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  • Alcohol withdrawal symptoms can be intense. Yet, many who would benefit from alcohol detox and substance abuse treatment are reluctant to begin the process and apprehensive of the discomfort involved.

    When someone who has become dependent on alcohol stops drinking, it can trigger a wide range of symptoms known as alcohol withdrawal syndrome. Hallucinations are one of these potential symptoms, along with a variety of others.

    Alcohol-Related Hallucinations

    However distressing they may be for those experiencing them, hallucinations are an uncommon symptom and aren’t considered dangerous on their own. 

    They are likely only experienced by those with a severe alcohol use disorder, rather than mild or moderate alcohol use disorders, following a long period of heavy drinking.

    According to data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), only 2% of those studied reported hallucinations during alcohol detoxification. 

    Another study by Open Access Emergency Medicine found the prevalence of alcohol withdrawal hallucinations was 2% to 8% among those with chronic, heavy alcohol use.

    Alcoholic Hallucinosis

    While some people experience relatively minor or limited visual hallucinations and/or auditory hallucinations during withdrawal, others may experience a more severe form known as alcoholic hallucinosis.

    This condition develops between twelve and twenty-four hours after an individual’s last drink. The person has likely been drinking continuously and heavily for a long period of time. 

    Alcohol hallucinosis can last for days and may involve: 

    • severe auditory hallucinations (things you hear)
    • severe visual hallucinations (things you see)
    • severe tactile hallucinations (things you feel) 

    These hallucinations can vary dramatically from person to person depending on their environment and state of mind, with those who have experienced them reporting:

    • hearing angry or accusing voices
    • distant crashes
    • looping melodies
    • insects
    • conversing with people who aren’t there

    These illusions may be clear, realistic, and vivid, and may be frightening or disturbing in some cases.

    Delirium Tremens

    Hallucinations may also occur as a symptom of delirium tremens (DTs)

    DTs are a serious and potentially life-threatening form of psychosis that may result from severe alcohol withdrawal in certain cases where an individual consumed a large amount of alcohol routinely for a month or more.

    Delirium tremens can develop three days into the withdrawal process and may last for two or three days. Symptoms may include: 

    • severe confusion
    • changes in consciousness
    • shaking
    • shivering
    • irregular heart rate
    • sweating
    • hallucinations
    • seizures

    Unlike alcoholic hallucinosis, those with delirium tremens are not in their right mind and do not have a clear state of consciousness.

    Delirium tremens is considered a medical emergency, and if not properly treated death can sometimes result due to high body temperature or withdrawal seizures.

    Risk Factors For Alcohol Withdrawal Hallucinations

    Exposure to alcohol during childhood brain development has been associated with up to a tenfold increase in the likelihood of hallucinations from alcohol withdrawal.

    Other risk factors for alcohol withdrawal hallucinations include:

    • preexisting mental health disorders
    • panic disorder
    • African American or Native American ethnicity
    • low income level
    • low level of education

    Causes Of Hallucinations In Alcohol Addiction Recovery

    Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter and slows brain activity. Glutamate is an excitatory neurotransmitter and increases brain activity.

    Chronic alcohol abuse will depress central nervous system (CNS) activity, similar to GABA. In response, the body will reduce it’s reaction to GABA and increase it’s reaction to glutamate, attempting to boost CNS activity to make up for the effects of the incoming alcohol.

    If alcohol is then taken away, this high sensitivity to glutamate vs. GABA will send the brain and body into overdrive until the brain can once again adapt to its new normal.

    This imbalance, if severe enough, is believed to be the source of hallucinations and most other physical and mental effects experienced during alcohol withdrawal.

    Other Symptoms Of Alcohol Withdrawal

    Other common effects of alcohol withdrawal include:

    • anxiety
    • shaky hands
    • headaches
    • high blood pressure
    • nausea
    • vomiting
    • insomnia
    • nightmares
    • sweating
    • cravings
    • restlessness
    • seizures

    These symptoms often peak by the third day and begin to improve after, likely resolving within seven days. However, in certain cases of protracted withdrawal, certain symptoms may linger for up to a year after detoxification. 

    Professional Care For Alcohol Dependence

    If you or a loved one struggles with problematic alcohol consumption, medical detoxification and participation in a professional substance use recovery program can give you the best possible chance for a lasting recovery. 

    Ark Behavioral Health offers a variety of healthcare options for alcohol dependence, including both inpatient and outpatient treatment options, 12-step support groups, behavioral therapy, dual diagnosis treatment, and more.

    To learn more about our addiction treatment programs, please contact us today.

    Written by Ark Behavioral Health Editorial Team
    ©2023 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    Industrial Psychiatry Journal - Alcoholic hallucinosis
    National Clinical Guidelines Centre - Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications
    National Library of Medicine: MedlinePlus - Alcohol withdrawal

    Medically Reviewed by
    Manish Mishra, MBBS
    on June 24, 2021
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