Acute Substance Dependence & Withdrawal
Acute dependence refers to the physiological state where the body has adapted to the presence of a substance, leading to withdrawal symptoms upon cessation. Management depends on the drug class and the risk of life-threatening complications.
| Substance Class | Key Withdrawal Symptoms | Management Focus |
|---|---|---|
| Alcohol / Sedative-Hypnotics | Tremor, autonomic instability, seizures, and delirium. | Benzodiazepine (e.g., Diazepam, Lorazepam). |
| Opioids | Dilated pupils, diarrhea, piloerection, muscle aches, and anxiety. | Clonidine, Buprenorphine, Methadone. |
| Stimulants | Dysphoria, fatigue, increased appetite, vivid dreams. | Supportive care; no specific antidote. |
High-Yield Clinical Notes:
- Life-Threatening Withdrawal: Alcohol and benzodiazepine withdrawal can be fatal due to status epilepticus or cardiovascular collapse. Always assess using standardized scales (e.g., CIWA-Ar for alcohol).
- Opioid Withdrawal: Rarely fatal but highly distressing. Use the COWS (Clinical Opiate Withdrawal Scale) to guide dosing for induction of maintenance therapy.
- Stabilization: The priority in acute withdrawal is ensuring physiological stability, hydration, and nutritional support (especially Vitamin B1 for alcohol-dependent patients).