Fear of withdrawal keeps many people from asking for help. Here is what nursing care during withdrawal actually looks like at a good residential clinic – and how you are kept safe and as comfortable as possible, day and night.
Rehab Abroad Guide works with our partner clinic in Cape Town. This guide is for anyone in the UK weighing up detox and rehab, here or abroad. It is general information, not a substitute for medical advice.
Clinically reviewed by Bongeka Chamane, Nursing Manager and Registered Nurse (SANC 16268179) at our partner clinic in Cape Town. Review date: 12 October 2026.
Why nursing care matters during withdrawal
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 our partner clinic, nursing care is available 24 hours a day, seven days a week. When you compare clinics – in the UK or abroad – ask whether a nurse is on duty overnight.
What is monitored – 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. Our partner clinic uses the CIWA-Ar, the COWS and the CIWA-B (for benzodiazepine withdrawal).
Vital signs
Blood pressure, pulse, temperature, breathing rate and oxygen levels are checked regularly. 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
Nurses 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 a nurse may need to wake you to check your blood pressure and other observations – it is for your safety.
Medication: the right support at the right time
Your doctor prescribes your withdrawal medication. 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 during withdrawal is simple, practical, human care:
| Symptom | How nurses 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 the nursing 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, the nurse escalates immediately to the doctor and arranges hospital transfer if needed. At our partner clinic, nursing staff are trained in Basic Life Support and the facility is equipped with emergency medical equipment. The clinic 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 accompanies you and makes sure you are settled in hospital; the clinic stays in contact with the hospital and collects you on discharge, once you are stable enough to continue 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: anxiety, insomnia, irritability and sensitivity to light and sound. These are reduced gradually rather than stopped suddenly.
- Opioids: 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. Mood is watched closely during this time.
- Cannabis: irritability, poor sleep, vivid dreams, reduced appetite and restlessness.
- GHB/GBL: can become severe quickly and requires close medical and nursing supervision. How GHB withdrawal is managed depends on how much you have been using and your pattern of use. Our partner clinic manages detox on site 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 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 the team help you.
- Speak up 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.
Frequently asked questions
Will someone check on me at night?
Yes. Nurses are on duty 24/7, and residents in detox are checked regularly through the night.
What if my medication isn't helping enough?
Tell your nurse. They 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 in the UK know how I'm doing?
With your consent, yes. Give the admissions team contact details for the family members to contact in an emergency, so they can be kept informed from the moment you land until the end of your stay. Your health information is handled under South Africa's POPIA and, for UK and EU residents, in line with the UK GDPR/GDPR.
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, most people get through it far more comfortably than they expected. Our partner clinic in Cape Town is a fully DSD-registered inpatient treatment centre with its own on-site detox and nurses on duty around the clock. If you'd like to talk through your options in confidence, WhatsApp +27 84 775 8623.
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 999 (or your local emergency number) immediately. In the UK you can also call NHS 111.
Sources
- Sullivan JT et al., "Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar)", British Journal of Addiction 84 (1989)
- Wesson DR & Ling W, "The Clinical Opiate Withdrawal Scale (COWS)", Journal of Psychoactive Drugs 35 (2003)
- NICE, Alcohol-use disorders: diagnosis and management of physical complications (CG100): nice.org.uk/guidance/cg100
- NHS, Alcohol misuse – treatment: nhs.uk
About the reviewer: Bongeka Chamane is a Registered Nurse (SANC 16268179) and Nursing Manager at our partner clinic in Cape Town, where she leads the 24/7 nursing team responsible for detox monitoring and medication management.