Substance Intoxication Delirium

Substance intoxication delirium is a mental health condition that occurs when the accumulation of drugs, medications or alcohol in the bloodstream leads to a delirious, disoriented state of mind.

It belongs to a larger group of mental health problems known as “delirium, dementia, and amnestic and other cognitive disorders.”

Some substances can trigger intoxication delirium within minutes or hours of use, while others can only trigger the condition after days of use.

The incapacitation associated with substance intoxication delirium can easily involve affected individuals in situations that carry clear risks for serious injury or death.

Delirium Basics

Delirium is the medical term for abnormal fluctuations in consciousness that produce rapid, unpredictable shifts between different or opposing mental states. Depending on individual circumstances, these fluctuations can include alternating shifts between high and low mental alertness, high and low levels of mental excitability, high and low levels of body mobility, and high and low levels of sleepiness. Emotional states commonly associated with these shifts in consciousness include confusion, anxiety, euphoria, agitation, depression, anger, irritability, and apathy.

Delirious people also typically experience some form of short-term amnesia, an inability to concentrate or sustain a purposeful train of thought, as well as an inability to purposefully direct their actions or behaviors, and an inability to speak coherently or consciously decide when to speak. Some people affected by delirium also lose the ability to control their bowels or bladder, or experience a form of aimless, subconscious body movement known as psychomotor agitation.

Almost all forms of delirium stem from problems such as substance use/abuse, traumatic head injuries, or disease processes within the body. Normally, psychiatric guidelines in the United States exclude all conditions with these underlying causes from any consideration as a form of mental disorder. However, because delirium involves so many changes in an affected individual’s emotional, behavioral and mental abilities, the American Psychiatric Association officially designates the condition as a mental disorder, regardless of its underlying causes.

Substance Intoxication Delirium Basics

According to the American Psychiatric Association’s guidelines, people with substance intoxication delirium have classic symptoms of delirium that clearly stem from the use of alcohol, medications or drugs, or from unintentional exposure to delirium-inducing toxic chemicals. In order to qualify as a mental disorder, the symptoms of delirium must cause greater mental disruption than the forms of disruption normally associated with the use of the substance in question. In addition, the amount of mental disruption present in an affected individual must be great enough to require some form of medical intervention.

In addition to alcohol, types of substances officially classified as unique potential causes of substance intoxication delirium include phencyclidine (PCP), drugs related to phencyclidine, amphetamine,drugs related to amphetamine, legal and illegal narcotics (opioids), inhalants, sedative medications, hallucinogens, cocaine, anti-anxiety medications, marijuana and hashish (cannabis), and soporific (sleep-producing) medications. All other substances capable of producing the condition-including Parkinson’s disease medications, digoxin (digitalis), and medications called histamine H2-receptor antagonists-belong to an undifferentiated category referred to as “other or unknown substances.”

Specific Effects

All substances capable of triggering intoxication delirium produce roughly similar delirium-related symptoms. However, the timing of those symptoms varies according to the specific substance in use, as well as the dosage of that substance. For example, intoxication delirium associated with the use of hallucinogens, cocaine, and cannabis typically occurs only in people who use/abuse high doses of these substances; its onset usually begins anywhere from minutes to hours after these doses are taken. Conversely, symptoms of the condition may only appear after several days of heavy alcohol consumption. Some medications (including diazepam (Valium) and certain other sedatives) accumulate in the body relatively slowly and are also eliminated from the body relatively slowly; this delayed buildup and elimination can produce delirium intoxication symptoms anywhere from hours to days after use of these substances.

Recovery

Most people with substance intoxication delirium recover when the substance in question leaves their bodies, the Diagnostic and Statistical Manual of Mental Disorders explains. However, in certain circumstances, the effects of delirium can last for significantly longer periods of time. Population groups at risk for unusually extended effects of substance intoxication delirium include people with pre-existing brain damage, people who use multiple substances at the same time, and people of advanced age.

Considerations

As noted previously, people under the influence of substance intoxication delirium have relatively high risks for involvement in dangerous situations that can result in serious injury or death. Potential problems here include accidental injury to self, accidental injury to others, intentional injury to self (i.e., suicide attempts or actual suicide), and intentional injury to others (i.e., physical assaults, homicide attempts or actual homicide).

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