Alcohol addiction treatment starts with detox, which can induce a wide range of withdrawal symptoms. If you or someone you know needs treatment for alcohol addiction, getting thorough and accurate information is crucial. The more you know about the road ahead, the more confident you can be in successful outcomes. Some symptoms of alcohol withdrawal are widely discussed, while others are not. In this post, we’re going to talk about alcohol-induced hallucinations. Can alcohol detox cause hallucinations and how long symptoms last are questions we’re going to answer below, and so much more.

Alcohol Detox and Hallucinations

The process of alcohol detox can, indeed, cause hallucinations. The subject is still being explored by researchers around the world, though evidence does exist to confirm it.

The journal Alcohol and Alcoholism published a study whose main objective was to characterize different stages of alcohol withdrawal. For that purpose, scientists applied the Alcohol Withdrawal Scale (AWS) to 217 alcohol-dependent patients every four hours until the withdrawal symptoms had passed. Scientists found five clusters representing the severity of alcohol withdrawal. The higher the number of a cluster, the more severe the symptoms are. Results showed the following:

  • Cluster 1 – 18.4% of the patients, no relevant symptoms observed
  • Cluster 2 – 18.9% of the patients, mild to moderate vegetative symptoms only
  • Cluster 3 – 40.6% of the patients, additional anxiety
  • Cluster 4 – 11.1% of the patients, disorientation and anxiety
  • Cluster 5 – 11.1% of the patients, hallucinations

As you can see, hallucinations during alcohol withdrawal are possible, and they are among the most severe symptoms that occur in the detox process.

Prevalence and Causes of Alcohol Detox Hallucinations

The study which identified different clusters of alcohol withdrawal symptoms put hallucinations in the cluster with the highest severity, but a small percentage of the affected subjects. Indeed, hallucinations as a result of alcohol withdrawal are fairly uncommon.

The Psychiatry Research journal published a study that used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to investigate how common alcohol withdrawal hallucinations really are. Scientists found that 2% of drinkers reported alcohol withdrawal hallucinations, consisting of 758 out of 34,533 subjects.

Although the mechanisms behind hallucinations during alcohol detox are still unknown, the study revealed they were highly associated with alcohol tolerance and withdrawal seizures. Interestingly, exposure to alcohol during brain development was associated with a 10-fold increase in alcohol withdrawal hallucinations compared to exposure during adulthood. The study also shows that other groups of people are more prone to alcohol withdrawal hallucinations, such as:

  • African Americans
  • Native Americans
  • Unmarried persons
  • Persons with a lower level of education
  • Persons with lower levels of income

It’s also useful to mention another finding from this research. Men and women with a history of alcohol withdrawal hallucinations had higher odds ratios for most psychiatric illnesses than those without such history. Of anxiety disorders, the only panic was linked with alcohol withdrawal hallucinations.

A study from the March 2020 issue of Open Access Emergency Medicine reports that the prevalence of alcohol withdrawal hallucinations is 2% to 8% among people with chronic, heavy alcohol use. This is especially the case for persons who started drinking before the age of 17. The discovery correlates with previous findings that state exposure to alcohol during brain development increases the risk of hallucinations during detox. Hallucinations tend to occur eight to twelve hours after the last drink. A person can experience the following types of hallucinations:

  • Auditory – false perceptions of sound, experience internal words or noises that have no real origin in the outside world and are perceived to be separate from the person’s mental processes.
  • Visual – these hallucinations involve seeing things that aren’t there. The hallucinations may be of objects, visual patterns, lights, or people.
  • Tactile – involve an abnormal or false sensation of touch or perception of movement on the skin or inside the body.
  • Gustatory – relatively common distortions or changes in taste, or the sensation of taste which occurs spontaneously in the oral cavity in the absence of food or beverage.
  • Olfactory – also known as phantosmia, makes a person detect smells that aren’t present in the environment. The odors detected vary from one person to another and maybe foul or pleasant. Olfactory hallucinations can occur in one or both nostrils.

In the stage of an alcohol withdrawal syndrome when hallucinations occur (eight to 12 hours after last drink), a person may also experience paranoia and other delusions as well. That being said, patients maintain a clear sensorium, which is why hallucinations are different than delirium tremens (DTs).

As a reminder, delirium tremens occurs in about 3% to 5% of patients with alcohol withdrawal syndrome. It is considered the severe form of alcohol withdrawal and is characterized by confusion, alterations of consciousness, severe autonomic changes, and hallucinations. Delirium tremens often begin within one to three days of abstinence, although they can occur abruptly as early as eight hours after an acute reduction in alcohol use.

Alcohol withdrawal hallucinations and delirium tremens are usually considered to be the same thing, but they’re not. Persons with DTs do not have a clear sensorium, which was observed in subjects with hallucinations. Since both hallucinations and DTs are severe, the safest way to recover from alcohol addiction is to get into an inpatient alcohol rehab center for men in Texas, such as Stonegate Center Creekside.

When it comes to alcohol withdrawal hallucinations, one study attempted to discover mechanisms of action behind them and other symptoms that occur during the withdrawal stage. The study, published in the journal Drugs, explained how alcohol withdrawal syndrome works. It all comes down to neurotransmitters in the brain.

Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the brain, while glutamate is the main excitatory neurotransmitter. Acute alcohol ingestion produces depression of the central nervous system (CNS) secondary to amplified GABA-ergic neurotransmission and a decreased glutamatergic activity.

Chronic exposure of CNS to alcohol consumption induces adaptive changes in several neurotransmitters, including GABA, norepinephrine (noradrenaline), and glutamate pathways. This happens because CNS is trying to compensate for destabilization brought on by alcohol and aims to restore neurochemical balance. What happens next is that the adaptive behavior induces a long-term reduction in the effects of alcohol on your central nervous system. In other words, you develop a higher tolerance to alcohol. As a result, you need to drink more in order to feel the “effects” you experience when consuming alcoholic beverages.

Alterations that occur due to chronic exposure to alcohol involve decreased number, function, and sensitivity to GABA receptors. At the same time, the number, sensitivity, and affinity for glutamate and n-methyl-d-aspartate (NMDA) receptors increase. Basically, GABA receptors are down-regulated while glutamate is up-regulated.

The sudden reduction or complete cessation of alcohol intake impairs the balance of neurotransmitters. Alongside reduced GABA activity comes elevated glutamatergic action followed by hyperexcitability and the development of alcohol withdrawal syndrome. The up-regulation of dopaminergic and noradrenergic pathways could be the main culprit for the development of hallucinations and autonomic hyperactivity in people who experience alcohol withdrawal syndrome.

Dopaminergic pathways are the sets of projection neurons in the brain that synthesize and release dopamine neurotransmitters. Dopamine is involved in many functions, particularly in reward-motivated behavior and motor control. In fact, dopamine is an integral component of the brain’s reward system.

Although more research is necessary about the relationship between dopaminergic pathways and alcohol withdrawal hallucinations, studies show dopamine, coupled with its up-regulation, have an impact on the development of schizophrenia, which is known for hallucinations, and other psychological disorders.

Despite the low overall body of evidence, the existence of hallucinations in alcohol withdrawal is evident. Moreover, the impaired balance of neurotransmitters is the primary culprit, but some people are at a higher risk than others. A lot more research is necessary to uncover all the mechanisms involved in alcohol detox-related hallucinations.

Heavy Alcohol Intake Can Cause Hallucinations

As seen throughout this post, alcohol withdrawal symptoms may include the presence of hallucinations. But heavy alcohol intake can cause hallucinations as well. This only depicts the severity of excessive and chronic alcohol consumption.

The Industrial Psychiatry Journal published a case study involving a 43-year-old soldier with multimodal hallucinations caused by heavy alcohol use. The subject was referred to a psychiatric evaluation in January 2010 by unit authorities after exhibiting behavioral abnormalities. The soldier was gloomy, reclusive, had trouble sleeping, and talked to himself. He had been consuming alcohol since 1984, and over time the frequency and quantity increased to 360ml of rum a day by 1996. After temporarily stopping alcohol consumption, the subject would experience tremors, irritability, and sleep disturbances.

Upon leaving the military service in 2004, the soldier started drinking about 600ml of country liquor a day. By 2005, the subject’s family noticed he was talking to himself and didn’t take adequate care of himself. The soldier would easily become irritated. He also complained about hearing the voices of family members even when he was alone. When he heard them, the voices abused and threatened him.

At first, he would reply to those voices but eventually started neglecting them when they were present. Sometimes he would see faces of previous acquaintances that would change in size and shape. Additionally, the soldier described he would feel as if someone was touching or fondling his genitals.

The thorough evaluation showed the patient experienced visual, auditory, and tactile hallucinations but no delusions. The treatment helped him, and he responded quickly. Scientists explained that alcoholic hallucinosis is a rare complication of chronic alcohol abuse. People mainly experience auditory hallucinations either during or after a period of heavy alcohol intake.

What Are The Alcohol Withdrawal Symptoms?

Alcohol detox is the very start of addiction treatment, but it’s important to keep in mind that various symptoms can occur over several stages. Common signs and symptoms of alcohol withdrawal syndrome include:

  • Elevated blood pressure
  • Tachycardia (fast heart rate)
  • Higher body temperature
  • Sweating
  • Tremors
  • Dilated pupils
  • Disorientation
  • Irritability
  • Nausea
  • Anxiety
  • Insomnia

Evidence confirms that symptoms may vary from one person to another, just like their severity. Not all persons will experience severe withdrawal symptoms. However, alcohol withdrawal syndrome may manifest itself through several stages in terms of severity.

Minor withdrawal starts about six hours after cessation of alcohol intake. This phase lasts 24 to 48 hours. Symptoms may involve tachycardia, sweating, tremors, gastrointestinal disturbances, headache, and anxiety.

Moderate to severe withdrawal may include the increased intensity of symptoms. Hallucinations and illusions may occur but with clear sensorium, as described above, but the vital signs of a patient often remain stable. This phase may last between 24 hours and six days, rarely beyond one month and definitely under six months. At this stage, alcohol withdrawal seizures may occur as well as delirium tremens.

You’re probably wondering how long does it take to detox from alcohol. The answer may vary from one patient to another, just like the symptoms. The initial detox may take about a week. However, it’s not uncommon for a person to find their symptoms continue for longer. Keep in mind that detox should always be supervised and performed at the best medical detox center for alcohol in North Texas.


Hallucinations are vivid and realistic. They can happen due to many reasons. People can experience visual, auditory, tactile, and other types of hallucinations where they see, hear, or notice things that aren’t there. What many people don’t know is that alcohol detox can also cause hallucinations.

Studies on this specific subject are rare, but current evidence confirms that alcohol withdrawal hallucinations can occur in a small percentage of patients. Their incidence has a lot to do with exposure to alcohol consumption, dopaminergic pathways, and other factors.

Treatment of alcohol addiction should be performed in a supervised setting for a successful and safe outcome. It’s also useful to mention that alcohol consumption can cause hallucinations too.


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Stonegate Center is a private faith-based and gender-separate rehab center located in Azle, Texas. We offer long-term residential addiction treatment for men and women struggling with drug & alcohol addiction. Our rehab center serves the communities of Fort Worth, Dallas, and as far as Oklahoma & New Mexico.

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