Fear of withdrawal keeps many people from asking for help. Here is what nursing care for managing withdrawal symptoms actually looks like – and how we keep you safe and as comfortable as possible, day and night.

In short: At Liberty Home, withdrawal is managed on site for all substances, at R4,500 a night. Registered nurses are on duty 24/7, and doctors are on call 24 hours. Nurses track your symptoms with recognised withdrawal scales (CIWA-Ar, COWS, CIWA-B), give the medication your doctor prescribes and provide comfort care. If withdrawal becomes acute, we refer you to hospital about 10 minutes away.

Clinically reviewed by Bongeka Chamane (Nursing Manager, Registered Nurse, SANC 16268179) Review date: 12 October 2026

Why nursing care matters when managing withdrawal symptoms

Withdrawal is the body readjusting after it has become used to alcohol or drugs. It can range from mildly uncomfortable to medically serious, and it doesn’t always follow a predictable path – someone can feel fine one evening and much worse by the next morning.

Doctors assess you and prescribe your withdrawal plan. Nurses are the people with you around the clock: watching how you are doing, giving your medication as prescribed, keeping you comfortable, and acting quickly if anything changes. At Liberty Home, registered nurses are on duty 24/7, and doctors are on call 24 hours.

What we monitor – and why

Withdrawal scales

Nurses use recognised, structured tools to measure withdrawal symptoms objectively, rather than guessing. Common examples include:

the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised), which scores symptoms such as tremor, sweating, nausea, anxiety, agitation and disturbances in perception;
the COWS (Clinical Opiate Withdrawal Scale) for opioid withdrawal, which looks at signs such as pulse, sweating, restlessness, pupil size, yawning and gooseflesh.

These scores help guide how much medication you need, within the limits your doctor has prescribed, so you get enough to stay safe and comfortable – but not more than you need. At Liberty Home we use the CIWA-Ar, the COWS and the CIWA-B (for benzodiazepine withdrawal).

Vital signs

We regularly check your blood pressure, pulse, temperature, breathing rate and oxygen levels. Changes in these can be an early sign that withdrawal is becoming more severe, or that something else – such as an infection or dehydration – needs attention.

Your overall wellbeing

We also keep an eye on things that numbers don’t capture: whether you are eating and drinking, how you are sleeping, your mood, whether you seem confused, and how you are coping emotionally.

How often?

Monitoring is most frequent in the first days of detox, when risk is highest, and becomes less frequent as you stabilise. Typically this ranges from hourly (in severe cases), to four-hourly as you stabilise, to eight-hourly towards the end of withdrawal. This applies day and night, so we may need to wake you to check your blood pressure and other observations – it is for your safety.

Medication: giving the right support at the right time

Your doctor prescribes your withdrawal medication, and registered nurses give every dose. The nursing team:

gives scheduled doses on time;
assesses you before giving “as needed” doses, using withdrawal scores and observations;
watches for side effects, such as excessive drowsiness, and holds or adjusts doses within the prescription – or contacts the doctor – when needed;
gives supplements such as thiamine (vitamin B1), commonly prescribed for people who have been drinking heavily;
records everything carefully, so the whole team can see how you are progressing.

Comfort care: the things that make a real difference

Medication is only part of the picture. Much of what helps with managing withdrawal symptoms is simple, practical, human care:

Symptom	How we help
Sweating, hot and cold flushes	Fresh bedding and clothes, warm showers, comfortable room temperature
Nausea and poor appetite	Small, light meals and snacks; sips of water; anti-nausea medication if prescribed
Dehydration	Encouraging fluids regularly; oral rehydration solutions where appropriate
Aches and restlessness	Rest, warm showers, gentle movement, medication if prescribed
Anxiety and low mood	Reassurance, someone to talk to, a calm environment, grounding and breathing techniques
Poor sleep	A quiet, dimly lit room; a calming evening routine; night nurse available to talk
Diarrhoea (common in opioid withdrawal)	Fluids, easily digestible food, medication if prescribed

Just knowing someone is nearby and understands what you are going through can ease a great deal of the fear.

Recognising warning signs early

Part of our role is to spot early signs that withdrawal is becoming dangerous, so the doctor can act quickly. These include:

rising pulse, blood pressure or temperature;
increasing tremor, agitation or sweating;
confusion or disorientation;
seeing, hearing or feeling things that aren’t there;
signs of a seizure;
severe vomiting or inability to keep fluids down;
thoughts of self-harm.

If any of these occur, we escalate immediately to the doctor, and arrange hospital transfer if needed. Our nursing staff are trained in Basic Life Support and the facility is equipped with emergency medical equipment. Liberty Home is contracted to ER24, one of South Africa’s leading private emergency medical services, who respond promptly to transfer you to a hospital about 10 minutes away. A nurse will accompany you and make sure you are settled in hospital. We stay in contact with the hospital and collect you on discharge, once you are stable enough to continue your therapeutic treatment.

What withdrawal typically feels like, by substance

Everyone is different, but in broad terms:

Alcohol: shakiness, sweating, anxiety, nausea and poor sleep, often starting within hours of the last drink. Because alcohol withdrawal can cause seizures or delirium, it is always closely monitored.
Benzodiazepines and sleeping tablets: benzodiazepine withdrawal can bring anxiety, insomnia, irritability and sensitivity to light and sound. These are reduced gradually rather than stopped suddenly. Where benzodiazepines are prescribed for withdrawal, they are given by registered nurses in small, controlled amounts, exactly as prescribed by the doctor, and reduced gradually.
Opioids: opioid withdrawal brings flu-like aches, sweating, runny nose, yawning, stomach cramps, diarrhoea, restlessness and cravings. Very uncomfortable, but symptoms can be eased considerably.
Stimulants (e.g. cocaine, methamphetamine): tiredness, increased appetite, low mood, irritability and cravings. We pay close attention to mood during this time.
Cannabis: irritability, poor sleep, vivid dreams, reduced appetite and restlessness.
GHB/GBL: In most cases GHB/GBL withdrawal needs hospital stabilisation first (often 5–14 days), followed by a gradual taper over several weeks. Withdrawal can become severe quickly and requires close medical and nursing supervision. How GHB withdrawal is managed depends on the amount you have been using and your pattern of use. Liberty Home manages detox on site for all substances under medical and nursing supervision, and any acute withdrawal from any substance is referred to hospital. You may need close observation at the nurses’ station for a few days, and a room close to the nurses’ station for the rest of your stay. All rooms are also fitted with emergency call buttons, so you can call for help at any time.

How you can help yourself

Be honest about how you are feeling – there are no wrong answers, and accurate information helps us help you.
Tell us early if something feels worse or different.
Keep sipping fluids and try to eat small amounts.
Rest – your body is working hard.
Don’t take anything that hasn’t been given by the nursing team, including medication you may have brought with you.

You can also see what your first 72 hours in rehab look like.

Frequently asked questions

Will someone check on me at night? Yes. Registered nurses are on duty 24/7 and doctors are on call 24 hours, and residents in detox are checked regularly through the night.

What if my medication isn’t helping enough? Tell your nurse. We will reassess you and, if needed, discuss it with your doctor.

Will I be too sedated to know what is going on? The aim is for you to be safe and comfortable, not heavily sedated. Doses are adjusted to your symptoms.

How long will withdrawal last? This depends on the substance, how much and how long you used, and your health. Most acute alcohol withdrawal settles within about a week, while benzodiazepine reductions often take longer. Your doctor and nurses will explain what to expect.

Can my family know how I’m doing? With your consent, we can keep your family updated. Please give the admissions team contact details for the family members we can contact in an emergency, so we can keep them informed from the moment you land until the end of your stay.

A closing note

Withdrawal doesn’t have to be something you face alone, or something to be afraid of. With careful monitoring, the right medication and genuine, compassionate nursing care for managing withdrawal symptoms, most people get through it far more comfortably than they expected. At Liberty Home – a fully DSD-registered inpatient treatment centre in Cape Town with its own on-site detox – our nurses are with you around the clock. On-site medical detox is R4,500 per night. See what detox costs and the phases of recovery, or if you’d like to know more about how we would support you, please get in touch.

References

Sullivan JT et al. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). Br J Addict, 1989. PubMed
Wesson DR, Ling W. The Clinical Opiate Withdrawal Scale (COWS). J Psychoactive Drugs, 2003. PubMed
World Health Organization. Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings (2009). NCBI Bookshelf
NICE CG100. Alcohol-use disorders: diagnosis and management of physical complications. NICE

This article is for general information and does not replace individual medical advice. If someone is having a seizure, is confused, or is seriously unwell during withdrawal, call emergency services immediately.