Chart — Mental Health
Substance Intoxication vs Withdrawal Chart
For each major substance class, intoxication and withdrawal are usually mirror images — and the two questions that matter most are “what reverses the intoxication?” and “can the withdrawal kill?” This chart answers both.
Educational use only. For study and pattern recognition; emergency management of intoxication and withdrawal is provider-directed. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
By Substance Class
| Substance | Intoxication | Withdrawal | Antidote / Treatment |
|---|---|---|---|
| Alcohol / sedatives (benzodiazepines, barbiturates) | Slurred speech, sedation, ataxia, disinhibition, respiratory depression in overdose | Tremor, anxiety, tachycardia/hypertension, seizures, delirium tremens | Intoxication: supportive (flumazenil for benzo overdose, cautiously). Withdrawal: benzodiazepines — withdrawal can be FATAL |
| Opioids | Respiratory depression, pinpoint (miotic) pupils, sedation, decreased GI motility | Dilated pupils, yawning, rhinorrhea, piloerection, GI distress, muscle aches — miserable but rarely fatal | Intoxication: naloxone. Withdrawal: methadone/buprenorphine, clonidine, supportive comfort |
| Stimulants (cocaine, amphetamines) | Tachycardia, hypertension, hyperthermia, dilated pupils, agitation, paranoia, seizures, chest pain | "Crash": fatigue, hypersomnia, increased appetite, depression, vivid dreams, intense craving | Intoxication: supportive, benzodiazepines for agitation/seizures, cooling. Withdrawal: supportive, monitor for depression/suicidality |
Which Withdrawals Are Dangerous?
Alcohol and sedative (benzodiazepine/barbiturate) withdrawal can be fatal — seizures and delirium tremens — and is treated by replacing the depressant with a tapering benzodiazepine. Opioid withdrawal is miserable but rarely fatal in healthy adults; the danger is post-detox overdose. Stimulant withdrawal is mainly a psychological “crash” — the risk is depression and suicidality, not physiologic collapse. Knowing this triage order tells you where to put your monitoring.
NCLEX Pearls
- ✦Opioid intoxication = pinpoint pupils + respiratory depression → naloxone. Withdrawal = dilated pupils + GI distress.
- ✦Alcohol/sedative withdrawal can kill (seizures, DTs) — benzodiazepines treat it. Opioid and stimulant withdrawal usually don’t.
- ✦Stimulant intoxication = sympathetic overdrive (hyperthermia, hypertension, seizures, chest pain); withdrawal = crash with suicidality risk.
- ✦Intoxication and withdrawal are typically opposites — pupils are a fast tell (pinpoint = opioid intoxication; dilated = opioid withdrawal or stimulant intoxication).
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Psychiatric Association (DSM-5-TR) · American Psychiatric Nurses Association (APNA) · SAMHSA. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →