Imagine you are walking down the sidewalk in a city. You turn a corner and suddenly in front of you is a giant brown bear. What happens next? You feel an adrenaline rush, your heart races, your blood pressure skyrockets, you shake like a leaf, your pupils get bigger like saucers, your hair stands on end, you start to sweat and run like hell. Do you have a strong mental image of this? Good. Hold that thought; we’ll get back to it.
Delirium tremens, also known as DT, is the most serious of several syndromes that can occur when someone who is physically dependent on alcohol stops drinking. By serious, I mean that people with this condition can die. Even with hospital treatment, the mortality rate can be 1-5%, but without treatment it could be 20%. Even convulsive seizures, another alcohol withdrawal syndrome, are less likely to be fatal than DTs.
Symptoms of TDs usually begin 2 to 4 days after the last drink in someone with a long-term heavy use of alcohol. The first signs of TD may be the three T’s: elevated temperature, tremor, and tachycardia (rapid heartbeat). The affected individual may experience anxiety, restlessness, nausea, and difficulty sleeping. By the time delirium tremens is fully developed, it includes the full range of “grizzly bear” symptoms listed above. These occur because a part of the nervous system responsible for regulating basic bodily processes, the sympathetic system, goes into overdrive.
But DTs involve much, much more. The parts of the brain responsible for perception and thinking go haywire. Ordinary lights and sounds seem excessively harsh. The afflicted individual becomes confused, agitated, and even psychotic. He or she might not even identify family members. There are constant and sometimes inconsistent conversations. Ordinary components of the environment, such as patterns on wallpaper, can be perceived as frightening threats, such as spiders or snakes.
Also, hallucinations may occur. These can include frightening sights, sounds, or smells that other people in the room cannot detect. Additionally, there may be distressing sensations as if the skin is being touched by insects or other unseen intruders.
At first, the person in TD may have lucid intervals in which he engages in adequate conversation, but then becomes increasingly unapproachable to questions. Subsequently, the symptoms usually subside in a matter of days and recovery can even be sudden.
What causes these terrible things to happen? Evidence to date suggests that in people who drink heavily and for a long time, the brain becomes accustomed to the constant presence of alcohol, and the normal chatter between brain cells is no longer dampened by alcohol as it is in human brains. of occasional drinkers. The brains of heavy drinkers likely accomplish this by reducing the number of locations in brain cells where the natural inhibitory chemical, GABA (gamma-amino-butyric acid), can act to slow things down.
So what happens if the alcohol is suddenly removed from the image? In that case, GABA in the brain has fewer places where it can act to slow down. As a consequence, brain cells become uncontrollably hyperactive and the symptoms of delirium tremens occur.
DTs are a medical emergency that requires hospitalization, usually in an intensive care unit. The patient needs intravenous fluids, vitamins, nutrition, and correction of water and salt imbalances in the bloodstream. Medications known as benzodiazepines are usually given to relieve overexcited brain cells. The medical team looks for complications, such as infections or an irregular heartbeat, that may require other treatments. The medical staff monitors the patient frequently. Family and friends provide valuable help in keeping the patient calm.
But in delirium tremens the old adage applies: prevention is better than cure. The best case is the one that doesn’t happen. Of course, this does not mean that a patient with alcohol dependence should continue to drink. Rather, it means that professional help should be included to safely withdraw from alcohol.
This raises the question of who has alcohol dependence in the first place. There is more than one set of criteria, but the “CAGE” quiz provides a simple and effective screen where the letters of the word correspond to each of the four questions:
C – Have you ever felt that you should REDUCE your alcohol intake?
A – Have people BOTHERED you by criticizing your drinking?
G – Have you ever felt bad or GUILTY about your drinking?
E – Have you ever had a drink first thing in the morning to calm your nerves or get rid of a hangover (revelator)?
A “yes” answer to one of the four questions raises the possibility of alcohol dependence. A “yes” answer to two of the questions makes alcohol dependence likely and help should be sought.
(C)2005 by Gary Cordingley