than 15 standard drinks weekly).

Delirium Tremens Symptoms & Signs

The most common symptoms of delirium tremens won’t just suddenly present themselves. They will begin as milder versions earlier in the alcohol detox process and eventually progress into the DTs. These symptoms can even change from one form to another in the middle of the day. Symptoms of delirium tremens include:

  • Irritability, agitation, aggression, or even hostility
  • Confusion about the individual’s surroundings and health state
  • Autonomic hyperactivity, including trembling of the hands or arms, uncontrollable sweating, irregular heartbeat, intense nausea, and vomiting
  • Impairment or loss of consciousness
  • Visual, auditory, or even tactile hallucinations
  • Body tremors
  • Seizures

If you see any of these signs in yourself or someone you love, you must seek medical attention immediately. Unchecked progression of these symptoms can be fatal.

Treating Alcoholism the Safe Way

Suppose you or someone you care about has been having trouble with alcohol for some time. In that case, it may be time to consider a professional alcohol treatment program where they can care for you in comfort and safety with the help and support of addiction professionals.


  1. Delirium Tremens – an overview | ScienceDirect Topics. Accessed January 3, 2023.
  2. Costin BN, Miles MF. Chapter 10 – Molecular and neurologic responses to chronic alcohol use. In: Sullivan EV, Pfefferbaum A, eds. Handbook of Clinical Neurology. Vol 125. Alcohol and the Nervous System. Elsevier; 2014:157-171. doi:10.1016/B978-0-444-62619-6.00010-0
  3. Rahman A, Paul M. Delirium Tremens. In: StatPearls. StatPearls Publishing; 2022. Accessed January 3, 2023.

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At Absolute Awakenings, we take information integrity seriously. We have dedicated our resources to ensure that all content published to our blog is medically sound. As such, all content on our blog has been thoroughly reviewed by a doctorate level clinician such as a Medical Doctor, or Psy.D, so that you can trust all of the data we publish.

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