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The Alcohol Withdrawal CIWA Protocol

Table of Contents

Alcohol withdrawal is a serious consequence of alcohol addiction, and Many addicts endure mild to severe withdrawal symptoms due to their alcohol addiction. Due to the potentially fatal side effects of alcohol withdrawal, medical detox programs are highly recommended for the detox process. 

Medically assisted detox programs ensure that medical professionals watch the patient and provide the necessary treatment when withdrawal symptoms appear.

If you are detoxing from alcohol, it is vital to be able to track the progression of your withdrawal. Doctors created the CIWA protocol for alcohol withdrawal to address this issue.


What Does CIWA Stand for?

The CIWA medical abbreviation stands for Clinical Institute Withdrawal Assessment. Medical experts use it to measure and identify the severity of alcohol withdrawal in patients undergoing treatment. According to the Centers for Disease Control and Prevention, the CIWA protocol is one of the most prevalent techniques for treating alcohol withdrawal, and family physicians frequently utilize it.

To prevent further health consequences and treat the withdrawal syndrome appropriately, clinicians use the CIWA-AR to assess the severity of their patients’ alcohol withdrawal symptoms.

The CIWA scale may assess a total of ten alcohol withdrawal symptoms, which include:

  • Agitation (0-7).
  • Anxiety (0-7).
  • Auditory disturbances (0-7).
  • Clouding of sensorium (0-7).
  • Headache (0-7).
  • Nausea/vomiting (0-7).
  • Paroxysmal sweats (0-7).
  • Tactile disturbances (0-7).
  • Tremor (0-7).
  • Visual disturbances (0-7)


How to use the CIWA Protocol Assessment

It is recommended that the CIWA procedure be implemented in a professional medical setting by a registered physician and their staff. Family doctors and physicians working in inpatient and outpatient treatment programs may benefit from using the CIWA protocol exam in their offices.


How Does CIWA Scoring Work?

The CIWA protocol assigns a score to each symptom on a scale ranging from 0 to 7, and it takes less than 2 minutes to complete. Physicians can determine the severity of a patient’s withdrawal syndrome by summing up the scores for each of the ten symptoms and calculating a total score.

Mild withdrawal is indicated by cumulative scores of fewer than 8-10 points. Following that, scores between 8 and 15 indicate mild withdrawal, and scores between 15 and more than 15 suggest severe withdrawal, with the possibility of delirium tremens on the horizon.

CIWA Protocol


Screening Questions for the CIWA Protocol

To give a CIWA protocol score, experts usually ask many questions regarding the withdrawal symptoms users are probably experiencing. The CIWA scoring is based on these screening questions. Let’s check them out below:


Do you have a stomachache, and have you vomited?

0 – There is no nausea or vomiting.

1 – a mild case of nausea without vomiting

2,3,4 – nausea with dry heaves on and off

5,6,7 – nausea, dry heaves, and vomiting regularly


Do you experience itching, pins & needles, burning, numbness, or the sensation of creatures crawling on or under your skin?

0 – There are no sensory disruptions.

1 – tingling, pins & needles, burning, or numbness

2 – slight itchiness, tingling, burning, or numbness

3 – itching, pins, and needles, burning, or numbness that is moderate

4 – moderately severe hallucinations

5 – Severe hallucinations 

6 – exceedingly intense hallucinations

7 – intense hallucinations regularly


Extend the patient’s arms and stretch their fingers to see whether they have any tremors.

0 – indicates that there is no tremor.

1 – cannot be seen but can be felt from fingertip to fingertip

2,3,4 – moderate, with arms extended by the patient

5,6,7 – extremely intense, even when arms aren’t extended


Do you think you hear things that aren’t there? (As well as other connected issues)

0 – not present.

1 – a slight degree of harshness or the potential to terrify

2 – the ability to terrify or mild harshness

3 – the ability to intimidate or soften the severity

4 – moderately severe hallucinations

5 –  Severe hallucinations

6 – exceedingly intense hallucinations

7 – persistent hallucinations


Observation of Paroxysmal Sweats.

0 – no apparent perspiration

1 – hardly discernible perspiration, moist palms

2,3,4 – visible sweat droplets on the forehead

5,6,7 – drenching sweats 


Is there anything you’re seeing that bothers you? Do you get visions of things that you know aren’t there?

0 – indicates that the item is not present.

1 – a shallow level of sensitivity

2 – sensitivity to light

3 – sensitivity is moderate

4 – moderately severe hallucinations

5 – Severe hallucinations

6 – exceedingly intense hallucinations

7 – persistent hallucinations


Do you have any anxiety?

0 – anxiety-free and relaxed

1 – mildly agitated

2,3,4 – moderately apprehensive or cautious, implying anxiousness

5,6,7 – a state of intense panic similar to that experienced in severe delirium or acute schizophrenia symptoms.


Do you have a headache or a strange sensation in your head? Is it as if you’re wearing a band around your head?

0 – indicates that nothing is present.

1 – extremely mild

2 – gentle

3 – average

4 – a moderately severe condition

5 – very serious

6 – extremely severe

7 – the worst-case scenario


Observation of agitation. 

1 – a little more than usual activity

2,3,4 – fidgety and restless to a degree

5,6,7 – paces back and forth for the whole of the conversation or thrashes about incessantly


What day is it today? Where have you gone? Who am I, exactly?

0 – Oriented and capable of serial additions

1 – is unable to perform serial additions or is unsure of the date

2 – off by no more than 2 calendar days in terms of date

3 – off by more than 2 calendar days in terms of date

4 – unsure of where you are or who you are


The CIWA Protocol’s Validity and Reliability

Researchers have expressed doubts about the CIWA’s legitimacy and reliability in the past decade. Just three of the 10 components (sweats, tremors, and agitation) may be quantified by observation alone; the other seven require patient talk.

A patient and physician’s language barrier can make this problematic, preventing accurate and precise grading. Some patients may not be in the optimal mental state to answer questions about their health while being tested and scored because they are already battling alcohol misuse.


Detox in Southern California

The CIWA protocol is just a tool to help medical professionals, but it is not a substitute for a certified detox program. If you or someone you care about is having problems with alcohol use or abuse, you may reach out to The Right Time Recovery at 800-630-1218. 

When you make the confidential call to our facility, one of our care coordinators will discuss your treatment options and details of our program. Also, If you are unsure if your insurance will cover treatment, we will be able to help you get answers fast.