Withdrawal: Alcohol, Cocaine, Opioids and Other Drugs

Ethanol, illicit drugs, and prescription drugs used for nonmedical purposes are a significant medical as well as social problem. The 2005 National Survey on Drug Use and Health found that 22.7% of Americans, or 55 million individuals, were binge drinkers, which includes 16 million heavy drinkers (five or more drinks on the same occasion at least 5 different days in the prior 30 days) (1). Pain relievers were used nonmedically by 4.7 million Americans, and 3.5 million used stimulants or cocaine. Casual or habitual use of these drugs contributes to acute and chronic illness. Substance abuse also underlies many forms of injury, including vehicular accidents, falls, near-drowning, thermal injuries, homicide, and suicide. Other critical illnesses may be impacted by either substance use or substance withdrawal. This chapter will cover acute toxicity and withdrawal syndromes related to ethanol, cocaine, opioids, and other selected drugs likely to be of importance to the critical care practitioner.