Delirium vs Dementia: Impact of Addiction & Withdrawal

Medically Reviewed:
Dr. Randy Gelow, MD, FASAM
Ray Hamilton, DNP, PMHNP-BC, FNP-C
Last Updated: March 4, 2025

When a loved one starts having memory problems, confusion, or sudden changes in behavior, it can be scary. Many people wonder if they have dementia, but sometimes the issue is delirium—a different condition that can come on suddenly and may be treatable.

For those struggling with substance use, the situation can be even more confusing. Alcohol or drug withdrawal can cause delirium, and long-term substance use can lead to cognitive impairment that looks like dementia.

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What Is the Difference Between Delirium and Dementia?

Delirium and dementia both affect the brain, but they are not the same.

  • Delirium happens suddenly—often in a few hours or days. It causes confusion, trouble focusing, and sometimes hallucinations (seeing or hearing things that aren’t there).
  • Dementia develops slowly over months or years. It causes memory loss, difficulty thinking, and changes in personality.

Someone struggling with substance use or withdrawal can experience both delirium and dementia symptoms, making it important to get the right diagnosis.

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Symptoms of Delirium

Delirium is a medical emergency that needs quick treatment. It is often caused by:

  • Withdrawal from alcohol or drugs
  • Certain medications
  • Infections
  • Dehydration or lack of oxygen

People with delirium may:

  • Become confused suddenly
  • Have trouble paying attention
  • Feel very drowsy or restless (hyperactive delirium)
  • See or hear things that aren’t there
  • Have fast mood changes

Delirium symptoms come and go throughout the day, making them different from dementia.

Symptoms of Dementia

Dementia happens over a long period and gets worse with time. It is more common in older adults and is caused by diseases like Alzheimer’s.

Symptoms include:

  • Memory loss that affects daily life
  • Trouble solving problems or making decisions
  • Forgetting words or names of loved ones
  • Personality changes, such as becoming angry or withdrawn
  • Struggling to do familiar tasks

Unlike delirium, dementia does not come and go—it slowly gets worse over time (disease progressive).

Unsure if it’s delirium or dementia? Get a professional assessment.

How Substance Use Affects Brain Function

Long-term alcohol or drug use can damage the brain, leading to problems that look like dementia. Some substances, such as alcohol, can cause permanent memory loss if used heavily for years.

At the same time, withdrawal from alcohol or certain drugs (like benzodiazepines) can trigger delirium, making it hard to think clearly. This is why it’s important to treat delirium quickly and seek help for substance-related cognitive impairment.

Diagnosing Delirium vs. Dementia

If a loved one is showing signs of confusion, it’s important to see a doctor as soon as possible. Diagnosing delirium vs. dementia involves:

  • A mental status test to check memory and thinking
  • Blood tests to look for infections, vitamin deficiencies, or withdrawal effects
  • Brain scans (MRI or CT) to check for damage
  • A substance use history to see if drugs or alcohol may be playing a role

A key question doctors ask is: Did the confusion happen suddenly or over time? If symptoms started quickly, delirium is more likely.

Facing withdrawal-related confusion? Safe treatment is here.

Treating Delirium

The good news is that delirium is often reversible if treated quickly. Delirium vs. dementia treatment is different because delirium is usually caused by an underlying issue, like an infection or withdrawal.

Treatment may include:

  • Medical detox to safely manage withdrawal symptoms
  • Fluids and nutrition to prevent dehydration
  • Adjusting medications that may be causing confusion
  • Hospital care for severe cases

Since older adults and those with mental health conditions are at higher risk, early treatment is key.

Managing Dementia

Dementia is not reversible, but certain treatments can help slow it down. These include:

  • Medications to support memory
  • Brain exercises and therapy
  • Lifestyle changes like healthy eating and staying active

Hearing aids and other sensory tools can also help those with dementia stay engaged and reduce confusion.

Concerned about a loved one’s mental state? Get expert guidance.

Can the Brain Heal from Substance-Induced Cognitive Decline?

If memory loss or confusion is caused by substance use, the brain may improve with the right care. This often includes:

  • Medical detox to remove harmful substances
  • Cognitive therapy to rebuild brain function
  • Long-term recovery support to prevent relapse

Seeking help early can make a big difference in preventing dementia-like symptoms from getting worse.

Delirium in Alzheimer’s Disease

People with Alzheimer’s disease are at higher risk for delirium, especially if they are hospitalized or on multiple medications.

If someone with Alzheimer’s develops delirium, it can cause:

  • Severe confusion and agitation
  • Rapid worsening of memory loss
  • Long-term decline in brain function

Substance use can make this worse by increasing confusion and damaging brain cells. This is why families must be aware of the risks and seek medical help quickly.

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Can Delirium Be Fatal?

Can delirium be fatal? The answer is yes—especially if it is caused by:

  • Untreated withdrawal (like delirium tremens from alcohol withdrawal)
  • Severe infections or organ failure
  • Falls or injuries due to confusion

Delirium is especially dangerous for older people and those with pre-existing cognitive impairment. Preventing delirium by managing health conditions and avoiding substance withdrawal is critical.

How The Hope House Can Support Recovery

If you or a loved one is struggling with substance-related confusion or memory problems, The Hope House can help. We provide medically supervised detox to safely manage withdrawal, cognitive therapy to support brain healing, and long-term addiction treatment to prevent future decline.

Long-term addiction treatment is also available to prevent future decline and provide individuals with the tools needed for lasting recovery. Through a combination of medical care, therapy, and personalized support, we help individuals rebuild their lives and improve their overall well-being.

Confusion and memory loss can be frightening, but you don’t have to face them alone. Contact The Hope House today to learn how we can help you or a loved one on the path to recovery.

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