Alcohol-Induced Psychosis: Signs and Symptoms

You’ve been drinking heavily for a while. Every day, it’s the same routine: you get home from work, fix dinner, and plop down on the couch with a bottle of wine to enjoy your favorite show. Pretty soon, you’re uncorking a second bottle of your favorite red. As you sit back down on the couch, something strange happens: you hear someone talking — or, at least, you think you do. What’s going on? 

Let’s explore the rare, disturbing condition known as alcohol-induced psychosis — what it is, what causes it, and what you can do about it. 

What Is Alcohol-Induced Psychosis?

Alcohol-induced psychosis is a serious mental health condition that causes us to experience hallucinations, delusions, or both due to excessive drinking. It’s relatively rare among the general population, but higher rates of alcohol-induced psychosis are often seen in those struggling with alcohol dependence.

Someone experiencing alcohol-induced psychosis might see, hear, or feel things that aren’t there either while drinking or after drinking. Typically, people who have psychosis lose touch with reality and have difficulty telling the difference between real and imagined experiences. They also become paranoid, frightened, easily confused, and sometimes aggressive.

What Causes Alcohol-Induced Psychosis? 

Alcohol-induced psychosis can be triggered in three different ways:

• Acute alcohol intoxication: While rare, acute alcohol psychosis can occur when we consume a large amount of alcohol in one sitting, such as in a night of binge drinking. Otherwise known as pathological intoxication, it usually occurs when people drink the same amounts of alcohol that can lead to alcohol poisoning. However, most people will become unconscious (from the alcohol poisoning) before any psychotic symptoms appear. Those who remain conscious may show signs of acute alcohol psychosis.
• Alcohol withdrawal psychosis: This form of alcohol-induced psychosis can occur when long-term heavy drinkers stop drinking. It happens temporarily during intense alcohol withdrawal, and it can be part of what is commonly known as delirium tremens (DTs). It can cause hallucinations, delusions, or a complete detachment from reality. Sometimes, people will even feel like bugs are crawling on their skin. 
• Alcoholic hallucinosis: This form of alcohol-induced psychosis can occur in people who use alcohol heavily for long periods of time, such as those with chronic alcohol use disorder. It usually causes auditory, visual or tactile hallucinations during or after drinking. Some people might also experience erratic mood shifts or delusions. 

This type of alcohol-induced psychosis may occur sporadically for hours or days. Over time, alcoholic hallucinosis can begin mimicking symptoms of schizophrenia and last indefinitely. In some cases, it can lead to brain damage, including Wernicke-Korsakoff syndrome.

What Are the Signs and Symptoms of Alcohol-Induced Psychosis?

People can experience a range of alcohol-induced psychosis symptoms. Here are some of the more common: 

• Visual hallucinations: Seeing objects or people that aren’t there. For instance, you might see someone outside lurking in the shadows.
• Auditory hallucinations: Hearing voices or other sounds that do not exist. For instance, you might hear someone talking to you, even though no one is there. 
• Olfactory hallucinations: Smelling scents that no one else can. For instance, you might smell something burning.
• Tactile hallucinations: Feeling like you’re being touched when no one or nothing is touching you. For instance, some people might start scratching themselves, as they hallucinate the feeling of bugs crawling on them.
• Delusions: Rigidly adhering to beliefs that have no basis in reality. For instance, you’re convinced that other people are “out to get you” even though there’s no evidence
• Paranoia: Extreme anxiety and fear. For instance, you might fear you’re being watched or followed.

These are some other symptoms of alcohol-induced psychosis:

• Speaking incoherently or being otherwise unable to express thoughts clearly
• Agitation or outbursts of violence or aggression
• Crying, laughing, or having other inappropriate emotional reactions for the situation
• Suicidal thoughts or actions
• Acting strangely or inappropriately
• Inability to hold a conversation
• Jumbled thoughts
• Rapid, constant speech
• Feeling disconnected from body 

Symptoms can vary in severity and intensity. For instance, some people might see or hear things that aren’t there for a brief moment, while others will see or hear things continuously, frightening them. 

To an outsider, it can sometimes be difficult to determine if a person is simply intoxicated or if they have developed alcohol-induced psychosis. However, we can usually make a diagnosis based on how long the symptoms last. 

How Long Does Alcohol-Induced Psychosis Last?

The symptoms of psychosis will last much longer than typical alcohol intoxication. In fact, for someone to be diagnosed with alcohol-induced psychosis, their symptoms typically persist for at least 48 hours. Symptoms will also be much more severe than the disorientation and reduced inhibitions usually associated with being drunk. 

While the symptoms of alcohol-induced psychosis tend to occur in the aftermath of heavy drinking, they might not become evident for up to two weeks. They can last for a couple days or longer. In some cases, episodes of alcohol-induced psychosis have lasted for up to six months. 

In rare cases, alcohol-induced psychosis can become permanent due to a condition called Wernicke-Korsakoff syndrome (WK). This is a serious complication of heavy alcohol use caused by low levels of thiamine (vitamin B1). Low thiamine levels can cause brain inflammation that creates dangerous neurological symptoms. If untreated, inflammation can lead to permanent brain damage that leads to psychosis and hallucinations. 

Who Is at Risk for Developing Alcohol-Induced Psychosis?

Anyone who drinks excessively or has alcohol use disorder is at risk for alcohol-induced psychosis. According to a 2018 review, about 4% of people who develop alcohol use disorder will experience alcohol-induced psychosis. If we’ve experienced an episode previously, we’re at an even greater risk of having another one. 

These are some other populations who are at greater risk for developing alcohol-induced psychosis:

• Heavy drinkers over age 40
• People with schizophrenia
• People with mental health disorders
• People going through alcohol withdrawal who have delirium tremens (DTs)
• People with a blood alcohol level concentration (BAC) high enough to cause alcohol poisoning
• People with thiamine (B1) deficiency (often caused by alcohol use)
• People who are abusing other substances that come with risks of psychosis, such as methamphetamine

Research also indicates that alcohol-induced psychosis is highest among working-age men, people who became addicted to alcohol at a young age, those of low socioeconomic status, and individuals who live alone or have little social support. 

Similarly, researchers have associated alcohol-induced psychosis with higher rates of anxiety, depression, and suicide. Furthermore, about 37% of people diagnosed with alcohol-induced psychosis have a co-occuring mental health disorder.

Can Alcohol Cause Schizophrenia? 

Alcohol cannot cause schizophrenia. However, the symptoms of alcohol psychosis can be similar to what people with schizophrenia experience. For instance, many people with schizophrenia experience delusions or hallucinations that cause them to see or hear things that aren’t there. 

However, in the case of alcohol-induced psychosis, these symptoms are brought on by heavy alcohol use, whereas a person with schizophrenia will experience them in the absence of alcohol or other influential substances. For people with schizophrenia, consuming alcohol can make their symptoms worse or more intense. 

While they are two separate conditions, alcohol-induced psychosis and schizophrenia can co-occur in the same person.

What Dangers Are Associated With Alcohol-Induced Psychosis?

Alcohol-induced psychosis can be dangerous if left untreated. For instance, people with untreated alcohol-induced psychosis could be subject to these risks: 

• Physical injuries due to confusion, disorientation, or aggressive behaviors
• Abuse or other victimization
• Arrest and incarceration due to reckless or dangerous behaviors
• Job loss
• Conflicts with friends and family members
• Worsening of co-occurring mental illness, such as schizophrenia 
• Social isolation
• Suicide

What Is the Treatment for Alcohol-Induced Psychosis?

If we or someone we know is experiencing alcohol-induced psychosis, it’s important to get medical help immediately. Treatment usually involves eliminating alcohol and getting through withdrawal symptoms. 

In chronic cases of alcoholic hallucinosis, neuroleptic medications (like haloperidol) or atypical antipsychotics (such as olanzapine or ziprasidone) may be necessary to control symptoms. Medical professionals might also administer benzodiazepines like lorazepam if there is a risk of seizures and alcohol withdrawal.

Because heavy drinking is often to blame for alcohol-induced psychosis, treatment also involves a long-term recovery plan for living an alcohol-free life. 

How Can We Prevent Alcohol-Induced Psychosis?

Abstinence from alcohol — not drinking — is the best way to prevent this condition. Anyone who drinks heavily or has an alcohol use disorder is at risk for alcohol-induced psychosis. And people who’ve already experienced one episode are at greater risk of having another one.

Getting the Help We Need

If you or a loved one is struggling with alcohol use, it’s important to get help right away before it causes more severe complications such as alcohol-induced psychosis. The best thing we can do is contact a medical professional and be upfront and honest about our alcohol consumption. They can help direct us develop a treatment plan or direct us to resources that can help, such as an in-patient or out-patient rehabilitation center. It’s never too late to get the help we need. 

If you’re drinking more than you’d like and want to cut down on your alcohol consumption, consider trying Reframe. We can help you change your drinking habits and offer tools and tips for enhancing your health and well-being.