Dependence

Physiologic or psychological need for a substance to function

Definition

Dependence is a physiologic adaptation to a substance characterized by tolerance (needing more for the same effect) and withdrawal symptoms when the substance is reduced or stopped. It differs from addiction, which includes compulsive use despite harm.

Common Withdrawal Syndromes

Alcohol: Tremor, anxiety at 6 to 12 hours; seizures at 12 to 48 hours; delirium tremens at 48 to 72 hours (life-threatening).
Opioids: Dilated pupils, diaphoresis, N/V, diarrhea, piloerection, muscle aches. Uncomfortable but rarely fatal.
Benzodiazepines: Anxiety, seizures, potentially fatal (taper gradually).
Nicotine: Cravings, irritability, poor concentration.

CIWA-Ar Assessment

The Clinical Institute Withdrawal Assessment-Alcohol revised is used to score alcohol withdrawal severity and guide benzodiazepine dosing.

Nursing Interventions

Administer symptom-triggered benzodiazepines for alcohol withdrawal; methadone/buprenorphine for opioid withdrawal. Provide hydration, thiamine (before glucose to prevent Wernicke's), folic acid, multivitamin, such as create a calm environment, implement seizure precautions.

NCLEX Relevance

Alcohol and benzodiazepine withdrawal can be fatal. Thiamine before glucose is a classic priority.