Futures Recovery Healthcare

Alcohol Hallucinations


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Alcohol use disorder (AUD) is characterized by the inability to stop or control excessive drinking despite negative consequences. Due to their alcohol dependence, they prioritize it above their family, friends, career, and health. According to a survey by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 14.1 million adults ages 18 and older had AUD in 2019.

Withdrawals are a key reason for how challenging it is to recover from alcohol use disorder. A sudden cessation of drinking can lead to alcohol withdrawal symptoms that can be dangerous to one’s health. One such withdrawal symptom includes hallucinations. Alcohol hallucinations can also occur due to acute alcohol intoxication. Alcohol hallucinations are a serious complication that can lead to adverse consequences if left untreated.

What Are Alcohol Hallucinations?

Hallucinations refer to sensory experiences that appear real but only exist in one’s mind. They can affect all five senses and often be as intense or real as sensory perceptions. For example, you may hear a voice that no one else in the room can hear or see an image that is not real.  

According to the U.S. National Library of Medicine, hallucinations during acute alcohol intoxication and withdrawal are rare and occur in only 0.6-0.7% of alcoholics. They are believed to be caused due to the effects of alcohol on the brain. Prolonged, heavy alcohol consumption disrupts the balance between two main neurotransmitters: gamma-aminobutyric acid (GABA) and glutamate. These disruptions result in reduced excitability during intoxication and increased sensitivity during alcohol withdrawal. Alcoholic hallucinosis is also thought to be caused due to an increase in dopamine, a decrease in serotonin, and amino acid abnormalities. This causes hyperarousal, which manifests as hallucinations in some people. 

Signs and Symptoms of Alcoholic Hallucinosis

Auditory hallucinations are a common symptom of alcoholic hallucinosis. People may hear sounds and voices that are not there. Tactile and visual hallucinations also occur, although not as often as auditory hallucinations. Tactile hallucinations are the sensation of feeling something that is not there, while visual hallucinations involve seeing things that are not there. 

Other less common symptoms of alcoholic hallucinosis include olfactory hallucinations, smelling scents that do not exist in the immediate surrounding, and gustatory hallucinations, tasting something that is not present. 

Alcoholic hallucinosis due to severe alcohol withdrawal can occur within 12 to 72 hours of the alcohol withdrawal timeline. In contrast, alcoholic hallucinosis due to acute intoxication occurs suddenly while drinking. 

Risk Factors for Alcohol Hallucinosis

Individuals who engage in heavy drinking over a prolonged period and those using other substances such as cocaine, methamphetamines, and psychedelic drugs like LSD are at a higher risk for developing alcoholic hallucinosis. 

Other risk factors for alcohol hallucinosis include:

  • Genetics 
  • Age and when the drinking habit first began 
  • The type of alcohol consumed 
  • Pre-existing mental health conditions, such as post-traumatic stress disorder (PTSD), bipolar disorder, schizophrenia, and depression
  • Low socioeconomic status 
  • Living alone 

Alcohol Hallucinosis vs. Alcohol Psychosis 

The terms alcohol hallucinosis and alcohol-related psychosis are often used interchangeably. Both occur during acute intoxication, alcohol withdrawal, and chronic alcohol abuse and include hallucinations. However, alcohol-related psychosis includes hallucinations and delusions. Alcohol-induced psychosis also includes inappropriate behaviors and disorganized thinking. 

Alcohol Hallucinosis vs. Delirium Tremens (DTs)

Alcohol-induced hallucinations and delirium tremens are both extreme conditions caused by abrupt cessation after excessive alcohol consumption. Both share symptoms, such as hallucinations. However, delirium tremens also include physical symptoms separate from alcohol hallucinosis. Alcohol withdrawal delirium is considered a more severe symptom of alcohol withdrawal that usually occurs within 48 to 72 hours after the last drink. 

Diagnosis and Treatment of Alcohol Hallucinations

The Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar) is commonly used in patients presenting signs of alcoholic hallucinosis to diagnose and assess the severity of alcohol withdrawal symptoms. Once it has been established that the patient is experiencing severe withdrawal symptoms, medical professionals will work with them to determine the appropriate level of medical treatment required. 

Generally, alcohol-induced hallucinations are temporary and can be treated in a professional medical setting. Most patients will be required to stay at a hospital or a 24-hour medical facility to receive treatment, as they can be vulnerable during episodes of alcoholic hallucinations. 

Medical professionals often place patients in a dark, quiet room where they will experience little to no stimulation. Some patients may also need to be sedated. For example, severe alcohol withdrawal is treated by sedating patients with medications and monitoring their vital signs until the withdrawal phase is complete. Since nutritional deficits frequently accompany alcohol addiction and alcohol withdrawal syndrome, healthcare professionals also provide nutritional support through diet and supplements to replenish the body.  

As alcoholic hallucinosis is a symptom of severe alcohol dependence, its successful management should be followed by addiction treatment at an inpatient facility. Alcohol addiction treatment often includes a medical detox program, counseling, behavioral therapies, and support groups. 

Can Alcohol Hallucinosis Be Prevented?

Alcohol-induced hallucinations can be prevented by moderate use or complete abstinence from alcohol. They can also be prevented by paying attention to the early warning signs and seeking emergency medical attention. The effects of alcohol withdrawal can be life-threatening in some circumstances. As such, it’s important to seek professional help if you wish to stop drinking. Medical detoxification programs can help patients safely and comfortably withdraw from alcohol and avoid life-threatening complications.   

Alcohol-related hallucinations caused due to acute alcohol withdrawal or excessive consumption of alcohol is a serious complication often indicative of chronic alcohol abuse. If you or someone you care about is struggling with alcohol addiction, Futures Recovery Healthcare is here for you. At Futures, adults can get the help they need to get sober, stay sober, and take care of their mental and physical health. 


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