Alcohol Withdrawal Scale

For those working to withdraw from alcohol misuse, the effects of withdrawing can be overpowering and unpleasant, often leading them to quit the process. In some cases, medications can be prescribed to help with those symptoms, however these drugs can be very strong on one’s body, can have side-effects of their own to be concerned with, and can sometimes lead to addiction themselves.

To help health care professionals objectify the severity of alcohol withdrawal symptoms when considering if medications are needed to ease or alleviate symptoms, a standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was created. Over time, this alcohol withdrawal scale has also been used for assessing patients in various situations other than those being considered for prescription drug administration to alleviate symptoms. These include assessment of those in general outpatient, emergency, surgical, or psychiatric care. Because patients sometimes under-report alcohol consumption, misuse can be overlooked by physicians. Potentially life-threatening consequences, such as delirium tremens or seizures, can be missed if alcohol withdrawal symptoms go unrecognized.

The CIWA-Ar Alcohol Withdrawal Scale

The CIWA-Ar scale consists of ten checkpoints (or conditions) for an attending health care provider to review towards an assessment of alcohol withdrawal. Each is evaluated separately, then an aggregated score is obtained to indicate the severity of alcohol withdrawal. 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 alcohol withdrawal being present.

The ten checkpoints of the scale are as follows. 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 answers to questions they ask of the patient.

• 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, 'Have you 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 'severity.'
• Orientation/Clouding of Sensorium - Ask 'What day is this? Where are you? Who am I?'

​Upon completion of the assessment, the points are tallied, and the level of alcohol withdrawal is calculated. A score of less than or equal to eight shows that withdrawal is absent or minimal; nine through nineteen indicates mild to moderate alcohol withdrawal; twenty and above is considered severe alcohol withdrawal.
Once the severity has been calculated, the health care provider can further reference a part of the tool that provides information on drugs that can be used to manage alcohol withdrawal symptoms when needed.
 

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