Is Alcoholic Psychosis a Sentence or Is There Any Hope?

Sep 23, 2019

“What a familiar topic. My parents stopped taking me to see my grandmother in the country in the summer, because my uncle had drunk himself silly and had started to catch invisible enemies in the house with an axe. Alcoholism was there already in a neglected form, treatment did not help, and there were many so called “well-wishers” who paid my uncle in vodka for the household work. My uncle was generally able to do many things about the house, so he was often asked to help, and then he was made drunk by others. He helped build a fireplace and was given a bottle as payment. What a deal! And no one cared that he was losing himself into drinking – he was a stranger to them”.

– Dina, 34


Alcoholic psychosis can actually cause fear. A person begins to behave very strangely and unpredictably. He/she talks nonsense, catches invisible creatures and shows aggression. Often the first and quite understandable desire is to distance oneself from such a person. But then a desire to understand and help takes the upper hand. But is it possible? What are the predictions for a person suffering not only alcoholism, but also alcoholic psychosis? How do you understand that it is developed condition, and not just an aggressive state because of alcohol? What are the peculiarities of different types of psychosis? Let’s talk about it in today’s article.


  • Alcoholic psychosis: General information
  • What is the difference from a hangover?
  • How to diagnose alcohol psychosis
  • Signs of the beginning of psychosis
  • Types of alcoholic psychosis: Manifestations and features
  • Abstinence
  • Alcoholic delirium
  • Alcoholic hallucinosis
  • Alcoholic delusional jealousy
  • Alcoholic paranoia
  • Alcoholic psychosis without additional clarifications
  • Alcoholic encephalopathy
  • What do you do when alcoholic psychosis is manifested?
  • How to treat alcoholic psychosis
  • What should be done as well as a medical treatment?

Alcoholic psychosis: General information

Alcoholic, or meta-alcoholic, psychosis is a common name for psychoses that arise due to the use of alcohol. It is accompanied by mental and physiological disorders and manifests itself in the form of an inadequate response to the objective reality.

These conditions often arise not at the peak of intoxication, but after a person has stopped drinking, for example, refrained from drinking him/herself, that is, at the moment of alcohol withdrawal syndrome. Sometimes this condition is called the cancellation syndrome, it is often confused with hangover.

What is the difference from a hangover?

A hangover also occurs after consuming a large amount of alcohol. It is often accompanied by fatigue, headache, thirst, tremor in the hands, nausea or vomiting and a sense of shame or guilt. This is the most common reaction of the body to alcoholic-poisoning and can occur in any healthy person after the use of a large amount of alcohol or poor-quality alcohol. In this state, a person experiences more of an aversion to alcohol than a desire to drink to ease the condition. A hangover lasts no more than 36 hours and passes after the body gets rid of all traces of the toxins. [1]


If a person has already passed the first or second stage of alcoholism, a “hangover” turns into withdrawal syndrome, which will be accompanied by a desire to drink. This syndrome is easily removed by a new dose of alcohol. The alcoholic knows this and seeks to “improve health” on the morning after a party. So a one-time use of alcohol turns into a long drinking session. If a person refuses alcohol in this state, alcoholic psychosis can occur. Of course, this does not mean you need to drink more, it is more important to correctly assess your condition or the condition of a close person and seek medical care in time.

How to diagnose alcohol psychosis

Only a doctor can diagnose alcoholic psychosis, since manifestations of different types vary from each other, but there are some symptoms that can alert you. They can be divided into two groups.

Group 1 – physiological symptoms:

  • headache;
  • tremor of hands or the whole body;
  • walking disorder;
  • gastrointestinal problems (vomiting, nausea, etc.);
  • high blood pressure, temperature, pulse;
  • sweat.

Group 2 – mental disorders:

  • increased irritability
  • severe sleep disorders, nightmares;
  • continuous bad mood or sharp mood swings;
  • anxiety, suspicion, aggressiveness;
  • memory gaps;
  • confusion of consciousness, delirium states;
  • uncaused fear;
  • hallucinations that are perceived as reality.

Symptoms may be present individually or all at once. Everything will depend on the type of psychosis, the state of health, physiological and genetic features, the stage of alcoholism and the experience of such a state in the past. Signs of alcoholic psychosis in men and women practically do not differ.

Signs of psychosis beginning

As you already know, psychosis most often occurs after a person stops drinking. There is some deceit in this though, for it begins almost always unexpectedly. Therefore, it is important to be very attentive to your condition or the condition of the close one after the termination of long drinking.

“I’ll tell you how it happened to us. It was like a thunderbolt. My husband generally believed that he had no problems with alcohol. He said everyone drinks, if he wanted to, he would quit all this but at the moment he didn’t want to. Then we holidayed in Turkey and of course, there was an all-inclusive service. He was drinking every day, but he almost did not drink very much, he was like normal. We returned home, he was feeling okay and went to work the next day. He worked the whole day well and in the night we were going to sleep but he wasn’t able to fall asleep. He was in bed saying: “Honey, why do we have so many cockroaches at home? There weren’t any before our vacation!” I jumped up, as I was very afraid of cockroaches. I turned on the light and looked where he was showing, and there was nothing! I turned to him, and he was sitting on the bed, pale, shaking and flipping something from the blanket. Then, he shouted, “Ohh, they are creeping on me!” I rushed to the phone and called an ambulance. They sent him to the narcologist, and the doctor said he had clanks. He had a long treatment, now he does not drink at all, saying he almost died from fear”.

– Elizaveta, 37


Because of the suddenness of the psychosis, it is important to pay attention to the state of a person between one and three days after he/she has stopped drinking alcohol or terminated a binge. Watch carefully for the symptoms listed in the previous section and note how a person feels, what he/she says and how he/she reacts to what is happening around. Let’s look at the manifestations of each type, so that you know how to recognize alcoholic psychosis from its beginning.

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Types of alcoholic psychosis: manifestations and features

The course of psychosis can be complicated by various diseases, the simultaneous occurrence of symptoms of different alcoholic psychosis, and so on. Some researchers distinguish up to 19 types of behavioral disorders associated with the use of alcohol. [2] Many of them are unlikely to be met in usual circumstances, so we will take the basis of the classification of alcoholic psychosis from the ICD-10 and will tell about the key symptoms and differences. [3]

1.   Abstinence 

Abstinence or alcohol withdrawal syndrome is an obvious sign of formed alcohol dependence. Some call it “cold turkey”. It also occurs when drinking is stopped, and at the first and second degrees of severity. Abstinence is accompanied by physiological manifestations: sweat, tremor, changes in pulse and pressure. Abstinence can also be complicated by seizures.
At the third degree of severity, difficulties with sleep, a sense of anguish, guilt, and fear are added. In this state, one has a very strong desire to consume alcohol, and the heavier the syndrome, the more difficult it is to control this craving. The lack of alcohol can be perceived as something terrible and irreparable.

It is not accompanied by nonsense and hallucinations but can be developed into meta- alcoholic psychosis. In this state, it is already worth seeking medical care.

2. Alcoholic delirium

Delirium tremens, acute alcoholic psychosis or clanks – that’s how people call it.  This can occur at the formed first and second stages of alcoholism. This is the most common type of psychosis – covering from 69 to 82% of all cases, so let’s look at this in more detail. [4] It occurs in 1-3 days after a person has stopped drinking, but in rare cases it can occur 4-6 days later.

In this form of psychosis, the abstinent state is complicated by a delirium, that is, a violation of perception, attention and thinking. 

Beginning of clanks development

Headache, speech disturbance, trembling hands, sweating, increased palpitations, redness of the eyes and face can appear even before the development of clanks. Sleep becomes intermittent and nightmares come often. There is a sense of impending trouble. The first hallucinations usually occur before sleep and are short-term and implicit. They are visible as if by lateral vision – someone walked or flew, or a door suddenly slammed. In the afternoon, after the symptoms of delirium decrease, the patient becomes more adequate, understands that he/she is ill and thinks lucidly, but by the evening the symptoms return and intensify.

Features of occurrence

The condition is accompanied by visual, auditory, and tactile hallucinations and delirium, i.e., judgments and conclusions are made which do not correspond to reality and cannot be changed from the outside, so it’s almost impossible to convince a person he/she is experiencing alcoholic delirium. Here are the most common situations:

  • a patient sees non-existent insects, mice, spiders, sometimes classical green devils or any other creatures. He/she feels them flying around. Creatures can stay by themselves or can attack.
  • a patient hears voices that humiliate, insult or turn him/her against others. One person will hear a knock on the door and screams calling: “Police, open!” Another will hear voices of devils who want to drag him/her to hell. A third will see relatives deciding to poison him/her. Almost always, voices will frighten, make them angry and drive them mad.

“We went to the country a few years ago, to celebrate as usual, and suddenly Dad’s brother began to shout that he heard some people deciding to rob and rape him. There were like five of them – a woman with a child and four men. He screamed that they would not talk to him but pretend to be birds. He ran through the bushes and searched where they were, demanding policemen with dogs. We were laughing so much, cracked up with laughter. It is not good, probably, but I saw an alcoholic nonsense psychosis for the first time”.

– Nikolay, 24

  • a patient can begin to see in the surrounding people chimeras, aliens, or monsters that want to cause him/her evil. Often the patient thinks that they let insects out or people are conspiring with unseen voices.

In a state of clanks a person can be aggressive and dangerous to himself/herself and others. Self-harm and attacks on relatives or doctors are quite common, so it is very important to seek medical assistance quickly. You should not be reassured by an apparently peaceful attitude of the person with alcoholic delirium, since his/her mental state is unstable. Even if he/she is friendly now and saves you from the invasion of the devils, at the next moment the character of hallucinations can change dramatically, and you might turn into the main enemy.

Features of recovery

Treatment usually lasts about 3-5 days, can take up to 7-10 days.

  • It may be accompanied by amnesia, when the patient forgets partially or completely what happened to him/her;
  • It can end with a full recovery without consequences;
  • Organic brain damage can occur, and as a result, dementia, impaired memory and orientation in space, permanent hallucinations, delusions and depressive states, etc. can develop;
  • It can end with death (lack of treatment increases the risk of death to 10%);
  • The risk increases of the re-development of alcohol delirium or other psychoses.

3. Alcoholic hallucinosis

This is the second most common type of psychosis, from 14 to 27% of all cases. [4] It can occur both during and after drinking. It is not part of abstinence. Verbal, so called, auditory hallucinations predominate here, where delusions of persecution, threats and accusations are formed. “Voices” can communicate with each other, discussing and criticizing the patient. Less often they can turn directly on him/her and can threaten or insult. 

Features of the development of disease and recovery

  • a patient is constantly worried;
  • excitation turns to apathy;
  • increases in the evening and at night;
  • duration of acute hallucinosis is from 2-3 days to 3-4 weeks;
  • in treatment, the duration may be less than a week; [5]
  • acute hallucinosis can develop into a depressive disorder;
  • duration of long hallucinosis from 1 to 6 months, sometimes up to 1 year;
  • a patient can get used to hallucinations and treat them calmly;
  • a high risk of re-occurrence, a risk of suicide.

4. Alcoholic delusional jealousy

Delusional jealousy can be combined with other types of psychoses or manifested separately. This condition is susceptible almost only to men, usually occurring in people who are prone to jealousy, instability, and excitability. [5]

Features of flow and recovery

  • may be accompanied by fears, insomnia, suspicion;
  • patients, as a rule, are rude, conflictive, selfish;
  • patients actually pursue the victim of jealousy – watching, interrogating, searching;
  • lack of evidence of infidelity causes strong anger;
  • a patient cannot be dissuaded;
  • a patient can use physical violence, up to a murder;
  • feelings of remorse can lead to attempts at suicide;
  • alcoholic psychosis without treatment and without resisting drinking can take a chronic form and last for years.

5. Alcoholic paranoia

This also occurs both against the background of withdrawal, and in the process of drinking alcohol. It can occur against the background of a delusion of persecution or influence (the feeling that someone’s own actions or thoughts are imposed from outside, via a secret influence of other people). It may also be accompanied by delusional jealousy.

Features of flow and recovery

  • delusional ideas are clear and certain, connected with close people or familiar patients;
  • patients often show aggression, wishing to stop persecution or influence;
  • the main emotions are fear and anxiety, emotions are bright and saturated;
  • behavior of a patient is built around delusional ideas;
  • behavior can be impulsive, a patient can suddenly run away from imaginary pursuers, or can attack the “enemy”; 
  • hearing and visual hallucinations are likely observed mainly in the evening and at night;
  • a patient clearly realizes his/her personality, is not confused in time and space;
  • alcoholic paranoia can last from 3-4 weeks (acute forms) to more than 3 months (chronic forms);
  • the chronic form develops from the acute, if the illusory component of delirium disappears, a patient becomes simply suspicious and distrustful;
  • alcohol consumption exacerbates delusions and paranoia.

6. Alcoholic psychosis without additional clarification

This group can include all psychoses that do not have pronounced symptoms and orientation. Examples include a state with a fantastic delirium, when the patient sees different scenes of battle, travels in time or between worlds, or a hypnagogic delirium, when visual hallucinations occur only with closed eyes [2], etc. The signs of these types of alcoholic psychosis do not differ from other types.

7. Alcoholic encephalopathy

This is a separate group of psychoses, since they are characterized by the predominance of somatic and neurological disorders, and not mental or behavioral problems. Alcoholic encephalopathy develops at the second and third stages of alcoholism with long periods of drinking from several weeks to months. Abstinence for this group of psychosis flows in a very difficult manner and has a prolonged nature.

Features of appearance and flow

  • the disease is preceded by long regular drinking bouts and repeated and severe withdrawal syndrome;
  • it usually develops in people of 40+;
  • patients often replace proper alcohol with surrogates – cologne water, poor-quality spirits, etc.;
  • it is accompanied by gastritis, peptic ulcer, liver cirrhosis;
  • there is a loss of appetite and signs of physical exhaustion, often the patient practically does not eat anything, only drinks alcohol;
  • paralysis, paresis, and limb sensitivity can occur;
  • treatment is difficult and long, a low effect from treatment is possible.
  • possible death due to brain damage.

This group includes:


  1. Gayet-Wernicke encephalopathy which is a physical exhaustion with impaired perception and mental activity.
  2. Korsakoff syndrome which is a gross violation of memory, partial amnesia (only for cases arising from the use of alcohol).
  3. Alcohol dementia which is a violation of cognitive functions, emotions and a destruction of the personality.

What do you do when alcoholic psychosis is manifested?

If any signs of psychosis appear, medical consultation and treatment in the hospital is mandatory! These conditions can have extremely adverse consequences for the health and life of both the patient and his/her relatives. Without treatment, some alcoholic psychoses acquire a chronic form. In most cases, it is necessary to get rid of alcohol addiction with the complete termination of taking alcoholic drinks.

How to treat alcoholic psychosis

The main task of treatment at the first stage is to remove the acute symptoms of the disease. Doctors usually prescribe detoxification therapy. Enterosorbents, restore the water-electrolyte balance in the body and vitamins and other supporting drugs can be added to the treatment.

For the treatment of acute forms, doctors can prescribe neuroleptics, hypnotics, tranquilizers, antipsychotics and/or antidepressants. [7] The treatment will depend on the symptoms and type of alcoholic psychoses. Thus, different drugs will be required to treat anxiety and increased excitability.

Please note that treatment should be prescribed by a narcologist, for self-treatment is extremely undesirable. Moreover, most drugs suitable for treatment are sold in pharmacies only by a doctor’s prescription.

At the second stage, the patient should understand his/her relationship with alcohol and come to the acceptance that he/she must get rid of alcohol addiction. In such cases, not only medical treatment, but also psychological help is probably needed.

What should be done as well as a medical treatment?

In acute form, only medical treatment can be applied. At the second stage,  a psychologist can be used to help get rid of alcohol addiction. This will help the process of giving up drinking and give strategies to avoid the emergence of alcoholic psychoses in the future.

One of the methods for getting rid of alcohol addiction is behavioral therapy. Note that it is suitable for treatment of alcohol addiction at the first and second stages. During these stages, irreversible changes have not yet occurred in the body, so psychological support can be very effective. 

Behavioral therapy is aimed at correcting current behavior, so you do not need to spend years looking for a cause. It is more effective to focus on changing behavior here and now, to replace the old habits that led to alcoholism with new and useful ones. The 7Spsy technique is about changing the old habits. In 2-6 weeks, a person who has a painful craving for alcohol will notice a decrease in his/her desire to drink, will learn to live without alcohol, and will develop new healthy habits.

The 7Spsy behavior modification technique is a patented method based on the theories of I.P. Pavlov, B.F. Skinner, A.A. Ukhtomsky, etc. The course can be held remotely, at a convenient time and in a convenient mode for you, and a psychologist will always be online to provide support and help in difficult situations. You choose the format of communication yourself – over the phone, in online chats or by e-mail. Full anonymity and confidentiality are guaranteed.

Remember that behavioral therapy is designed to accompany drug treatment, but not to replace it. To relieve an acute condition, first contact the doctors, and only then, to completely eliminate alcohol addiction, add the therapy.



Information from this website cannot be used for self-therapy and self-diagnostics. 

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