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More than 18% of American adults are living with alcohol use disorder, which may be moderate, severe or in remission. If you drink heavily, your body can become dependent on regular doses of alcohol in order to function. While stopping problem drinking is generally a good idea, suddenly stopping can cause serious effects. Abruptly cutting off your alcohol intake can trigger severe symptoms that can make it harder for you to permanently stop drinking. Severe alcohol withdrawal can even become life-threatening.
Not every case of alcohol withdrawal gets this bad. Doctors use an alcohol withdrawal scale chart to determine how serious the symptoms are getting and whether medical intervention is needed. This scale helps establish the severity of withdrawal. It also helps predict the likelihood that the person will develop delirium tremens (DTs), a common complication of alcohol withdrawal.
If you’re going through alcohol withdrawal or intend to stop drinking soon, it’s important to consult with your doctor. Only your doctor can give you medical advice, and medical supervision from a qualified professional can help keep you safe while you detox.
What Is the Clinical Institute Withdrawal Assessment Alcohol Scale Revised?
The CIWA-Ar is a 10-point scale that gauges the various symptoms of alcohol withdrawal from 0 to 7. On this scale, 7 is the most severe. By asking the 10 questions on the scale and assigning a numeric value to the severity of each, your doctor can reliably determine how serious your symptoms are and whether you’re at risk for DTs. The full alcohol withdrawal scale chart looks like this:
- Do you feel sick to your stomach and have you vomited?
- Do you have any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?
- Observe tremors in the patient by having the patient extend their arms and spread their fingers.
- Are you hearing things you know are not there? (And other related questions)
- Paroxysmal sweats — observation.
- Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?
- Do you feel nervous?
- Does your head hurt or feel different? Does it feel like there is a band around your head?
- Agitation — observation.
- What day is this? Where are you? Who am I?
Each of the questions on this scale is an attempt to determine a different aspect of a person’s mental or physical well-being. The questions are aimed at developing a comprehensive picture of the person’s overall health at the moment. They also assess the severity of the most common symptoms of withdrawal:
Do you feel sick to your stomach and have you vomited?
Nausea and vomiting are some of the most common symptoms of alcohol withdrawal. A 0 score for this question indicates no nausea, while anything 5 and above indicates constant nausea, vomiting and/or dry heaves.
Do you have any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?
Skin irritation like this frequently happens during withdrawal. The feeling that bugs are crawling over (or under) the skin is the result of tingling nerves in the skin that create tactile hallucinations.
Observe tremors in the patient by having the patient extend their arms and spread their fingers
People going through withdrawal sometimes develop tremors, which may be mild or severe.
Are you hearing things you know are not there?
Auditory hallucinations can be mild or severe, and they’re frequently frightening. This part of the scale assesses both the severity of and the distress caused by auditory hallucinations, which can be severe and continuous.
Paroxysmal sweats — observation
Alcohol withdrawal can cause sweating that’s unrelated to the ambient temperature or physical exertion. This part of the scale requires an observation by the doctor, who looks for light or heavy sweat on the palms, where it usually appears first. A 7 on this question indicates heavy, drenching sweat.
Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?
Visual hallucinations are commonly associated with alcohol withdrawal.
Do you feel nervous?
This question helps gauge a person’s anxiety, which runs from at ease to virtual panic.
Does your head hurt or feel different? Does it feel like there is a band around your head?
Tension headaches often feel like a band of pain around the head and may be mild or severe during withdrawal.
Agitation — observation
A doctor may want to assess how agitated a person going through withdrawal is. This can be as simple as visual observation.
What day is this? Where are you? Who am I?
Confusion and an inability to orient to where a person is and what day it is are signs of mental disorientation. Mild or nonexistent signs of confusion are generally not caused for concern. The inability to place the current day within 2 days, however, may indicate serious mental impairment.
How Should the CIWA-Ar Scale be Used?
The CIWA-Ar alcohol withdrawal scale chart is a helpful tool for people who are planning to detox at home, but it should not be used to self-diagnose or make medical decisions on your own. Only a medical professional who’s been trained to use this scale should make a diagnosis or medical recommendations. It’s most useful in a clinical setting, during a supervised detox, to help your doctor predict the best treatment for you during withdrawal.
Other Alcohol Withdrawal Scales
CIWA-Ar is not the only tool doctors use to monitor symptoms of alcohol withdrawal. Under some conditions, a doctor might decide to use the 7-point Riker scale, which usually measures a person’s response to sedation. If, for example, a person has opted to undergo withdrawal under heavy sedation, it’s essential to monitor their responsiveness on a scale that CIWA-Ar really isn’t designed for. Riker scores are based on visual observation, with a 0 indicating total unresponsiveness and a 7 showing severe agitation.
If you have a problem with excessive drinking or need help to stop, you’re not alone. Recovery from even severe alcohol use disorder is possible, and millions of people have successfully achieved sobriety. Contact us today by calling (833) 596-3502. Our compassionate team of counselors is standing by to take your call 24/7. Start your journey to recovery today.
