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Alcohol-Induced Psychosis: Hallucinations, Withdrawal Psychosis

Written by Abby Doty

& Medically Reviewed by Benjamin Caleb Williams, RN

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Medically Reviewed by Benjamin Caleb Williams, RN

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Updated 09/22/2023

Alcohol-induced psychosis can occur with acute intoxication, alcoholic hallucinosis and alcohol withdrawal psychosis. The symptoms of each can vary widely in severity.

Alcohol-induced psychosis describes multiple types of psychosis caused by alcohol use. Psychosis is a psychiatric term that describes a detachment from reality. During these episodes, individuals may see, hear or believe things are present when they are not. 

Alcohol psychosis symptoms may include agitation, paranoia, confusion and disorganized thoughts. Other alcohol-related psychosis symptoms can include inappropriate behavior and emotions, lethargy, loss of interest in regular activities, inaccurate beliefs and irritability without cause.

What Is Alcohol-Induced Psychosis?

Alcohol-induced psychosis refers to any type of psychosis caused by alcohol use. Psychosis occurs when someone’s senses or beliefs are not based in reality. Typically, psychosis will manifest as hallucinations or delusions. Hallucinations cause someone to see or hear something that is not really there, while delusions cause someone to believe something is true even though it is not.

Alcohol-induced psychosis typically occurs due to one of three conditions. These include:

  • Alcoholic hallucinosis
  • Alcohol withdrawal psychosis
  • Wernicke-Korsakoff syndrome 

Depending on the cause, alcohol-induced psychosis may be temporary or permanent.

Symptoms of Alcohol-Induced Psychosis

The symptoms of alcohol-induced psychosis will be the same as any other kind of psychosis. However, specific symptoms can vary based on the type of alcohol-induced psychosis someone experiences. The symptoms of alcohol-induced psychosis may include:

  • Seeing things that are not there
  • Smelling things that are not present
  • Hearing sounds that others cannot
  • Tasting things that are not in the mouth
  • Feeling touch when not being touched
  • Holding irrational beliefs that someone is out to get them
  • Believing that you have abilities or powers that you do not
  • Believing in something that is untrue

The one consistent feature of any kind of psychosis involves an experience or belief that is not based in reality.

Types of Alcohol-Induced Psychosis

While drinking alcohol does cause symptoms like decreased inhibition or impaired coordination, it rarely causes symptoms of psychosis. Alcohol-induced psychosis typically occurs due to secondary effects of alcohol use — not from alcohol use itself. These effects can include alcohol hallucinosis, delirium tremens and Wernicke-Korsakoff syndrome.

Psychosis From Alcoholic Hallucinosis

Alcoholic hallucinosis is a fairly uncommon outcome of alcohol abuse and is generally only seen in people with a chronic alcohol use disorder. Alcoholic hallucinosis usually develops 12 to 24 hours after heavy alcohol consumption abruptly stops, and it can last for several days. Severe and recurrent alcohol abuse can increase the risk of developing alcoholic hallucinosis.

Psychosis from alcoholic hallucinosis is primarily characterized by auditory hallucinations, such as accusing and threatening voices, along with visual hallucinations. Delusions and mood disruptions may also occur.

Psychosis From Delirium Tremens

Psychosis from delirium tremens is a more severe diagnosis than alcoholic hallucinosis. Delirium tremens is a severe complication of alcohol withdrawal and is classified as a medical emergency, as symptoms can be life-threatening. Delirium tremens usually develops two to three days after excessive alcohol consumption concludes.

Symptoms of delirium tremens may include a significant lack of coordination, excessive sensitivity to sensory input, abrupt mood changes and elevated heart rate and respiration. Other symptoms can include delusions, hallucinations and body tremors. Extremely severe seizures and alcohol withdrawal hallucinations may require sedation as a part of treatment.

Delirium tremens is often fatal if left untreated and requires professional medical intervention. For this reason, it is critical for people going through alcohol withdrawal to be supervised by medical professionals in a medical detox program.

Wernicke-Korsakoff Syndrome (WKS)

Wernicke-Korsakoff syndrome (WKS) is a serious complication of heavy alcohol use and is caused by low levels of thiamine (vitamin B1). Alcohol is the main cause of Wernicke-Korsakoff syndrome in developed areas of the world, as the substance affects how thiamine is absorbed. Low thiamine levels can cause brain inflammation that creates dangerous neurological symptoms. 

If treated by replacing thiamine levels, inflammation caused by Wernicke-Korsakoff syndrome can be reversed. If untreated, however, this inflammation can lead to permanent brain damage. It is during this stage that psychosis can occur. Wernicke-Korsakoff syndrome can cause hallucinations and memory gaps that a person will fill with made-up memories called confabulations.

Alcoholic Paranoia

Alcoholic paranoia is a specific type of psychosis that can occur when using alcohol. This is not technically a medical syndrome or condition but is merely a term used to describe paranoia caused by alcohol use. Paranoia is a type of psychosis in which someone has an illogical, deep-seated suspicion of someone or something else. Paranoia is a type of psychosis because the suspicion and distrust the person has is not grounded in reality or based on coherent, logical reasoning.

Role of Alcohol in Triggering Paranoia

While alcohol is better known for causing other types of psychosis, paranoia is a type of psychosis that has been observed to occur. Because alcohol-related paranoia is relatively uncommon, medical science does not fully understand the potential triggers. This symptom primarily occurs in those who have been using alcohol for a long time and are heavy drinkers.

Common Symptoms of Alcoholic Paranoia

Alcoholic paranoia typically manifests as a type of paranoid jealousy. Very often, it is a married man who is concerned that his spouse is cheating on him without any evidence or basis for this suspicion. Alcoholic paranoia will always be some kind of unreasonable suspicion without any basis for reality. Paranoia can be a dangerous condition, as the person experiencing it can often become aggressive or violent against those they suspect.

Is Alcohol-Induced Psychosis Permanent?

It is unknown what exactly causes alcohol-induced psychosis, but it is known that continued alcohol use has a distinct impact on the human body and brain. Alcohol-induced psychosis is believed to result from this impact.

Alcohol-induced psychosis is temporary when due to delirium tremens or alcoholic hallucinosis, but it can become permanent in people with Wernicke-Korsakoff syndrome. In most people, psychotic symptoms usually stop after a few weeks of sobriety, but they may persist in those who continue to drink. In these cases, individuals may need long-term treatment and prescriptions for antipsychotic medications.

How Long Does Alcohol-Induced Psychosis Last?

The duration of alcohol-induced psychosis depends entirely on its cause. Alcoholic hallucinosis, for example, may resolve within 24 hours. Psychosis experienced during delirium tremens can last for several days in severe cases. Psychosis caused by Wernicke-Korsakoff syndrome is generally permanent if it develops.

Treatment for Alcohol-Induced Psychosis

Treatment for alcohol-induced psychosis focuses on medical stabilization while helping a person stop drinking. Neuroleptics, benzodiazepines and atypical antipsychotics are types of medications that can be used if sedation is warranted. Individuals with alcohol-induced psychosis may undergo a suicide assessment since the condition is often linked with higher rates of suicidal behaviors.

Although psychosis can result from excessive alcohol intake, it may also be indicative of a co-occurring psychotic disorder. Psychotic conditions may include schizophrenia, schizoid personality disorder or schizotypal personality disorder. If an alcohol-induced psychosis is present in conjunction with a co-occurring psychotic disorder, a dual diagnosis treatment program may be recommended. A dual diagnosis treatment program can address the alcohol use disorder and mental health condition simultaneously to ensure that both are treated correctly.

Since alcohol-induced psychosis usually only occurs when people consume excessive quantities of alcohol that are linked to dependence and withdrawal, it is often critical that alcohol consumption is stopped under medical supervision. A medical detox program can ensure that a person is safely detoxing from alcohol in order to avoid alcohol-induced psychosis.

Treatment interventions that help a person maintain sobriety can help improve outcomes for those who have experienced alcohol-induced psychosis. The Recovery Village Palm Beach at Baptist Health is an alcohol treatment center in South Florida that can provide treatment for alcohol addiction and co-occurring disorders.

If you or someone you know is experiencing alcohol-induced psychosis, our experts are here to help. Contact us today to speak with a knowledgeable representative who can provide information, answer your questions and help direct you to a treatment program that meets your needs.

Medical Disclaimer: The Recovery Village Palm Beach at Baptist Health aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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