Bowie wrote most of the tracks on the road in the US between shows. Because of this, many of the tracks are greatly influenced by America and Bowie's perceptions of the country. Due to the American influence and the fast-paced songwriting, the record features a tougher and raunchier glam rock sound than its predecessor. The lyrics reflect the pros of Bowie's newfound stardom and the cons of touring and paint pictures of urban decay, drugs, sex, violence and death. Some of the songs are influenced by the Rolling Stones, and a cover of their song "Let's Spend the Night Together" is included. The album features a new character called Aladdin Sane, a pun on "A Lad Insane", whom Bowie described as "Ziggy Stardust goes to America". The cover artwork, shot by Brian Duffy and featuring a lightning bolt across Bowie's face, was the most expensive cover ever made at the time and represents the split personality of the Aladdin Sane character and Bowie's mixed feelings of the tour and stardom. It is regarded as one of his most iconic images.
The title is a pun on "A Lad Insane", which at one point was expected to be the title. When writing the album during the tour, it was under the working title Love Aladdin Vein, which Bowie said at the time felt right, but decided to change it partly due to its drug connotations.
Fans immediately saw through it. Aladdin Sane (or, more pointedly, "a lad insane") was Bowie's not-so-subtle shifting of personas to keep himself from getting, as he sang in "Ziggy Stardust," too "sucked up into his mind." Aladdin Sane, the character, was Bowie stepping back a bit, grounding himself to Earth. But there was no pulling back by this point; Aladdin Sane, the album as well as the character, was pretty much Ziggy Stardust, the album and the character, reborn. Bowie even referred to the album as "Ziggy goes to America," partly inspired by the fact that many of the songs were written while he was touring the States.