An alcohol-induced delirium may occur during intoxication (alcohol intoxication delirium) or during withdrawal (delirium tremens, or DTs).

Alcohol intoxication delirium (unlike delirium from stimulants or hallucinogens, which may emerge in hours) requires days of heavy use of alcohol to occur. Evidence for a delirium would include a disturbance in consciousness manifested by inability to shift, sustain, or focus one's attention; reduced awareness of the environment; and cognitive impairment, such as disorientation, memory deficits, and language disturbance (e.g., mumbling). The symptoms would fluctuate during the course of a day and would be linked by history and physical or laboratory data to the use of alcohol (American Psychiatric Association, 1994).

DTs are most likely to develop if the patient has had an alcohol withdrawal seizure or a concomitant medical disorder, such as an infection, hepatic insufficiency, pancreatitis, subdural hematoma, or a bone fracture. Onset is usually 2-3 days after cessation of alcohol use and usually lasts 3-7 days, but can be prolonged. DTs must be considered a medical emergency (Goforth, Primeau, & Fernandez, 2003) and are characterized by visual, auditory, and/or tactile hallucinations, gross tremor, tachycardia, sweating, and, possibly, fever, as well as the disturbances of consciousness described earlier.

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