CIWA-AR Scale
Use the CIWA-AR Scale to assess the level of alcohol withdrawal in patients.
Fact Checked by Ericka Pingol.
What is alcohol withdrawal?
Alcohol withdrawal is a complex process that requires careful assessment and management to ensure the well-being of individuals experiencing symptoms. The Clinical Institute Withdrawal Assessment (CIWA-Ar) scale is a widely used tool to evaluate the severity of alcohol withdrawal symptoms. This scale, developed by the Addiction Medicine Working Group, encompasses a range of withdrawal symptoms, from mild to severe, including nausea, hallucinations, itching, and more.
The CIWA-Ar scale allows healthcare professionals, particularly family physicians and addiction medicine specialists, to gauge the intensity of symptoms and tailor treatment accordingly. It takes into account various factors, such as the severity of hallucinations, tactile disturbances, and nervousness, among others. The scale's objective is to provide an individualized treatment approach, utilizing symptom-triggered therapy and fixed schedule doses as needed.
Treatment guidelines based on evidence-based practice emphasize the importance of assessing and treating alcohol withdrawal in both inpatient and outpatient settings. The severity of alcohol withdrawal is a crucial factor in determining the appropriate pharmacological management and the need for inpatient detoxification. Visual disturbances, auditory disturbances, and other symptoms are carefully considered in creating an effective management plan.
Healthcare professionals play a vital role in the continuous assessment and treatment of alcohol withdrawal itself, considering factors like blood pressure, sweating patterns, and psychological symptoms. The goal is to ensure a safe and comfortable withdrawal process for individuals seeking support for alcohol use. Overall, the CIWA-Ar scale and its comprehensive assessment approach contribute to evidence-based practices in the management of alcohol withdrawal, promoting the well-being of individuals in their journey toward recovery.
Printable CIWA-AR Scale
Download this CIWA-AR Scale to assess alcohol withdrawal in patients.
How to use the CIWA-AR Scale
Using the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-AR) scale involves a systematic evaluation of various withdrawal symptoms to assess the severity and guide appropriate treatment. Here are the general steps to use the CIWA-AR scale:
Baseline assessment:
Begin by obtaining a baseline measurement of vital signs, including blood pressure, pulse rate, respiratory rate, and body temperature.
Initial CIWA-AR score:
Administer the CIWA-AR scale questionnaire, which consists of items related to withdrawal symptoms such as nausea, sweating, tremors, anxiety, and others. Assign a score to each symptom based on the individual's reported experience.
Scoring and evaluation:
Tally up the scores for each symptom to calculate the total CIWA-AR score. The severity of withdrawal is categorized into mild, moderate, or very severe symptoms based on the total score.
Frequency of assessment:
Depending on the severity of withdrawal symptoms, the frequency of assessment may vary. In severe cases, continuous monitoring may be necessary, while in milder cases, periodic assessments suffice.
Treatment decision:
The CIWA-AR scale assists healthcare professionals in making informed decisions about the appropriate level of care and treatment interventions. It guides the use of medications and helps determine the need for inpatient or outpatient management.
Symptom-triggered approach:
In some cases, a symptom-triggered approach is employed, where medication is administered based on the specific symptoms and their severity rather than a fixed schedule.
Reassessment:
Regularly reassess the individual's condition using the CIWA-AR scale throughout the withdrawal process. Adjust treatment plans accordingly based on the evolving severity of symptoms.
Documentation:
Document the CIWA-AR scores and any changes in symptoms during the withdrawal period. This documentation is valuable for tracking progress and informing further treatment decisions.
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 Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-AR) scale is best used in the following situations:
- Alcohol withdrawal assessment: The CIWA-AR scale is specifically designed for assessing and monitoring individuals undergoing alcohol withdrawal. It is most appropriate for patients with a history of alcohol dependence who are at risk of experiencing withdrawal symptoms.
- Inpatient detoxification: The scale is commonly employed in inpatient settings, especially during detoxification programs where individuals are closely monitored for alcohol withdrawal symptoms. It helps healthcare professionals determine the severity of alcohol withdrawal syndrome and guide appropriate treatment interventions.
- Symptom-triggered management: The CIWA-AR scale is particularly useful when employing a symptom-triggered approach to medication administration. Instead of fixed schedules, medications are administered based on the severity of specific withdrawal symptoms, as indicated by the scale.
- Continuous monitoring: In cases of severe alcohol withdrawal, the CIWA-AR scale is valuable for continuous monitoring of symptoms. This allows healthcare providers to respond promptly to changes in symptom severity and adjust treatment plans accordingly.
- Assessment for medication need: The scale is instrumental in determining the need for pharmacological interventions to manage withdrawal symptoms. It guides healthcare professionals in choosing appropriate medications and adjusting dosages based on the individual's symptomatology.
- Outpatient management: While the CIWA-AR scale is commonly associated with inpatient care, it can also be adapted for outpatient settings, especially when individuals are at risk of developing or are experiencing mild to moderate alcohol withdrawal symptoms.
- Follow-up assessments: The scale is valuable for follow-up assessments during the course of alcohol withdrawal treatment. It allows healthcare providers to track progress, identify any resurgence of symptoms, and make necessary adjustments to the treatment plan.
- Assessment Standardization: The CIWA-AR scale provides a standardized method for assessing alcohol withdrawal symptoms, ensuring consistency in evaluation and facilitating communication among healthcare professionals involved in the individual's care.
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.
Commonly asked questions
Approximately 5 minutes.
The scale mentions that patients who score below 10 don’t usually need additional medication. If they score higher, you might want to provide additional medication based on the overall score and the symptoms' high rating.
No. Only professionals should use this because they will know what they need to observe while administering the scale. If you need to get checked or know someone going through alcohol withdrawal, please contact a healthcare professional.
