Trezza and Popp (1998) sought to delineate the key substance-induced emergency situations a clinician might face and to detail appropriate interventions, both medical and behavioral. A subsequent article (Trezza & Popp, 2000) examined the potential for violence and self-harm in the patient using substances. The purposes of this chapter are to update those reviews with new evidence-based information on the management of alcohol-and druginduced emergency situations and to call attention to new issues in the field of substance abuse triage.Substance abuse is an issue in a large number of emergency department (ED) presentations. For instance, Rockett, Putnam, Jia, and Smith (2006) found that overall use of eight targeted substances was 56% for women and We, the chapter authors, thank our colleague Susan Vickory, RN, for helpful assistance with the literature review of this chapter and for help with training in the clinical use of the Clinical Institute Withdrawal Assessment Scale for Alcohol instruments.