Unlike the transient disturbances in attention and focus that are normal and that everyone experiences from time to time when tired, or even the temporary hangover or "crash" that affects people the morning after alcohol or drug use, substance withdrawal delirium is considerably worse and lasts for much longer. For some people, it involves a complete inability to attend to the external environment.
Symptoms of Delirium
Delirium is a change in someone's state of consciousness, which significantly disrupts their attention and awareness, and ability to process information about the world around them. They become less able to direct and focus their attention, keep their attention focused on something over time, or shift their attention from one thing to another. Their attention can wander so dramatically that questions need to be repeated for the person to be able to focus long enough to answer, or they may continue to focus on giving the answer to a previous question when a new question has been asked. They can easily be distracted by things that have nothing to do with what is being asked. In severe cases of delirium, they may be so disoriented that they might not know where they are or even who they are.
As well as the change in attention and focus, there is at least one other area of mental functioning that is affected. The person might not be able to remember properly, and in particular, they may lose their memory for events that have just recently happened. It could be orientation, and they may have particular trouble knowing where they are and the time and date. Other mental functions that may be affected are learning, language, or problems with perception which can even take the form of hallucinations.
When physicians give a diagnosis of substance withdrawal delirium, they check to make sure that the delirium is not part of another condition that affected the person before withdrawing from alcohol or drugs. A condition like this could be well-established in the person's medical record, or it might be a condition that has been emerging for a while. This is because there are different physical causes of delirium, and if the symptoms were there before the substance withdrawal, it isn't the substance/medication withdrawal type of delirium. And although a person can eventually fall into a coma, at that point, delirium would not be diagnosed.
How Soon After Discontinuing the Drug Can Delirium be Induced?
In some cases, delirium can occur during intoxication, and can continue into the withdrawal period. There is even another diagnosis called substance intoxication delirium, which means that the episode of delirium actually begins when the individual is high on the drug. Whether the delirium starts during intoxication or withdrawal, it will usually subside within hours or days of ceasing to take the drug, although in withdrawal, delirium can sometimes last for weeks.
Delirium usually develops over a fairly short period of time, ranging from a few hours to a few days. The severity of the disturbance in orientation to the environment and thought processes changes a fair bit during the course of delirium, and is usually worse towards night-time, when there is less going on around the person to help keep them oriented.
Which Drugs Cause Substance/Medication Withdrawal Delirium?
A wide variety of psychoactive substances can cause substance withdrawal delirium, including:
- Alcohol withdrawal delirium
- Cannabis withdrawal delirium
- Phencylidine withdrawal delirium
- Other hallucinogen withdrawal delirium
- Inhalant withdrawal delirium
- Opioid withdrawal delirium
- Sedative withdrawal delirium
- Hypnotic withdrawal delirium
- Anxiolytic withdrawal delirium
- Amphetamine withdrawal delirium
- Other stimulant withdrawal delirium
- Cocaine withdrawal delirium
- Other substance withdrawal delirium
- Unknown substance withdrawal delirium
People can develop symptoms of delirium after quitting alcohol or another drug cold turkey, and they require immediate medical attention. If someone seems to be in this state, call 911 immediately, and let the paramedics know what they are withdrawing from.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.