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Alcohol Hallucinosis: Causes, Risk Factors & Treatment

Alcohol hallucinosis involves vivid hallucinations, delusions, and intense feelings of anxiety or fear. Sometimes, the problem fades quickly. However, some people have symptoms for up to six months.

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Understanding what alcohol hallucinosis looks like is critical. If someone you love drinks excessively, they may develop the condition and need your help. Learning more about the condition may also prompt you to limit how much alcohol you consume. 

What Is Alcohol Hallucinosis?

Alcohol hallucinosis is a set of symptoms that develop within two weeks of alcohol consumption and persist for at least two days.[1] The signs can be subtle, especially if the person doesn’t discuss them. But life with alcohol hallucinosis can be terrifying. 

Common signs include the following:[1]

  • Hallucinations: People hear things others can’t hear, and those sounds can be vivid. They may believe people are talking about them or threatening them. 
  • Delusions: People may believe that they’re in danger, even if no one else can spot the threat. 
  • Powerful feelings: Some people feel intense ecstasy, but others experience fear or terror. 

To qualify for an alcohol hallucinosis diagnosis, symptoms must last at least two days. However, some people have episodes that last for up to six months.[1]

Causes of Alcohol Hallucinations 

Researchers began investigating alcohol hallucinosis in the 1800s, but even now, there’s a lot we don’t know about why it happens.[1] Doctors say alcohol abuse is to blame, but they’re not sure why drinking can cause such persistent changes in how people experience the world around them. 

Some researchers say alcohol changes dopamine receptors in the brain. When cells are flooded with this powerful chemical, they can’t communicate effectively, and hallucinations develop.[2]

Other researchers blame amino acid abnormalities or elevated levels of beta-carbolines for hallucinations.[2]

It’s clear that drinking can cause alcohol hallucinosis. But researchers must dig harder to find out why these changes appear in some people and not others. 

Alcohol Hallucinosis Risk Factors

Drinking a large amount of alcohol is the largest risk factor for alcohol hallucinosis, experts say. Some people develop the problem as a side effect of alcohol addiction. But anyone who drinks too much can experience this altered state of consciousness.[3]

Other risk factors include the following:[1]

  • Beginning a drinking habit at a young age 
  • Repeated admissions to a hospital due to alcohol abuse 
  • Low economic status 
  • Other mental health issues 

Researchers haven’t identified a specific amount of alcohol that always causes hallucinosis. Everyone digests and metabolizes alcohol differently. An amount that’s safe for you may be too powerful for someone else. 

But in general, drinking a lot of alcohol and doing so regularly can significantly increase your risk of developing alcohol hallucinosis.[1]

Alcohol Hallucinosis vs. Delirium Tremens vs. Alcohol Psychosis 

Doctors use many terms to describe brain changes caused by alcohol. They’re very rarely interchangeable. Understanding which one applies can help you talk openly with your medical team. 

Alcohol hallucinosis and alcohol psychosis are sometimes considered synonyms.[2] Doctors say these terms both apply to psychosis that appears during or shortly after an episode of heavy alcohol intake. 

Delirium tremens is a separate medical diagnosis. It is also caused by alcohol abuse, but the symptoms are different and slightly more severe. 

Alcohol hallucinosis/alcohol psychosis differs from delirium tremens in the following ways:[1]

  • Duration of symptoms: Alcohol hallucinosis symptoms can last for months, while delirium tremens has a shorter time frame.
  • Perception: Many people with alcohol hallucinosis are aware of their symptoms. People with delirium tremens are too ill to make that distinction. 
  • Hallucination type: Alcohol hallucinosis typically causes auditory hallucinations, such as hearing voices. Delirium tremens typically causes visual changes, such as seeing bright lights. 
  • Shaking: Both conditions can cause tremors. But delirium tremens causes severe shaking and can progress into seizures. 

Delirium tremens can cause heart-related symptoms that don’t appear with alcohol hallucinosis. For example, people with delirium tremens may have a fast heartbeat. Since they’re typically breathing quickly, they can hyperventilate too. These problems just aren’t seen in alcohol hallucinosis.[4] 

How Is Alcohol Hallucinosis Treated?

People with alcohol hallucinosis are incredibly uncomfortable. And since the problems can last for so long, treatment can be critical. 

Some doctors use antipsychotic medication to rebalance brain chemistry.[3] Medications like this can reduce hallucinations and anxiety, helping people to feel much more relaxed and comfortable. 

People can also benefit from alcohol withdrawal treatments.[3] If hallucinations develop due to long-term alcohol abuse and an attempt to quit, doctors might use medications like benzodiazepines to ease withdrawal symptoms and help people recover more comfortably. 

A more tapered approach to alcohol withdrawal can also help, allowing the body to ease into sobriety rather than suddenly stopping drinking.

Treatment Options for Alcohol Abuse 

Anyone who develops alcohol hallucinosis needs to stop drinking. Regular alcohol abusers will need help to do so. 

Chronic alcohol abuse can alter brain chemistry in persistent ways. When long-time drinkers try to quit abruptly, they can develop seizures during withdrawal.[5] 

A treatment program with medications can help you to get sober without experiencing life-threatening problems. You’ll also have medical supervision throughout the process to ensure you stay safe and supported the entire time. 

Withdrawal management can help you get sober, but it can’t help you stay that way. A rehab program can help you identify drinking triggers, and you can learn new ways of dealing with them. With a program like this, you can stop drinking for good, as you’ll acquire the skills to deal with life’s stressors without turning to alcohol.

Updated October 31, 2023
  1. Acute alcoholic hallucinosis: A review Skryabin V, Martinotti G, Franck J, Zastrozhin M. Psychopathology. 2023;56(5):383–390
  2. Alcohol-related psychosis Stankewicz H, Richards J, Salen P. StatPearls. Published July 10, 2023. Accessed September 25, 2023.
  3. Treatment of alcohol-induced psychotic disorder (alcoholic hallucinosis)—A systematic review Masood B, Lepping P, Romanov D, Poole R. Alcohol and Alcoholism. 2018;53(3):259–267
  4. Management of moderate and severe alcohol withdrawal syndromes Hoffman R, Weinhouse G. Up to Date. Published September 15, 2023. Accessed September 25, 2023.
  5. Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J. 2013;22(2):100-108. doi:10.4103/0972-6748.132914
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