Non-Pharmacological Approaches to

Managing Substance Use Withdrawal

Bari K Platter, MS, RN, PMHCNS-BC

Clinical Nurse Specialist

Alcohol

• Tremors

• Anxiety

• Nausea

• Vomiting

• Headache

• An increased heart

rate

• Sweating

• Irritability

• Confusion

• Insomnia

• Nightmares

• High blood pressure

Substance Use Withdrawal Symptoms

Opiates

• Watery eyes

• Runny nose

• Yawning

• Sweating

• Hot and cold flashes

• Dilated pupils

• Chills or gooseflesh

• Loss of appetite

• Restlessness

• Agitation

• Anxiety

• Tremors

• Abdominal

• Cramps

• Nausea

• Vomiting

• Fever

• Muscle aches and

pains

• Increased blood

pressure and/or

heart rate

• Insomnia or other

sleep problems

Benzodiazepines

• Flu-like symptoms

• Shaking

• Excessive sweating

• Insomnia

• Severe anxiety or

panic attacks

• Depression or

anxiety

• Stomach pain and

cramping

• Vision problems

• Headaches

• Heightened

sensitivity to lights,

smells and sounds

• Unsteadiness or

dizziness

• Depersonalization

and derealization

Substance Use Withdrawal Symptoms

Cocaine

• Agitation and

restlessness

• Depressed mood

• Fatigue

• Generalized malaise

• Increased appetite

• Slowing of activity

• Vivid and unpleasant

dreams

Meth

• Hopelessness

• Mood changes

• Muscle weakness

• Decreased appetite

• Fatigue

• Lack of motivation

• Anxiety

• Insomnia despite

exhaustion

• Headache from

dehydration

• Muscle pain, especially

in the jaw from

clenching

Substance Use Withdrawal Symptoms

Marijuana

• Anxiety

• Depression

• Mood changes

• Irritability

• Stomach pains

• Loss of appetite

• Nausea

• Insomnia

• Insomnia

• Anxiety

• Mood changes

• Irritability

• Restlessness

• Agitation

• Depression

Common Symptoms Addressed

with Holistic Approaches

• Mindfulness practice

• Distress Tolerance skills

• Aromatherapy

• Auricular acupuncture

Ways to Holistically Manage Withdrawal

• Integration of two evidence-based models of care

• Includes Mindfulness, Distress Tolerance, Interpersonal

Effectiveness and Emotion Regulation

• Worksheets can be used to support nurses in teaching

concepts that address withdrawal symptoms

Platter & Cabral, 2012

Integrating Dialectical Behavior Therapy

with the Twelve Steps Curriculum

Mindful Breathing

Body Scan

Seeking Guidance

• Lavender sachet

• Polished stones

• Hard candy

• Stress ball

• Word search,

crossword and

sudoku puzzles

Self-Soothing Kit

• Evidence-based research has noted success in using

aromatherapy

• Can be used safely in withdrawal

• Lavender- anxiety, agitation, restlessness, insomnia

• Sandalwood-insomnia, obsessive thinking, grief

• Mandarin- stress, insomnia, mental fatigue, overactivity,

nervous tension, restlessness

• Marjoram- anxiety, insomnia, nervous tension, agitation,

grief, obsessive thinking

Cho, et al, 2013

Aromatherapy

6 parts Lavender essential

oil

2 parts Marjoram essential

oil

1 part Mandarin essential oil

• Apply droplets to a small vial that

contains carrier oil

• Instruct patient to dab the solution

on pulse points on wrist and neck

up to 2 times/day

• Wash hands after application

Deep Relaxation Blend

10 drops Lavender

essential oil in a

small spray

container, add water

to fill

Lavender Spray

• Can be integrated with other

interventions

• Is barrier free- no lengthy

assessments

• Regular treatments

• Communal setting

• Cross-trained health

providers offer the therapy

• Evidenced-based model of

care

National Auricular Detoxification Association

(NADA) Protocol

Stuyt & Voyles, 2016

• Medications used to address SUD withdrawal have

large side effect profiles

• Medications reinforce neuro-pathways formed in active

addiction

• Many non-pharmacological approaches are evidence-

based

• Patients are increasingly interested in holistic

approaches to care

• Nurses are in a great position to support holistic

approaches

Summary

Bari K Platter, MS, RN, PMHCNS-BC

1693 N. Quentin St

Aurora, CO 80045

Bari.Platter@uchealth.org