CIWA-AR Assessment for Alcohol Withdrawal

What is the CIWA-AR?

CIWA-AR is a method for diagnosing and assessing alcohol withdrawal. It’s become one of the most common treatment modalities for alcohol withdrawal because it provides accurate test results and gives medical professionals an idea of how bad alcohol withdrawal is. In turn, this helps physicians come up with a plan to treat alcohol withdrawal symptoms. Treatment is often carried out with therapy for less severe cases and medications for more severe cases.

What does CIWA-AR Stand for?

CIWA-AR stands for Clinical Institute Withdrawal Assessment Alcohol Scale Revised. It’s a test that’s designed to help doctors understand the severity of alcohol withdrawal. Over time the Clinical Institute Withdrawal Assessment Alcohol Scale has been revised to account for testing errors or discrepancies. The questions have been tested for years and continue to evolve with each iteration of the CIWA-AR assessment.

What Symptoms can be Measured with CIWA-AR?

The CIWA-AR assessment is used to measure many symptoms like agitation. While symptoms vary in complexity, it gives doctors a chance to understand a patient’s specific symptoms.

The symptoms the CIWA-AR assessment measures are below.

• Agitation
• Anxiety
• Auditory disturbances
• Clouding of the sensorium
• Headaches
• Vomiting, nausea, stomach discomfort
• Sweats (Paroxysmal)
• Tactile disturbances
• Tremors
• Visual disturbances

All patients that take the CIWA-AR assessment are tested for these symptoms and the severity of each symptom.

How is the CIWA-AR Scored?

The CIWA-AR uses a scale of 0-7 for each question. On the CIWA-AR assessment, each question takes about 2 minutes to complete. When the exam is completed physicians add up the scores for each of the 10 symptoms. The total score gives physicians an idea of how mild or severe a case of alcohol withdrawal is. Physicians use a cumulative score range to determine the severity of alcohol withdrawal.

When a patient has a cumulative score between 8-10 alcohol withdrawal is mild. Scores between 10-15 indicate moderate withdrawal. It’s also important to note that some questions can lead to a moderate alcohol withdrawal diagnosis with scores that are between 8-15. In these cases, physicians weigh symptoms like tremors and visual/audio disturbances more heavily. If a patient has scores that are greater than 15 alcohol withdrawal is severe and there is a higher risk of delirium tremens, which can lead to death if not treated properly.

Who Should Use CIWA-AR Assessment Tool?

The CIWA-AR assessment tool should only be used by medical health professionals. Medical health professionals include physicians, therapists, and licensed doctors. While patients can take the test on their own, it’s important to work with a healthcare provider for accurate scoring. Accurate scoring can only be done by medical professionals because they’re qualified to evaluate a patient’s answers.

What are the Questions in CIWA-AR?

There are 10 questions on the CIWA-AR assessment. While some medical health professionals may ask different variations of the questions, each question is based on the same template. Some questions are also based on observation, so some healthcare providers will simply observe a patient for symptoms.

The questions on the CIWA-AR assessment are listed below.

1. Do you feel sick to your stomach and have you vomited?
2. Do you have any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?
3. Observing tremors in the patient. Having the patient fully extend their arms and spread their fingers.
4. Are you hearing things you know are not there?
5. Observing paroxysmal sweats
6. Are you seeing anything that is disturbing to you? Things you know are not there?
7. Do you feel nervous?
8. Does your head hurt or feel different? Does it feel like there is a band around your head?
9. Observe agitation
10. What day is this? Where are you? Who am I?

Each question has a score range based on the patient’s answers.

What are the Limitations of CIWA-AR Assessment Tool?

The CIWA-AR assessment has several limitations. Some researchers have pointed out that only 3 questions out of 10 can be answered by observing the patient. Therefore, physicians must rely on the accuracy of a patient’s answers to dialog-based questions to score the rest of the exam. Therefore, one limitation of the CIWA-AR assessment is that patients might not always answer honestly. Another limitation is that patients might not be able to accurately explain or understand their symptoms. Patients can also be in denial of alcohol withdrawal and purposely answer questions with inaccurate answers.

Furthermore, the CIWA-AR assessment can be limited by language barriers. Patients who can’t communicate effectively with physicians are unable to express the extent of their symptoms. Moreover, people who are struggling with alcoholism might not be in the best state of mind to answer questions on the CIWA-AR assessment effectively. These are a handful of the limitations that the CIWA-AR assessment has.

How Reliable is CIWA-AR to Measure Alcohol Withdrawal Symptoms?

The CIWA-AR assessment is one of the most common treatment modalities for alcohol withdrawal because it’s reliable. That said, researchers have pointed out that it does have flaws and inaccuracies. While the CIWA-AR assessment is reliable in patients that are honest and in the right state of mind to take the assessment, it’s less reliable for people who have language barriers. It’s also less reliable for patients who are unable to answer the questions because of the severity of their alcohol withdrawal.

Overall, the CIWA-AR assessment is one of the most accurate tools for diagnosing alcohol withdrawal. While there are assessments that people with alcohol abuse disorder (AUD) can take on their own, the CIWA-AR assessment is one of the few exams administered by medical health professionals.