Many intoxicating substances can lead to psychosis, which is a mental condition characterized by disruptions to a person’s thinking and perceptions of the world. Often, psychosis is referred to as a break with reality because changes in perception lead to hallucinations, delusions, persistent thoughts, emotional changes, and drastic changes in behavior. The person typically struggles to understand the difference between reality and hallucination.

Often, psychosis induced by intoxication on powerful drugs is temporary; unfortunately, in some instances, induced psychosis can persist and may become permanent. While many people understand that alcohol can lead to behavioral and mood changes, few understand how serious acute intoxication or chronic alcohol abuse can be. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines substance-induced psychosis, including alcohol-induced psychotic disorder (AIPD), as requiring either hallucinations or delusions.

What Is Alcohol-Induced Psychotic Disorder?

Hallucinations, delusions, or persistent thoughts caused by alcohol abuse fall under the umbrella of alcohol-induced psychotic disorder (AIPD). However, there are three basic forms of this kind of psychosis: from acute intoxication or alcohol poisoning, alcohol withdrawal symptoms, and chronic, long-term alcohol use disorder. Symptoms typically begin while, or shortly after, the person consumes a lot of alcohol.

Usually, AIPD is a secondary psychosis, caused by a different condition than primary psychoses like schizophrenia. This is because the condition is induced by something – in this case, a toxin like alcohol – outside of the individual rather than being caused by brain structures that are organic, or pre-existing. Although AIPD is rare, rates of psychosis are higher among people struggling with alcohol dependence or addiction. Rates are about 0.4 percent in the general population and about 4 percent among those who abuse alcohol. People who develop AIPD are at risk for other mental illnesses, too; one study found that there was roughly a 37 percent comorbidity rate with other mental conditions.

Once one develops AIPD, the psychotic episode usually lasts between one and six months, although it may clear up in a matter of days with hospital treatment. Suffering side effects from psychosis puts the person at risk of accidents and self-harm, so the condition can be deadly.

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Acute Intoxication to Alcohol-Induced Psychotic Disorder

Called pathologic intoxication, this is an uncommon diagnosis that is believed to occur after one consumes a large amount of alcohol in one sitting. In most instances of hospitalization due to intoxication-caused psychosis, the condition ends when the body clears the alcohol out of the system. However, hospitalization is vital at this point in alcohol abuse. It is likely that the person has consumed so much alcohol that they are at risk of poisoning, which can be fatal. Signs of acute intoxication AIPD include:

  • Unusual aggression
  • Prolonged bouts of sleep
  • Impaired consciousness
  • Transient hallucinations
  • Delusions
  • Illusions
  • Amnesia when the condition ends

Psychotic Disorders from Alcohol Withdrawal Delirium

Alcohol withdrawal delirium (AWD) is a rare condition caused by withdrawing from alcohol, especially after high-volume use for a long time and if the person stops drinking suddenly. AWD is considered the most severe, risky, and acute form of alcohol withdrawal. The condition may also be compounded if the person drinks while they have a head injury, or they do not eat enough while they undergo alcohol withdrawal. Symptoms of AWD include:

  • Agitation or excitement
  • Irritability
  • Anxiety
  • Chest pain
  • Excessive sweating
  • Fever
  • Fatigue or exhaustion
  • Increased heart and breathing rate
  • Increased startle reflex, jumpiness, or fear
  • Involuntary contractions in muscles
  • Nausea or vomiting
  • Nightmares
  • Sensitivity to stimuli, like light, sound, or touch
  • Mood changes
  • Stomach pain
  • Delirium
  • Hallucinations and delusions
  • Eye movements that are involuntary
  • Seizures

Symptoms associated with AWD do not begin immediately after one stops drinking. Anxiety, insomnia, headache, heartbeat changes, and sweating start within 6-12 hours after the last drink; after 12 hours, however, the person may begin to experience hallucinations; then, after a day has passed, the person may experience seizures.

It is extremely important to get help detoxing from alcohol, with supervision from medical professionals to avoid AWD. A doctor can use diagnostic criteria, in an appropriate detox facility, to understand how serious one’s experience of alcohol withdrawal may be. The doctor will look for:

  • Hand tremors
  • Fever
  • Dehydration
  • Irregular heart rate

The physician may also perform a toxicology screening. These and some other criteria will help the doctor understand how to manage the individual’s detox process, so they do not experience seizures or develop psychosis.

Chronic Alcohol Use Leading to Hallucinations and Other Forms of Psychosis

Heavy abuse of alcohol for a long time will change fundamental structures in the brain. This can induce psychotic conditions. Malnutrition from drinking alcohol instead of eating and damage to the digestive tract from alcohol abuse can cause forms of dementia with associated psychotic symptoms.

In people who struggle with chronic alcohol use disorder, there are three basic types of psychosis:

  1. Alcohol hallucinosis: These hallucinations are typically auditory, but may manifest as visual or tactile. The condition is also characterized by mood disturbances, rapid mood swings, and delusions, and it may ultimately mimic schizophrenia in presentation. It is unlike delirium tremens and can appear in a person who otherwise had clear thinking and memory previously.
  2. Alcoholic paranoia: This condition involves extreme anxiety, fear of being watched or followed, and other symptoms associated with paranoia, but it is caused by brain state changes due to drinking too much for too long.
  3. Wernicke-Korsakoff syndrome: Caused by a lack of thiamine in the body, this condition is a combination of two conditions: Wernicke’s encephalopathy, and Korsakoff syndrome. Wernicke’s encephalopathy has various symptoms, including confusion, loss of mental activity, ataxia or loss of muscle coordination, abnormal eye movements, leg tremors, double vision, and eyelid drooping. Korsakoff syndrome involves an inability to form new memories, loss of old memories, confabulation or replacing old memories with false memories, and hallucinations. Often, these conditions will clear up on their own, especially if the person gives up drinking with help and returns to a healthy diet with enough B12 to improve brain activity.

Treatment to Manage or Reverse Alcohol-Induced Psychotic Disorder

One report suggests that people who experience psychosis caused by alcohol or drugs are likely to experience this condition again if they continue to abuse substances. Unfortunately, those who have experienced psychosis, including alcohol-induced psychotic disorder, are more sensitive to the effects of drugs and alcohol; without help from a comprehensive treatment program, they will be unable to pull themselves away.

Psychotic symptoms can be addressed in an emergency room with medications to calm the person down, and treat hallucinations and delusions. If psychotic symptoms persist, these can be managed with prescription medications, alongside talk therapy to manage symptoms like hallucinations or persistent thoughts when they appear. All alcohol consumption must be stopped, which requires appropriate detox help, often involving the use of small doses of benzodiazepines or other, similar drugs to prevent seizures if the individual is at risk of AWS. Then, a rehabilitation program addresses all related issues in therapy.