In general, withdrawal syndromes are characterised by symptoms opposite to those of the main effects of the drug itself, occurring as a result of neuroadaptation which itself results from prolonged and regular exposure to the drug. Withdrawal syndromes of CNS depressant drugs are potentially life-threatening with the exception of opiate withdrawal. Withdrawal syndromes from CNS stimulant drugs are not directly life-threatening, although the associated dysphoria may acutely increase suicide risk. A description of the common withdrawal syndromes can be found in appendix 3, page 117. The management of withdrawal essentially involves the amelioration of withdrawal symptoms by the prescription of appropriate medication - detoxification. However, if detoxification is to be successfully completed and abstinence maintained the process must be planned and the patient psychologically prepared. A 'stand-alone' detoxification will usually end in relapse to substance misuse, either before completion of the detoxification, or soon afterwards. An aftercare plan aimed at preventing relapse should be formulated in advance of the detoxification and may include residential or community options.

Detoxification should be planned for in advance wherever possible. Urgent in-patient psychiatric admission may be indicated for the management of