Alcohol and sedative-hypnotic withdrawal can result in a frank delirium that is life-threatening (Marco and Kelen 1990; Olmedo and Hoffman 2000). The acute signs of early alcohol, sedative-hypnotic, and benzodiazepine withdrawal are similar and include autonomic instability, tremulousness, diaphoresis, and gastrointestinal disturbances. Autonomic signs include tachycardia, hypertension, and hyperthermia. Treatment of this withdrawal state is best accomplished with a long-half-life benzodiazepine. Use of long-half-life agents such as diazepam or chlordiazepoxide prevents peaks and troughs in blood levels, thereby leading to a smoother taper. During the first 24 hours, vital signs should be taken at 2- to 4-hour intervals and additional benzodiazepine given if vital signs are still elevated. After 24 hours, the total dose should be added up and given as four divided doses, which are then decreased 10%–20% per day. In patients with significant liver disease, lorazepam or oxazepam should be used in preference to other benzodiazepines because their metabolism is not as dependent on hepatic function. It is important to consider concomitant medications, since -blockers prescribed for a general medical condition may mask the autonomic signs of withdrawal.