A 27-year-old female patient presents for a follow-up appointment for generalized anxiety disorder. She has a complex history including polysubstance use disorder and borderline personality disorder, but she had been doing well. She achieved remission of her symptoms over one year ago and has been well managed on escitalopram 10 mg daily. She has been substance free for over one year, and is in therapy for her personality disorder. Today she is not feeling well. She reports some major psychosocial stressors and a brief substance relapse, but she stopped using all substances 2 days ago.  

The PMHNP notes a pronounced postural and intention tremor and suspects this is due to withdrawal from which of the following substances? 

A. Kratom 

B. Opioids 

C. Marijuana 

D. Alcohol 

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