CIWA-B Scale
Use the CIWA-B Scale to assess the level of benzodiazepine withdrawal in patients.
Fact Checked by Ericka Pingol.
What is benzodiazepine and benzodiazepine withdrawal?
Benzodiazepines are a class of medications used to treat anxiety and insomnia. They act as central nervous system (CNS) depressants, meaning they have a sedative effect that slows down brain activity. These drugs are commonly prescribed due to their efficacy in addressing and managing the mentioned psychological and mental health conditions.
Nevertheless, as with any sedative medication, there is a potential risk of addiction or dependence associated with benzodiazepines. To ensure safety, it is advisable to strictly adhere to the prescribed benzodiazepine and dosage provided by a healthcare professional, thereby mitigating the risk of developing dependency or addiction.
Prolonged usage of this drug can lead to the body developing tolerance, making it harder to adjust to lower doses or sudden discontinuation. This can result in withdrawal symptoms, such as headaches, heightened anxiety, insomnia, tremors, difficulty concentrating, and in severe cases, hallucinations.
The was created to gauge the severity of benzodiazepine withdrawal symptoms.
Printable CIWA-B Scale
Download this CIWA-B Scale to assess the level of benzodiazepine withdrawal in patients.
How to use the CIWA-B Scale:
The CIWA-B Scale is similar to the CIWA-AR Scale, which is used to gauge symptoms of alcohol withdrawal. Still, this variation of the CIWA Scale can be used as a self-report assessment, meaning this can be administered in two ways:
- You can approach it as an interview, where you ask the listed questions and have the person rate themselves on a scale of 0 to 4. It's important to clarify the descriptions for each rating, as they may vary per item.
- Alternatively, you can provide a copy of the questionnaire to the patient and ask them to fill it out. Once they're finished, they can submit it back to you.
Either option works. Whichever you pick is fine. You just need to take note that Items 18 to 20 are clinical observations, so the professional will need to use the scale either way.
Here are some of the questions that need to be answered:
- Do you feel irritable?
- Do you feel fatigued?
- Do you feel tense?
- Do you have difficulties concentrating?
- Do you have any loss of appetite?
- Have you any numbness or burning on your face, hands or feet?
- Do you feel your heart racing? (Palpitations)?
After the scale has been accomplished, you just need to add up the scores from Items 1 to 20. The minimum score is 0, and the maximum is 80. The last two items (Item 21 and 22) are not scored, but they provide additional information regarding the benzodiazepine withdrawal.
Here’s how to interpret the results:
- 1 to 20 = Mild withdrawal
- 21 to 40 = Moderate withdrawal
- 41 to 60 = Severe withdrawal
- 61 to 80 = Very severe withdrawal
CIWA-B Scale Example:
Now that you know what benzodiazepine and benzodiazepine withdrawal are, what the CIWA-B Scale is, how it’s answered, and how it’s scored, it’s time for you to see what it looks like. We just adapted the original from Busto, U., Sykora, K. and Sellers, E for our template. A clinical scale to assess benzodiazepine withdrawal. Journal of Clinical Psychopharmacology, 1989. 9(6): 412-416. We only added radio buttons for people to tick using a pen or click when engaging with the digital version and an additional comments box where professionals can jot down their observations while administering the scale.
If you like what you see and believe the template will help you gauge your patients better, feel free to download this free CIWA-B Scale PDF template!
Download this CIWA-B Scale Example:
When is it best to use the CIWA-B Scale?
The Clinical Institute Withdrawal Assessment – Benzodiazepine Scale is most effectively utilized when assessing patients admitted to hospitals, clinics, or rehabilitation centers for benzodiazepine detoxification programs. Assigned professionals should promptly employ the scale to evaluate the severity and progression of withdrawal symptoms.
By accurately gauging benzodiazepine withdrawal symptoms, professionals can devise appropriate treatment plans, including medication substitution. The score obtained from the scale will guide the safe implementation of the detoxification process for the patient.
Moreover, the CIWA-B Scale can be used multiple times at intervals to monitor the progression of benzodiazepine withdrawal symptoms in patients. The onset of these symptoms varies, with some individuals experiencing them immediately and others after several hours. It's important to note that symptoms can rapidly escalate from mild to severe within minutes or hours after the initial test.
What are the benefits of using the CIWA-B Scale?
The CIWA-B Scale is standardized and easy to use.
One of the best things about the CIWA-B Scale is that it creates a standardized method for healthcare professionals to assess patients undergoing benzodiazepine withdrawal and detoxification. It doesn’t even require any special equipment to administer.
The professional using the scale simply needs to hand the patient a copy of the scale and then complete Items 18 to 20 when they receive it back from the patient. Or, they can just ask the questions on the scale and then have the patient rate accordingly. This scale ensures that patients are assessed the same way.
The CIWA-B Scale assists professionals in assessing appropriate courses of action for patients.
The actions professionals need to take for patients will vary based on the severity of their benzodiazepine withdrawal symptoms. Since severe symptoms can pose life-threatening risks, the use of the score can assist in determining the necessary course of action.
It serves well as a monitoring tool.
As previously mentioned, the CIWA-B Scale can be used as an ongoing monitoring tool rather than just a one-time assessment. This is because individuals undergoing benzodiazepine detoxification may initially experience mild symptoms, which can progress to moderate or severe symptoms over time. By regularly implementing the CIWA-B Scale during a patient's hospital, clinic, or rehabilitation center stay, healthcare professionals can promptly adapt their treatment approach based on any changes observed in the patient's symptoms.
Commonly asked questions
5 to 10 minutes.
Yes. They can come back from time to time to have their symptoms checked.
If it’s not handed to you by a professional, no. It’s best that it’s given to you by a professional because Items 18 to 20 require them to observe you.
