Alcohol Withdrawal Scale

For those working to abstain from alcohol misuse, the symptoms of alcohol withdrawal can be overpowering and unpleasant, often leading people to stop the process and drink again. In some cases, medications are prescribed to help treat symptoms; however, these drugs are very strong and may have side effects of their own to be concerned about. Additionally, taking these medications can sometimes lead to addiction and dependence on the drugs themselves.

A standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was created to help healthcare professionals assess the severity of alcohol withdrawal symptoms when considering whether or not medications are needed to ease or alleviate symptoms. Over time, this alcohol withdrawal scale has also been used for assessing patients in various other situations as well. These include assessment of those in general outpatient, emergency, surgical, or psychiatric care. Because patients sometimes underreport alcohol consumption, physicians often overlook misuse. Potentially life-threatening consequences, such as delirium tremens or seizures, could be missed if alcohol withdrawal symptoms go unrecognized.

Alcohol Withdrawal Scale
The CIWA-Ar scale consists of ten checkpoints (or conditions) that an attending health care provider reviews to assess the severity and potential for alcohol withdrawal symptoms. Each checkpoint is evaluated separately and then combined to produce an aggregated score that indicates the severity and potential for alcohol withdrawal symptoms. It should be noted that any sign indicating a pattern or the side effects of excessive alcohol consumption should raise a concern for the possibility of severe alcohol withdrawal symptoms.

Some checkpoints give the provider instructions on what to say to the patient or what the patient should be asked to do. Once each is done, there are seven qualifiers for the health care provider to use for the assessment – some based on observation of the patient, while others are based on the answers to their questions. The ten checkpoints include:

  • Nausea/vomiting – Ask: “Do you feel sick to your stomach? Have you vomited?”
  • Tremor – Arms extended and fingers spread apart
  • Paroxysmal Sweats
  • Anxiety – Ask: “Do you feel nervous?”
  • Agitation
  • Tactile Disturbances – Ask: “Do you have any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?”
  • Auditory Disturbances – Ask: “Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?”
  • Visual Disturbances – Ask: “Does the light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?”
  • Headache/Fullness in Head – Ask: “Does your head feel different? Does it feel like there is a band around your head?’ Do not rate for dizziness or lightheadedness. Otherwise, rate the severity.”
  • Orientation/Clouding of Sensorium – Ask: “What day is this? Where are you? Who am I?”

After completing the assessment, the points are tallied and the level of alcohol withdrawal is calculated. A score of less than or equal to eight points shows that withdrawal is absent or minimal; nine through nineteen points indicates mild to moderate alcohol withdrawal; twenty points and above is considered to be indicative of severe alcohol withdrawal.

Once the severity is calculated, the healthcare provider will further reference a part of the tool that provides information on drugs that can manage alcohol withdrawal symptoms.

Alcohol Withdrawal Scale
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