Chronic alcohol exposure produces neuroadaptive changes: GABA-A receptors are downregulated and internalized, reducing inhibitory neurotransmission, while NMDA glutamate receptors are upregulated to compensate for chronic suppression. Upon alcohol cessation, this imbalance creates a hyperexcitable state. The withdrawal cascade progresses through predictable stages: minor withdrawal (6-24 hours), alcoholic hallucinosis (12-48 hours), withdrawal seizures (24-48 hours), and delirium tremens (48-96 hours). The kindling hypothesis explains progressive worsening with repeated withdrawal episodes. The nurse performs CIWA-Ar scoring, implements symptom-triggered benzodiazepine protocols, manages fluid and electrolyte replacement, coordinates seizure management, and recognizes delirium tremens requiring ICU-level care.