CIWA Scale for Alcoholism

The symptoms of alcohol withdrawal can be anxiety-provoking.

The CIWA scale for alcoholism has numerous benefits - the best benefit being that it helps to ensure appropriate medication dosing for individuals going through alcohol withdrawal syndrome symptoms.

Introduction to the CIWA

CIWA (pronounced SEE-WAH) stands for Clinical Institute Withdrawal Assessment. When it comes to making clinical assessments regarding alcohol withdrawal symptoms and management there are various tools available, but the CIWA has been considered the gold standard of these tools for years.

For simplicity's sake in this article, the CIWA will be referred to as the "CIWA", but technically it goes by another name; the CIWA-AR. CIWA-AR stands for Clinical Institute Withdrawal Assessment - Alcohol, Revised. The assessment has been revised to stay current as treatment for alcohol addiction, alcoholism treatment and withdrawals have been studied over the years.

When Is the CIWA Used

There are various situations where the CIWA is used. The assessment is used by care providers such as nurses and doctors, but the type of setting varies. The assessment can be and is completed in emergency rooms, alcohol treatment programs, mental health programs and facilities, and also sometimes during general hospital care. The assessment can be used in other areas of health care as well if a care provider feels it's necessary. The assessment can be administered in as little as five minutes, but it still shows useful results.

Some typical situations where a CIWA Scale for alcoholism is used include the following:

  • Obviously one of the most typical times to use the CIWA is when a care provider knows that an individual is going through the process of alcohol detoxification.
  • Many hospitals or areas within hospitals; for example Cedars-Sinai Medical/Surgical units have instituted a protocol stating that all individuals admitted must receive an assessment. This is because you can't always tell who is experiencing alcohol withdrawals. If an individual is going into withdrawal, it can affect the treatment plan or the next course of action such as sedation for surgery.
  • The CIWA is also used for scientific research studies and to promote further understanding of alcohol withdrawal symptoms.

Why Use the CIWA Scale

Alcohol withdrawal is an actual clinical diagnosis, and the symptoms can be very difficult for the individuals experiencing them. Delirium tremens are one of the most dangerous symptoms and can result in death, but they aren't the only symptom. Other symptoms of alcohol withdrawal include:

  • Headache
  • Chills
  • Tremors
  • Anxiety
  • Stomach pain
  • Agitation
  • Seizures

The goal of safe alcohol detox is to be able to detox people off of alcohol without having them suffer too badly, get too sick or possibly die from withdrawal symptoms. The CIWA Scale for Alcoholism can help care providers meet this goal. Certain medications, most notable Benzodiazepines, are effective at treating withdrawal symptoms. The goal of medication for alcohol withdrawal symptoms is to medicate but not over-medicate; this is another reason to use the CIWA.

Sometimes alcohol withdrawal can be managed without medication or partly with and partly without medications. The CIWA helps to figure out which treatment plan is necessary for individuals. Since alcohol withdrawal symptoms can change rapidly, the CIWA is often used continually throughout the primary withdrawal time sometimes every two to four hours. This allows care plans for treatment to adapt as needed.

Lastly, as mentioned above, sometimes individuals are admitted and have a drinking problem that is unknown to clinical staff. This can be highly dangerous because there's always a risk of medicating someone incorrectly. This is why the CIWA can be a very useful general assessment tool even if a person is not admitted for alcohol addiction.

What Does the CIWA Scale for Alcoholism Measure

Clinicians administering the CIWA should be properly trained, but the assessment is actually set up in an easy-to-follow format. Most health care workers, even without training, could administer the assessment easily.

Some of the CIWA measurements include:

  • Pulse and blood pressure measurements
  • Nausea and vomiting incidences including frequency and severity
  • Tactile disturbances that have a wide range from feeling a "pins and needles" sensation to itching to severe or continuous hallucinations
  • Tremor severity, if any
  • Visual and auditory disturbances
  • Sweating severity
  • Anxiety and agitation which may be noted from mild to serious panic attack mode
  • Orientation or disorientation levels

Where to Learn More about the CIWA

The CIWA can be an important tool when it comes to alcoholism recovery so it pays to read more about it. The CIWA is not copyrighted, and the document can be freely reproduced and given to anyone who'd like to administer the assessment or just take a look at it.

The Center for Substance Abuse Treatment (CSAT) offers free copies and more information regarding the CIWA.

Finally, The Knowledge Application Program (KAP) of the Center for Substance Abuse Treatment offers numerous useful TIPS sheets about administering the assessment and some basic information about the CIWA.

CIWA Scale for Alcoholism