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Is Alcoholic Psychosis a Sentence or Is There Any Hope?

23.09.2019 Author: Psychologist Pavel Khoroshutin

“What a familiar topic. My parents stopped taking me to my grandmother to the country in the summer, because my uncle has drunk himself silly and started to catch invisible enemies in the house with an ax. Alcoholism was there already in the neglected form, treatment did not help, and there were many so called “well-wishers” who paid my uncle vodka for the household work. The 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 for them”.

– Dina, 34 

Alcoholic psychosis can actually frighten. A person begins to behave very strangely and unpredictably. He/she talks nonsense, catches invisible creatures, shows aggression. And often the first and quite understandable desire is to distance oneself from such a person. But then the 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 to understand that it is development, but not just aggressive states 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

alcoholic delirium

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 stopped drinking, for example, left drinking himself, that is, at the moment of alcohol withdrawal syndrome. Sometimes this condition is called the cancellation syndrome, and is also confused with hangover.

What is the difference from hangover?

Hangover also occurs after consuming a large amount of alcohol, accompanied by fatigue, headache, thirst, tremor in hands, nausea or vomiting, a sense of shame or guilt. This is the most common reaction of the body to 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 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 drinks. [1]

If a person has already formed the 1st or 2nd stage of alcoholism, a “hangover” turns into a withdrawal syndrome, which will be accompanied by a desire to drink. This syndrome is easily removed by a new dose of alcohol, and 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. If a person refuses alcohol in this state, alcoholic psychosis can occur. Of course, this does not mean the need to drink more, it is more important to assess correctly your condition or the condition of a close person and seek medical care in time.

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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.);
  • 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, 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 – 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 he would quit all this but at the moment he didn’t want to. Then we returned from Turkey, of course, there was 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, went to work the next day, worked the whole day well, in the night we were going to sleep but he wasn’t able to fall asleep. He was in bed saying: “Honey, from where do we have so many cockroaches at home? There weren’t any before our vacation!” I jumped up, as I was very afraid of the cockroaches, turned on the light, I 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, 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 was dead from fear”.

– Elizaveta, 37 

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

Types of alcoholic psychosis: manifestations and features

alcoholic psychotic disorder

The course of psychosis can be complicated by various diseases, 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] Most of them are unlikely to be met by a usual person, 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 1st and 2nd degrees of severity, abstinence is accompanied by physiological manifestations: sweat, tremor, changes in pulse and pressure. Abstinence can be complicated by seizures.
   At the 3rd degree of severity, difficulties with sleep, a sense of anguish, guilt, fear are added. In this state, one has a very strong desire to consume alcohol, and the heavier the syndrome, the more difficult 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.  It occurs at the formed 1st or 2nd stages of alcoholism. This is the most common type of psychosis – covering from 69 to 82% of all cases, so let’s stop here in more detail. [4] It occurs in 1-3 days after a person stopped drinking, but in rare cases it can occur in 4-6 days.

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, nightmares come down. There is a sense of impending trouble. The first hallucinations usually occur before sleep, short-term and implicit, visible as if by lateral vision – someone walked or flew, or just a door slapped. In the afternoon, the symptoms of delirium decrease, a patient becomes adequate, understands that he/she is ill, thinks well, but by the evening the symptoms return and intensify.

Features of occurrence

It is accompanied by visual, auditory and tactile hallucinations, delirium, i.e., judgments and conclusions that do not correspond to reality and cannot be changed from the side, so it’s almost unreal to convince a person of 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 person;
  • a patient hears voices that humiliate, insult or turn him/her against others. Someone will hear a knock on the door and screams: “Police, open!”, someone – voices of devils who want to drag him/her to hell, someone – relatives deciding to poison him/her. Almost always, voices will frighten or make angry, driving mad.

“We went to the country a few years ago, celebrated something as usual, and suddenly the dad’s brother began to shout that he heard some people decided to rob and rape him. There were like five of them – a woman with a child and four men. He screamed that they do not talk to him but pretend 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 such an alcoholic nonsense psychosis for the first time”.

– Nikolay, 24

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

In a state of clanks a person can be aggressive and dangerous for himself/herself and others. Self-harm, attacks on relatives or doctors are quite common, so it is very important to seek medical assistance in time. You should not be reassured by the peaceful attitude of a person with an 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 will 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 a 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 of re-development of alcohol delirium or other psychosis increases.

3. Alcoholic hallucinosis

It 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 turning directly to him/her, can threaten or insult. 

Features of the development of disease and recovery

  • a patient is constantly worried;
  • excitation turns to freezing;
  • increases in the evening evening and at night;
  • duration of acute hallucinosis from 2-3 days to 3-4 weeks;
  • in treatment, 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 type 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 persuaded;
  • a patient can use physical violence, up to a murder;
  • feelings of remorse can lead to attempts of suicide;;
  • alcoholic psychosis without treatment and without stopping drinking can take a chronic form and last for years.

5. Alcoholic paranoia

It 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 his delusional ideas;
  • behavior can be impulsive, a patient can suddenly run away from the pursuers, or can attack the “enemy”; 
  • hearing and visual hallucinations are rarely observed, mainly in the evening and at night;
  • a patient clearly realizes his/her personality, does not confuse in time and space;
  • alcoholic paranoia can last from 3-4 weeks (acute forms) to more than 3 months (chronic forms);
  • chronic form develops from acute, 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, for example, a state with a fantastic delirium, when the patient sees different scenes of battles, 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

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 2nd and 3rd stages of alcoholism with long periods of drinking from several weeks to months. Abstinence for this group of psychosis flows very difficult and has a prolonged nature.

Features of appearance and flow

  • the disease is preceded by long regular drinking, repeated and severe withdrawal syndrome;
  • usually develops in 40+ people;
  • patients often replace alcohol with surrogate – cologne water, poor-quality spirits, etc.;
  • accompanied by gastritis, peptic ulcer, liver cirrhosis;
  • loss of appetite and signs of physical exhaustion, often a patient practically does not eat anything, only drinking 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 is a gross violation of memory, partial amnesia (only for cases arising from the use of alcohol).
  3. Alcohol dementia is a violation of cognitive functions, emotions, destruction of the personality.

What to do when alcoholic psychosis is manifested?

alcohol withdrawal

If some signs of any 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 and complete termination of taking alcohol drinks.

How to treat alcoholic psychosis

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

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For the treatment of acute forms, doctors can prescribe neuroleptics, hypnotics, tranquilizers, antipsychotics, 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, 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, a patient should understand his/her relationship with alcohol and come to the need to get rid of alcohol addiction. In this case, not only medical treatment, but also psychological help is possible.

What should be done except a medical treatment?

In acute form, only medical treatment can be applied. At the second stage, the help of a psychologist can be used to get rid of alcohol addiction. This will help quit drinking easier and simpler, avoiding 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 1st and 2nd 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 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 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 acute condition, first contact the doctors, and only then, to completely eliminate alcohol addiction, add the therapy.


  1. Slovar’ terminov VOZ (https://www.who.int/substance_abuse/terminology/who_lexicon/en/).
  2. Alkogol’nye psihozy: klinika, klassifikaciya (https://cyberleninka.ru/article/n/alkogolnye-psihozy-klinika-klassifikatsiya).
  3. MKB-10 (apps.who.int/iris/bitstream/10665/85974/1/5225032680.pdf).
  4. Statistika rasprostranyonnosti alkogol’nyh psihozov (https://www.ncbi.nlm.nih.gov/pubmed/22611692).
  5. Fenomenologiya i techenie alkogol’nogo gallyucinoza (https://www.ncbi.nlm.nih.gov/pubmed/31161915).
  6. Osobennosti breda revnosti pri alkogol’nyh psihozah (https://cyberleninka.ru/article/v/osobennosti-breda-revnosti-pri-alkogolnyh-psihozah).
  7. Klassifikaciya MKB-10 s rekomenduemymi preparatami (https://www.rlsnet.ru/mkb_index_id_2437.htm).
  8. Ispol’zovany materialy knigi «Osnovy narkologii», Burkin M. M., Goranskaya S. V.