Written by Agwalogu Bob,
Someone who decides to stop substance abuse is making a monumental choice for a good life. But this choice comes with the price of withdrawal symptoms, and, as every clinician knows, it’s rarely the same for everyone.
One patient may go through it with nothing worse than sweaty palms and a bad mood. Another may end up in the ICU. Take alcohol, for example. The National Library of Medicine notes that while about 50% of alcohol dependent people experience withdrawal, only a few experience true medical emergencies.
This is why recognizing withdrawal symptoms early enough should be one of the key skills healthcare frontline workers should learn.
The good news? Most withdrawal cases are manageable with appropriate monitoring and treatment. The challenge is recognizing the ones likely to lead to a medical emergency.
Read on as we discuss the clinical red flags of withdrawal symptoms that every healthcare practitioner should know.
Why Some Withdrawal Symptoms Become Medical Emergencies
As we’ve already established, withdrawal isn’t the same for everyone. So, why do some withdrawal symptoms become medical emergencies while others are just mild?
The substance is the biggest factor. Withdrawal from alcohol and benzodiazepines can be very difficult. When a person starts withdrawing from these substances, they can experience seizures and delirium tremens (DTs).
Opioid withdrawal, on the other hand, is rarely fatal. However, it can cause incredible pain and misery. Patients also tend to vomit a lot, which can cause dehydration and other serious issues.
Other factors that can also determine the severity of the withdrawal include:
- Duration of substance use disorder (SUD)
- Age of the patient
- Overall health
- Previous withdrawal complications
- Coexisting medical conditions
Clinical Tip. Do not rely 100% on what a patient tells you, as they often downplay the problem because of shame. This can lead to cognitive bias if you don’t do proper verification. Cognitive bias accounts for up to 65% of diagnostic errors in primary care settings.
Common Withdrawal Symptoms vs. Clinical Red Flags
Withdrawal comes with symptoms, even though it looks different for different people. Here are some common examples clinicians should know.
Common Withdrawal Symptoms
Common symptoms of substance use withdrawal basically show that the body is recalibrating after prolonged substance use.
They include:
- Anxiety and irritability
- Restlessness
- Sweating
- Nausea
- Mild tremors
- Poor sleep
- Increased heart rate
These symptoms will surely make the patient uncomfortable, but they’re usually not dangerous. If they get worse, or too many appear at the same time, however, it may indicate something more serious.
Clinical Red Flags
These symptoms are also part of the substance use withdrawal process, but they tend to be more severe. These red flag symptoms mean that the patient’s body is starting to destabilize.
Some of these symptoms include:
- Seizures
- Hallucinations
- Severe confusion or delirium
- Persistent vomiting with dehydration
- Extremely high blood pressure or rapid heart rate
- Chest pain
- Difficulty breathing
- High fever
- Loss of consciousness
- Suicidal thoughts or severe agitation
- Delirium tremens (DTs)
Keep an eye out for these red flags, as each one can quickly become life-threatening. Delirium tremens, in particular, have a high mortality rate of about 20%.
Clinical Tip: Multiple red flag symptoms occurring together means emergency. Immediately refer the patient to emergency services or inpatient care.
Withdrawal Symptoms Assessment for Healthcare Professionals
Many of the symptoms of substance use withdrawal can be mistaken for mental health conditions. This is because both conditions disrupt the same neurotransmitters in the brain.
Dr. Mark Horowitz, a Clinical Research Fellow in the NHS, sums it up perfectly:
“Withdrawal is commonly confused with other conditions, even misdiagnosed as mental health concerns. This often leads to an inappropriate reinstatement of the medication causing the withdrawal.”
So, how do you tell exactly what you’re looking at?
Consider the following checks:
- Mental health checks
- A thorough substance use history, including timing of last use
- Vital signs that you track over time and not just in one appointment
- Medication review, including any current medications the patient is taking
- Input from family or caregivers (They’re often the first to notice behavioral changes)
But the checklist above might not be enough on its own. Use screening tools like CIWA-Ar for alcohol withdrawal and COWS for opioids to complement the results of your physical examination.
When to Refer for Medically Supervised Withdrawal
One of the biggest decisions you’ll make with a substance use patient is deciding when to refer the person for medically supervised withdrawal.
You should make this recommendation if:
- Symptoms that worsen despite treatment
- The patient develops seizures, hallucinations, or DT
- Vomiting or diarrhea causes dehydration
- The patient has a history of complicated withdrawal
- The patient has medical or psychiatric conditions
- The patient is pregnant or old
- There’s no reliable support system for the patient
The good news? There are hundreds of centers that offer medically supervised withdrawals, also known as detox, all over the country.
In California, that might mean referring a patient to a safe medical detox in Orange County, since the area offers many options. Figure out which medically supervised detox centers in your area actually take referrals and have a good reputation.
South Shores Detox notes that detoxing can be a tough process, both physically and emotionally. But that doesn’t mean you should wait until a patient is crashing out before making the call.
Bottom line? Get them to the right level of care while you still have control of the situation.
Supporting High-Risk Patients Beyond Withdrawal
We’ve already discussed the red flags that may lead to an emergency. But some patients actually happen to have a higher risk of developing those complications.
These patients usually meet the following criteria:
- Previous withdrawal seizures
- Previous delirium tremens
- Heavy daily alcohol use
- Benzodiazepine dependence
- Polysubstance use
- Pregnancy
- Older age
- Liver disease
- Cardiovascular disease
- Serious mental illness
For these patients, safely managing withdrawal is only the first step. Once that has been safely completed, the focus will then shift to long-term recovery.
This can happen through counseling, behavioral therapy, medication-assisted treatment, and ongoing follow-up care.
The goal is to create a care coordination plan that addresses the whole person. It’s also to prevent a relapse. More than 60% of people recovering from SUD relapse within twelve months, so it’s important that this stage is handled properly.
FAQs
Which withdrawal symptoms should prompt immediate emergency evaluation?
Any symptom suggesting a threat to life demands immediate emergency evaluation. Examples include seizures, hallucinations, severe confusion, chest pain, difficulty breathing, or an altered level of consciousness.
Which substances are most likely to cause life-threatening withdrawal symptoms?
Withdrawal from alcohol and benzodiazepines can be life-threatening. This is due to the risk of seizures and delirium tremens, which can cause severe cardiovascular and neurological issues.
Can withdrawal symptoms become worse after the first day?
Yes. Alcohol withdrawal symptoms can definitely escalate after the first day. In fact, delirium tremens (DTs) typically starts 48 to 72 hours after the last drink.
Withdrawal Symptoms: Key Points to Remember
| Key Clinical Takeaway | What to Remember |
| Withdrawal Varies | Most cases are mild, but there are some withdrawal that can become life-threatening |
| Know the Red Flags | Seizures, hallucinations, delirium, chest pain, dehydration, and so on require urgent medical evaluation |
| Assess Thoroughly | Don’t rely on history alone. Verify findings using screening tools |
| Escalate Early | Refer patients for medically supervised withdrawal when outpatient care is no longer ideal |
| Think Beyond Detox | Long-term success depends on follow-up care, proper support, and relapse prevention |
Wrapping Up
Substance use disorder is a big problem all over the world, and for someone to decide that enough is enough, that’s a big deal.
Of course, deciding to quit often means facing withdrawal symptoms that can be either mildly uncomfortable or life-threatening. Knowing the different symptoms to look out for to ensure proper medical intervention early is the key to long-term recovery.
Hopefully, this article has shown you how to identify those symptoms so that you can respond with confidence.
Author Bio
Agwalogu Bob believes great content doesn’t just inform; it resonates and then sticks. For over eight years, he’s been helping agencies across four continents craft just that kind of content: sharp, engaging cut-through-the-noise copy across SaaS, finance, tech, health, and lifestyle.
When he’s not putting pen to paper, you’ll likely find him scouring the internet for funny memes.
Connect with him on LinkedIn or Medium.
Please also review AIHCP’s Substance Abuse Certification program and our CE courses as well, to see if they meet your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification