Substance Use Disorders & Withdrawal Management

Alcohol withdrawal follows a recognizable timeline and is potentially life-threatening, unlike withdrawal from most other substances: early symptoms (tremor, anxiety, sweating, nausea, elevated heart rate and blood pressure) typically begin within 6–12 hours of the last drink; withdrawal seizures can occur within 12–48 hours; and alcoholic hallucinosis (hallucinations with otherwise clear orientation) can appear in a similar window. Delirium tremens (DTs) — severe confusion, disorientation, hallucinations, autonomic instability, and a significant risk of death if untreated — typically emerges 48–96 hours after the last drink and represents a medical emergency requiring close monitoring, often in an intensive setting. The CIWA-Ar scale is commonly used to structure and score withdrawal symptom severity, guiding benzodiazepine dosing (benzodiazepines are the mainstay treatment for alcohol withdrawal, since they act on the same GABA system alcohol does, safely easing the transition).