Alcohol Withdrawal
Timeline: 6–8h after last drink (mild), 12–48h (seizures), 48–96h (DTs). Symptoms: tremors, anxiety, nausea, hallucinations, seizures, autonomic instability. CIWA-Ar scale guides treatment. Treatment: benzodiazepines (lorazepam — safe in hepatic disease), thiamine (prevent Wernicke's), folate. Severe withdrawal = ICU admission.
Opioid Use Disorder
Withdrawal: extremely uncomfortable but rarely fatal (unlike alcohol). Symptoms: yawning, lacrimation, rhinorrhea, piloerection ("goosebumps"), muscle aches, diarrhea, anxiety. Treatment: methadone, buprenorphine (Suboxone), clonidine for symptoms. Overdose: respiratory depression, pinpoint pupils, unconsciousness — NALOXONE immediately.
Stimulant Use
Cocaine, methamphetamine. Intoxication: euphoria, energy, tachycardia, hypertension, dilated pupils, psychosis. Withdrawal: dysphoria, fatigue, increased appetite, depression (can be severe — suicide risk). Treatment: supportive — no specific antidote. Monitor for cardiac arrhythmias, hypertensive crisis, psychosis.
Overdose Management
Opioid: naloxone (Narcan) — IV, IM, or intranasal. Repeat as needed (shorter half-life than most opioids — monitor for re-narcotization). Alcohol: supportive care, benzodiazepines, thiamine before glucose (prevent Wernicke's). Stimulant: benzodiazepines for agitation, antipsychotics for psychosis, treat cardiac complications.
Recovery Support
Motivational interviewing. Harm reduction: needle exchange, naloxone distribution, safe consumption sites. Treatment options: inpatient detox, outpatient MAT (medication-assisted treatment), 12-step programs, SMART Recovery. Stigma reduction is a nursing responsibility — use person-first language ("person with substance use disorder").
Important Notes
- Alcohol withdrawal can be fatal — DTs have 5–15% mortality untreated. Use CIWA-Ar scale and treat aggressively.
- Naloxone: shorter half-life than fentanyl and methadone — watch for re-narcotization and repeat dosing.
Clinical Tips
- Always give thiamine (Vitamin B1) BEFORE glucose in patients with suspected alcohol use disorder — prevents Wernicke's encephalopathy.
Summary
Substance use disorders require compassionate, evidence-based care. Nurses must recognize withdrawal syndromes, manage overdoses, and support recovery while reducing stigma.
