# Withdrawal --- **Withdrawal** is when you abruptly withdraw from using a [[medicine|substance]] regularly. For the most part withdrawal is unpleasant but nonfatal--with the notable exceptions of alcohol and benzodiazepines, which must be tapered off or it can cause massive seizures and death. There are characteristic withdrawal symptoms for: - [[alcohol]] - potentially fatal - for a chronic daily drinker, 6-12 hours after the last drink we usually see early withdrawal symptoms...nausea, shaky, anxious. - this isn't really a hangover, but it kind of looks like it. - 3 days after the last drink is when we're really in the danger zone where we really start worrying about seizures - by about day 5 we are at the end of withdrawal symptoms. - treated with **benzos (Ativan) or barbiturates (phenobarbital)** - CIWA - can vary wildly between different nurses - if there is a CIWA protocol and they're sleeping, you wake them up. People *can* sleep through withdrawal symptoms and wake up seizing - above a 12 you start to treat for withdrawal - above 30 you go to the ICU - nursing considerations - Many people are not honest about their use of alcohol. Consider the need for monitoring for alcohol withdrawal in a wide variety of patients - Although the risks of withdrawal are higher in older people who have been drinking for longer periods of time, but some young people can also have severe withdrawal symptoms - [[alcohol use disorder#Treatment for Withdrawal|alcohol withdrawal treatment]] - [[benzodiazepines]] - potentially fatal - we use benzos to manage withdrawal from alcohol - "taking a shot in pill form" - [[opioids]] - COWS scale - shaking, vomiting, diarrhea - we give meds based on their symptoms - [[opioid use disorder|clonidine]] used for symptoms such as sweating, chills anxiety and insomnia - once a person is dependent on these medicines their brain chemistry and it is *very difficult* to maintain complete abstinence. many people have much better outcomes if they are initiated on an [[opioid use disorder|opioid replacement therapy]] - tolerance is a factor - [[stimulants]] - [[nicotine]] - THC - these are not as obvious, but there is anxiety, sleep disturbances, restlessness - [[SSRIs]]/[[SNRIs]] - flu-like symptoms, brain zaps, insomnia - [[amphetamines]] - not life threatening but very unpleasant - dehydration - skin breakdown - headache, muscle ache - irritated ___