Alcohol use disorder (AUD), formerly called alcoholism and alcohol addiction, is one of the more serious problems plaguing the United States. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) approximates that, as of 2015, there are about 16 million Americans who have AUD — more than 15 million adults and more than 600,000 adolescents. This represents about 6.2 percent of the overall population in the country.
Overview of Alcohol-Induced Psychosis
The term psychosis refers to a collection of psychiatric symptoms that occur together for a certain period, with the most prominent being delusions and hallucinations. Typically, people who have psychosis lose touch with reality, have difficulty telling the difference between real experiences and hallucinations, and are easily confused, frightened, and sometimes aggressive. Additional symptoms of psychosis are:
- Jumbled or disorganized thoughts
- False beliefs
- Seeing, hearing, or feeling things that are not there
- Fear and paranoia
- Loss of interest in activities
- Trouble holding a coherent conversation
- Difficulty maintaining hygiene or performing regular daily activities
- Laughing or crying inappropriately
- Other inappropriate behavior
- Becoming angry, upset, or energized for no apparent reason
- Becoming lethargic, inactive, or experiencing anhedonia for no apparent reason
- Completely losing touch with reality and experiencing the only hallucination
Substance-induced psychosis, including alcohol-induced psychosis, is caused by abusing a drug, and the psychosis was not present before the substance abuse. While many people who have psychotic disorders like schizophrenia are also more likely to abuse drugs and alcohol, people who abuse alcohol are also likely to trigger a psychotic disorder over time. People who experience one instance of alcohol-induced psychosis are more likely to experience another one shortly. It will become chronic if left untreated.
This form of psychosis indicates several different conditions, depending on when psychosis appears — during intoxication, during withdrawal, or with regular chronic abuse. Problems that contribute to developing alcohol-induced psychosis include:
- Chronic abuse of alcohol with no medical help
- Thiamine (B1) deficiency
- Early-stage or late-stage alcohol withdrawal
- Abusing other substances, like benzodiazepines
- Lack of social support during withdrawal
- Impulse control disorder
- Early-onset alcohol use, during early adolescence
More on Drinking
The U.S. Centers for Disease Control and Prevention (CDC) also defines other problematic forms of drinking. They are:
- Binge drinking: This is defined as four or more servings of alcohol in a two-hour period for women and five or more for men.
- Heavy drinking: This involves drinking one or more servings of alcohol every day, or seven drinks total per week, for women; drinking two or more servings of alcohol every day, or 14 or more drinks total per week, for men.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has 11 criteria used to determine if someone struggles with alcohol addiction; meeting two out of these 11 criteria indicates a potential AUD. The disorder often combines regular periods of compulsive, uncontrolled binge drinking alongside heavy drinking.
People who struggle with addiction to alcohol are at the highest risk of side effects when they try to quit, although people who are otherwise alcohol dependent, like those who drink heavily, are also at risk of experiencing these symptoms. All kinds of alcohol abuse can lead to memory problems, liver damage, acute harm from falls or car accidents, chronic health problems like gastrointestinal damage and cancer, and brain damage, including a type of psychosis called alcohol-induced psychosis.
This condition actually encompasses a few types of medical problems. Both acute and chronic alcohol abuse can lead to alcohol-induced psychosis — as a symptom of withdrawal, in the case of delirium tremens, or as an effect of chronic drinking, like Wernicke-Korsakoff syndrome. There are a few types of alcohol-induced psychosis, but they are all very dangerous and require medical treatment.
Types of Alcohol-Induced Psychosis
Some more commonly diagnosed forms of alcohol-induced psychosis include:
Delirium tremens (DTs): One of the most known forms of alcohol-induced psychosis, this condition develops because of alcohol withdrawal. People who are most at risk for developing delirium tremens are those who drank several pints of hard or soft alcohol per day, who chronically abused alcohol for 10 years or more, or who have tried to quit abusing alcohol and relapsed repeatedly.
Symptoms of this serious condition that begins 48 hours to 72 hours after the final drink are:
- Body tremors
- Agitation, touchiness, and edginess
- Changes in mental functioning that appear suddenly
- Sleeping for a full day or more
- Intense, sudden excitement, or fear
- Bursts of energy for no reason
- Rapid mood changes
- Sensitivity to light, sound, or touch
- Stupor, or being unconscious but appearing awake
These symptoms all indicate psychosis; however, the most life-threatening symptoms from DTs include heart palpitations and rapid heartbeat (tachycardia), high fever, and seizures. After quitting alcohol cold turkey, seizures may appear within 12-to-48 hours after the last drink. They may precede psychotic symptoms or occur alongside them.
Treatment for DTs is focused on alleviating symptoms and saving the individual’s life, so being admitted for emergency treatment is the first step. Medical professionals will work to stabilize the person’s seizures and hallucinations. They will also check vital signs and manage blood chemistry.
- Alcoholic hallucinosis: This rare form of alcohol-induced psychosis involves mostly auditory hallucinations. These appear during or just after a period of heavy drinking, among people who have chronically struggled with AUD. There are also delusions and mood disturbances, as with other psychotic conditions.
Alcoholic hallucinosis is more likely than DTs to become a chronic form of psychosis. A study on the condition found that, among those who had quit abusing alcohol, 13.5 percent still hallucinated after three years of abstinence.
In general, this condition has a prevalence among people who chronically abuse alcohol of 0.6 percent to 0.7 percent, and it tends to resemble schizophrenia. Otherwise, there is little consensus on what the condition is, other than noting that it is distinct from DTs.
- Wicke-Korsakoff syndrome (WKS): This is a complex condition that combines two types of mental health disorders associated with thiamine deficiency, which can be caused by alcohol abuse: Wernicke encephalopathy and Korsakoff syndrome. Unlike the two previous forms of alcohol-induced psychosis, WKS is caused by long-term brain damage due to loss of thiamine in the body, which may be associated with drinking a lot of alcohol. Typically, symptoms of Wernicke encephalopathy occur first, followed by symptoms of Korsakoff syndrome, but this is not always the case.
Symptoms of Wernicke encephalopathy include:
- Overall confusion
- Gradual loss of mental activity, leading to coma or death
- Loss of muscle coordination, starting with a leg tremor
- Abnormal eye movements
- Other changes to vision like double vision
- Alcohol withdrawal symptoms
Symptoms associated with Korsakoff syndrome include:
- Inability to form new memories
- Loss of older memories, leading to dementia-like symptoms
- Confabulation, or making up stories to fill in memory gaps (not done on purpose)
- Other psychotic symptoms
Because Wernicke-Korsakoff syndrome occurs due to a vitamin deficiency, the leading method of treatment is to replace thiamine.
When this condition occurs because of chronic alcohol addiction, the addiction must also be treated.
The person must be examined for additional physical problems, especially in the intestines, which may lead to vitamin deficiency in the future.
Typically, this condition gets worse over time if it is left untreated or if the underlying alcohol addiction is not overcome.
Sometimes, the condition spontaneously clears on its own, but this should not be relied on as a method of treatment.
Get Help With Ending Alcohol Abuse Before Psychotic Symptoms Appear
If a person has been diagnosed with alcohol-induced psychosis, one report found that there is a 68 percent chance that they will be readmitted to a hospital for medical treatment, a 37 percent chance of comorbidity with other mental health disorders, and a 5 percent to 30 percent chance that psychosis will become a chronic, schizophrenia-like syndrome.
Each type of alcohol-induced psychosis has different risks, but overall, the best way to avoid developing any of these conditions is to quit drinking. This means entering an evidence-based detox program, completing a rehabilitation program that specializes in AUD, and creating an aftercare plan.