Alcohol-Induced Psychosis

Types of Alcohol-Induced Psychosis & Associated Symptoms

Symptoms of alcohol hallucinosis vary depending on the severity of your alcohol use, age, and overall health status. While a psychotic episode caused by drinking may seem difficult to discern from diagnoses like schizophrenia, knowing which stage of alcohol use you are in can be helpful.

Alcohol-Induced Psychosis Differs From Other Psychotic Disorders as Follows:

• Symptom onset occurs within two weeks of alcohol misuse.
• Symptoms must continue for at least 48 hours but must not exceed six months.
• There are higher levels of depressive and anxious symptoms.
• Cognition (thinking) is more organized.
• The person may have greater insight into their illness.
• Functional impairment is not as severe.

Acute Intoxication

Acute alcohol intoxication is the immediate onset of physical and neurological impairment following binge drinking. For men and women who have had more than five drinks on one occasion, the likelihood of manifesting psychotic symptoms is higher. This form of alcohol-induced psychosis is the rarest and is more likely to occur if you have a low alcohol tolerance. Symptoms usually resolve after the alcohol is cleared from your system. 

Chronic Alcoholic Hallucinosis

Unlike acute intoxication, where an individual consumes a large quantity of alcohol once or twice per month, chronic alcohol use is long-term. Regularly having more than seven drinks a week for women or 14 drinks a week for men is often indicative of alcohol use disorder. 

People with chronic alcoholic hallucinosis are prone to auditory hallucinations, delusions, and mood changes. Long-term alcohol use is responsible for vitamin deficiencies – thiamine, folate, B6, and B12 – and mineral loss – namely, magnesium, calcium, and iron. Thiamine (B1) deficiency is implicated in Wernicke-Korsakoff syndrome, characterized by confusion, movement problems, and vision loss. Left untreated, it can advance to Korsakoff psychosis, causing amnesia, severe emotional changes, and confabulation (creating false memories or scenarios).

Alcohol Withdrawal Psychosis

Alcohol cessation after chronic use requires medical monitoring. If you suddenly stop drinking, you will likely experience uncomfortable alcohol withdrawal. In mild cases, agitation, anxiety, shaking, and irritability are common. Severe cases lead to seizures, hallucinations, high blood pressure, vomiting, excessive sweating, confusion, loss of consciousness, and a racing heart. 

Because alcohol is a nervous system depressant (or “downer”), it initially lowers your blood pressure, heart rate, and breathing. It blocks some excitatory brain chemicals while triggering some inhibitory neurotransmitters. As you develop a physical dependence to alcohol, greater levels are required to maintain depressant effects. When you stop drinking abruptly, your body has no time to readjust to its pre-alcohol levels, activating the excitatory cascade responsible for withdrawal symptoms. In the case of withdrawal psychosis, excess dopamine is responsible for hallucinations and agitation.

Treatment Options for Alcohol-Induced Psychosis

Treatment for alcohol hallucinosis depends on the duration of alcohol use, symptom severity, and individual health. With acute intoxication, symptoms should resolve once you are sober. Chronic alcohol hallucinosis and withdrawal frequently require hospitalization and medically-managed care until you are stable. 

Medications Used to Treat Alcohol-Induced Psychosis Include:

• Benzodiazepines (e.g., Ativan, Valium, or Librium) to prevent seizures, anxiety, and agitation.
• Antipsychotics (e.g., Haldol or Zyprexa) to treat agitation and hallucinations.
• Vitamins and minerals (e.g., folate, thiamine, magnesium, and multivitamins – also known as a “banana bag”) to treat or prevent potentially fatal deficiencies.

After hospital discharge, you may need to continue medications until symptoms have fully cleared. Your healthcare provider may also prescribe acamprosate or naltrexone to curb alcohol cravings.