The North American version was released a month later on October 20. Changes and additions were made to this version, such as a choice of three difficulty settings when starting a new game (with a fourth setting that is unlocked after completing the game once), an alternate tuxedo outfit for Snake (which the character wears on every third playthrough on the same save file), and a "demo theater" mode where the player views every cutscene and radio conversations relevant to the main story. Jeremy Blaustein, who previously worked on the English localization of Snatcher for the Sega CD, wrote the English version of the script. One change in the English script was the addition of Western sources and authors to Mei-Ling's pool of motivational quotes; originally the character only cited Chinese proverbs natively, providing an explanation afterward in Japanese, but this proved challenging to adapt during the translation. The games detected by Psycho Mantis when he reads the player's memory card were also changed, due to certain games (such as the Tokimeki Memorial series) not being released outside Japan. This resulted in Kojima's cameo (in which he thanks the player for supporting his work via a voiceover) being cut from the Western versions, as save data from two PlayStation games not available outside Japan, Snatcher and Policenauts, needed to be present on the player's memory card for this Easter egg to appear.
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