Substance Withdrawal in ICU Environment

  • Nuria MartínezEmail author
  • María-Consuelo Pintado
Reference work entry


In oncologic patients, emotional distress and psychiatric disorders are common, leading to high consumption of sedative substances (alcohol and benzodiazepines) and/or pain relievers (opioids). The prolonged and excessive use of these drugs can cause substance use disorders. Alcohol consumption is associated with an increased risk of developing an alcohol-related cancer, so it is common that oncologic patients have a medical record of consumption of alcohol, benzodiazepines, and opioids.

Substance withdrawal syndrome is a cause for intensive care unit admission as a primary or secondary diagnosis, and it may complicate the treatment course. Because the number of cancer patients requiring intensive care unit admission is increasing due to substantial increases in survival, intensivists should be prepared to treat withdrawal syndromes in this population.

Diagnosis is based on clinical findings, and general management begins with an assessment of the ABCs (airway, breathing, and circulation). Pharmacologic treatment usually includes symptom-triggered treatment, substitution of a long-acting replacement for the abuse drug in gradual tapering doses, treatment of underlying diseases, and establishing a plan for long-term management.

With an early diagnosis and a correct treatment, withdrawal syndromes are rarely life-threatening diseases.

Intensive care practitioners should be aware and used to recognize and treat this syndrome. This chapter is a review about the incidence, pathophysiology, clinical features, management, and prognosis of opioids, benzodiazepine, and alcohol withdrawal syndromes.


Withdrawal syndrome Opioids Alcohol Benzodiazepines GABA receptor Dexmedetomidine Cancer Delirium tremens 


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Authors and Affiliations

  1. 1.Intensive Care UnitHospital MD Anderson Cancer CenterMadridSpain

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