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Alcohol use disorder, also known as alcohol addiction or alcoholism, remains one of the most severe issues that are currently plaguing the country. As of 2015, the United States has more than 16 million people abusing alcohol daily, including more than 600,000 adolescents and 15 million adults. With a significant chunk of people involved in the wrongful use of alcohol, the risk of experiencing side effects automatically becomes very high. One of these potential side effects of alcohol abuse is alcohol psychosis.
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Characterized by a loss of touch with reality, alcohol psychosis can make it difficult to live normally and may continue to cause problems unless adequately addressed and treated. Fortunately, recovery is possible; however, it requires dedication and motivation.
What is Psychosis and Can Alcohol Cause it?
Psychosis describes disruptions in a person’s perceptions and thoughts in ways that may make it challenging for them to differentiate between what is real and what’s not. These difficulties in determining reality from fantasy can easily make life difficult for people and extremely hard for them to interact with their daily environment. Instead of being a distinct mental illness, psychosis is a term that embodies multiple symptoms. Sometimes, it is thought of as a break from reality as it involves many perceptual and cognitive changes associated with certain psychotic illnesses that give rise to symptoms like hearing, feeling, or seeing things that are not there. Other symptoms of psychosis include the following:
- Disturbed thoughts or perceptions
- Trouble thinking clearly or concentrating
- Poor executive functioning
- Problems with memory
- Hallucinations and delusions
- Exhibiting inappropriate behavior in the situation
- Difficulty understanding what is real and what’s not
- Incoherent speech
Psychosis due to alcohol involves secondary psychotic episodes with similar presentations as those seen in primary psychosis but arising due to alcohol or alcohol-related issues. Such episodes are more likely to occur in certain circumstances, such as when a person has used too much alcohol or undergoing a withdrawal after suddenly ceasing alcohol use after a long time of consumption. Alcohol psychosis is also common in chronic drinkers, including those with alcohol use disorders or underlying compulsive patterns of alcohol consumption.
Once a person develops psychosis due to the use of alcohol or any other substance, the symptoms start occurring pretty quickly and subside within a few days to a few weeks. While the symptoms resolve shortly for most people, those who continue to drink alcohol despite experiencing the psychotic symptoms may continue to experience them for much longer, potentially leading to a longer-lasting psychotic disorder.
The common symptoms of alcohol-induced psychosis include the following: [1]
- Paranoia, such as thinking others are out to get you or harm you
- Increased agitation
- Heightened fear
- Scratching oneself
- Acting inappropriately or strangely
- Jumbled thoughts
- Harboring false beliefs
- Inability to hold a conversation
- Hallucinating sounds, feelings, or sights
- Laughing, crying, or having other reactions that are inappropriate for the situation
- Talking to oneself or to someone who’s not there
- Aggression or violence and lashing out for no reason
- Losing touch with reality
Types of Alcohol-Induced Psychosis
While drinking commonly leads to symptoms like impaired coordination or decreased inhibition, it very rarely causes psychosis. Alcohol-induced psychosis generally occurs as a secondary effect of alcohol use instead of stemming from alcohol use itself. This type of psychosis can be of three types, each of which has been briefly described below.
Acute Intoxication
Acute intoxication can sometimes lead to acute symptoms of alcoholic psychosis that appear shortly after an individual consumes a large amount of alcohol in one go. For most people, the symptoms of acute alcoholic psychosis clear up as soon as the excessive amount of alcohol exits the body. However, the situation goes further downhill, eventually leading to alcohol poisoning. Acute alcohol poisoning can be extremely dangerous and must be considered a medical emergency where seeking treatment urgently can potentially save a life.
Chronic Alcoholic Hallucinosis
Alcoholic hallucinosis is another rare condition that arises in people who have been abusing alcohol for years. While other types of alcohol-induced psychosis may involve tactile and visual hallucinations, those related to chronic alcoholic hallucinosis are primarily auditory and occur as a person drinks alcohol or shortly after the heavy alcohol drinking session. This type of psychotic episode may last from a few hours to weeks. The condition may also become chronic and long-lasting with effects similar to schizophrenia.
Alcohol Withdrawal Psychosis
Sometimes, people may experience hallucinations following a drinking session as a possible side effect of alcohol withdrawal. In some of these people, the hallucinations may escalate to temporary psychosis known as alcohol withdrawal delirium (AWD).[2] Individuals who suddenly stop drinking after a heavy intake of alcohol over an extended time period are at particularly higher risk of developing alcohol withdrawal delirium and psychosis.
Also known as delirium tremens, the following are some symptoms of AWD:
- Increased sensitivity to light, sound, or touch
- Increase in heart rate and breathing
- Sudden changes in mood
- Hallucinations and delusions
- Body tremors
- Formication or a feeling that tiny insects are crawling on or under the skin
Keep in mind that delirium tremens remains one of the most dangerous side effects of alcohol withdrawal. These symptoms can quickly become life-threatening and always require professional medical attention. Because of the high risks, anyone undergoing alcohol withdrawal must do so under the supervision of medical experts, preferably as a part of a medical detox program.
Alcohol and Psychosis: What is Treatment Like?
Despite sounding extreme and obvious, alcohol-induced psychosis may not be evident from the outside. Many people suffering from this issue start by isolating themselves from others to hide their symptoms. They may stop paying attention to their personal hygiene and other daily obligations. Sometimes, the psychotic episodes cause confusion or unusual outbursts. Many times, the delirium seen in a person with alcohol-induced psychosis is mistaken as inebriation.
Regardless of the symptoms and their intensity, it is always essential to seek treatment for alcohol psychosis.
Emergency Treatment
Individuals experiencing alcohol-related psychosis must immediately get in touch with a medical professional. Their emergency treatment plan may include restraints, sedatives, and continuous monitoring. Emergency treatment aims to stabilize the patients before transitioning them to the detox and rehabilitation phases.
Medically Supervised Detox
If people experiencing alcohol psychosis continue to drink, they may end up having recurrent attacks of similar episodes. Hence, starting a detox program is imperative as soon as they are medically stabilized. Because most people who experience psychosis due to alcohol are highly dependent on alcohol, their detox programs must always be medically supervised by a medical professional to ensure safety. Sometimes, experts may use medicines, such as benzodiazepines, to minimize the withdrawal symptoms and reduce the risk of developing another alcoholic psychosis episode in the near future.
Rehabilitation
Seeking treatment from a substance abuse specialist right after completing a detox process is crucial for recovery. Keep in mind that detox alone is not enough to address the psychological complications of alcoholism and most people require a follow-up rehabilitative program to make a recovery long-lasting. Many rehab facilities are working across the United States to help people maintain the sobriety that they achieved during detox and work on addressing their addiction-related issues.
FAQs
Can alcohol cause psychosis?
Alcohol can cause short-term psychosis, including alcoholic hallucinosis, acute alcoholic psychosis, and alcohol withdrawal delirium. In most cases, this psychosis ends upon the cessation of alcohol consumption and withdrawal symptoms. However, if the symptoms persist beyond this point, they are typical because of a co-occurring mental health disorder that an individual may have picked up during their alcohol use, such as schizophrenia.
Is alcohol-induced psychosis dangerous?
While heavy drinking can certainly lead to plenty of dangerous side effects, alcohol psychosis doesn’t directly affect physical health. Most of its effects on health come indirectly through its uncomfortable symptoms. For example, it can lead to paranoia or hallucinations which can, in turn, make anyone put themselves in a dangerous situation due to their distorted perceptions of reality.
Is alcohol psychosis permanent?
Alcohol-induced psychosis is usually temporary when it is secondary to alcoholic hallucinosis or delirium tremens. However, in the case of Wernicke-Korsakoff syndrome, it can be permanent. Most people stop exhibiting symptoms after a few weeks of sobriety; however, they may persist in those who continue drinking. In these cases, people may need to seek long-term treatment and prescription medications to manage psychosis.
Who is more likely to exhibit alcoholism paranoia and psychosis?
Anyone who drinks an excessive amount of alcohol or suffers from alcohol addiction is at risk of developing alcoholism-related psychosis and paranoia. The risk of this condition is particularly high in the:
Heavy drinks over 40 years of age
People with underlying mental health disorders
People with schizophrenia
People suffering from thiamine or B1 deficiency
People with a very high blood alcohol concentration can easily precipitate alcohol poisoning
People currently going through alcohol withdrawals with delirium tremens (DT)
People who have experienced a previous episode of alcohol-induced psychosis
People who are abusing other substances that can potentially trigger psychosis, such as methamphetamine
How long does alcohol-induced psychosis last?
How long alcohol-induced psychosis persists depends on the severity and type of the episode a person is suffering from. Other factors related to personal mental health can also determine the duration. Most people generally start experiencing the symptoms within 24 hours of their last drink as this is when the withdrawal phase usually begins. The psychotic symptoms linked with alcohol can last a few days, sometimes even longer. For most people, alcohol psychosis subsides as soon as all the alcoholic residue has left the body. Chronic alcoholic hallucinosis episodes may last for days, weeks, or sometimes months.
References
1 Stankewicz HA, Richards JR, Salen P. Alcohol-Related Psychosis. [Updated 2022 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459134/
2 Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic review. Industrial psychiatry journal, 22(2), 100–108. https://doi.org/10.4103/0972-6748.132914
