CIWA-AR Scale

What is alcohol withdrawal?

Before discussing the revised version of the or CIWA-AR Scale for short, let’s talk about what the scale assesses: alcohol withdrawal.

When we speak of alcohol withdrawal, we refer to an alcohol-related state or experience. Alcohol withdrawal happens to people who are dependent on alcohol. These people become dependent due to the constant and excessive consumption of alcoholic drinks.

When a person becomes dependent on alcohol, their body will adjust to the fact that alcohol is a constant, gradually becoming reliant on the presence of alcohol to function. So, when the person decides to consume less alcohol or stop consuming it entirely, the body will try to adjust to the presence of less alcohol or the complete lack of it, and it will have difficulty doing so. When the body tries to readjust, it will give rise to withdrawal symptoms. These symptoms can include the following: anxiety, irritability, trouble sleeping (insomnia at worst), and profuse sweating.

The Clinical Institute Withdrawal Assessment for Alcohol was developed for healthcare professionals to assess the severity of their patients’ withdrawal symptoms.

How to use the CIWA-AR Scale

The revised version Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR Scale) comes in the form of a ten-item questionnaire that focuses on the following symptoms of alcohol withdrawal:

1. Nausea and Vomiting

• The healthcare professional administering the scale will ask "Do you feel sick to your stomach? Have you vomited?" They will also observe the patient.

2. Tremors

• The healthcare professional will have the patient extend their arms forward and spread their fingers apart. They will observe the arms and hands for tremors.

3. Paroxysmal Sweats

• The professional will observe the patient for sweats.

4. Anxiety

• The professional will ask the patient: "Do you feel nervous?" They will observe them for signs of anxiety.

5. Tactile Disturbances

• The professional will ask: "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?" They will also observe the patient.

6. Auditory Disturbances

• The professional will 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?" They will also observe the patient.

7. Visual Disturbances

• The professional will 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?" They will also observe the patient.

8. Headache, Fullness in the Head

• The professional will ask: "Does your head feel different? Does it feel like there is a band around your head?" The professional will not rate for dizziness or lightheadedness. They will rate for severity.

9. Agitation

• The professional will observe if the patient has signs of being agitated.

10. Orientation and Clouding of Sensorium

• The professional will ask: "What day is this? Where are you? Who am I?"

The patient will rate them based on the descriptions for each item. Each description has a corresponding number rating. Nine items have ratings from 0 to 7. The Orientation and Clouding of Sensorium only has ratings from 0 to 4.

The maximum score is 67. Patients with scores below 10 usually don’t require additional medication for their withdrawal symptoms.

CIWA-AR Scale Example

Now you know the basic gist of alcohol withdrawal and what the revised version of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AR Scale) is, it’s time to see what it looks like. The template that we have uses the original version down to every word. The original has no copyright and can be reproduced freely. The only alteration we made is adding an additional comments box just in case healthcare professionals want to write down their observations.

If you like what you see and believe this will help you with your alcohol withdrawal-related work, feel free to download our free CIWA-AR Scale PDF template.

Download this CIWA-AR Scale Example:

When is it best to use the CIWA-AR Scale?

The CIWA-AR Scale is best used when a person with alcohol dependence is admitted to a hospital or clinic with a detoxification program. The scale will be used to assess them immediately so the professionals can gauge their symptoms' severity and progress. By gauging their symptoms, professionals can figure out what medications they should give and what their dosages should be to ensure that each person’s detoxification process goes relatively smoothly and they’re safe.

This scale is used several times for each patient to track the progress of their withdrawal symptoms over time. People don’t experience symptoms at a set time. Some will start to experience symptoms within just a few hours, while some might take days before they show up and progress. For those admitted to a hospital, clinic, or rehabilitation center, the CIWA-AR Scale will be administered in intervals. Some do so every hour or two because symptoms that are mild might become moderate or severe in a short span of time.

What are the benefits of using the CIWA-AR Scale?

It is easy to administer and has a standardized structure.

One of the great things about the CIWA-AR Scale is that it creates a standardized structure for healthcare professionals to assess patients undergoing alcohol withdrawal and detoxification. They will ask them questions related to ten symptoms, and they will simply observe them. The scale doesn’t require any special equipment to administer. By having a set structure, all patients will be assessed the same way.

It helps healthcare professionals determine what to do for their patients.

The CIWA-AR Scale can detect the severity of a patient’s withdrawal symptoms. The healthcare will base their scores on specific factors labeled for each number rating, and when these factors are evident in the patient, the professional will score accordingly. The total score will help the professional decide what to do. If the patient scores below 10, the scale mentions that patients who get such scores usually don’t require additional medication. If they score higher than 10, the medication and dosage given will depend on how high the score is.

It is an excellent monitoring tool.

As we mentioned earlier, the CIWA-AR Scale is the type of assessment that’s used multiple times. It is used as a monitoring tool because the first result may not necessarily be consistent throughout the detoxification process. Symptoms rated as mild might become severe in a few hours, so the CIWA-AR Scale is always used in intervals. By monitoring the patients in intervals, professionals can make the necessary adjustments immediately so that patients are safe and their detoxification process goes as smoothly as possible relative to their symptoms.

How can Carepatron help with rehabilitation-related work?

If you’re reading this guide, you’re likely a healthcare professional who works in rehabilitating patients who are dependent on alcohol. If so, we hope this guide served as a good introduction or refresher to the revised version of the Clinical Institute Withdrawal Assessment for Alcohol, and we hope the template tied to it serves you well when gauging patients for their alcohol withdrawal symptoms.

While we have you here, we’d like to ask you for your time to check out more of the Carepatron platform. We have numerous features that might tickle your fancy, and we believe that what we have can help you improve your work in terms of streamlining your workflows and improving the overall quality of your work. We won’t get into all of them here, but we would like to highlight one: our resource library.

Our resource library is one of the features we’re most proud of. It houses a massive collection of clinical resources that cover numerous healthcare fields, practices, and topics. We have numerous assessments you can use for rehabilitation work, whether for substance abuse, alcohol abuse, or physical injuries. An example of a clinical tool that you might want to use is the Alcohol Screening Test (AUDIT), which should help you gauge if a person has an Alcohol Use Disorder (AUD) or if they’re at risk of developing one. Our resources are free to download, so go ahead and download as much as you want and need!