What Is the CIWA Protocol for Alcohol Withdrawal?

Table of ContentsView AllTable of ContentsHistoryUsesScoringGuidelinesImpactTipsPotential Pitfalls

Table of ContentsView All

View All

Table of Contents

History

Uses

Scoring

Guidelines

Impact

Tips

Potential Pitfalls

The CIWA protocol for alcohol withdrawal is a questionnaire that measures the severity of an individual’salcohol withdrawal symptoms.

The goal of the CIWA protocol is to minimize the risk of complications and optimize the patient’s recovery. It is also known as the Clinical Institute Withdrawal Assessment for Alcohol scale.

History of the CIWA Protocol for Alcohol Withdrawal

The CIWA protocol was designed to standardize the care of patients with alcohol withdrawal and to improve outcomes. The original CIWA protocol included 30 items, but has since been reduced to include 10 in the revised version (CIWA-Ar).

More recently, the CIWA protocol has been shown to be an effective tool formanaging alcohol withdrawal. A study published in Hospital Pharmacy in 2016 found that patients who were managed with the CIWA protocol had a reduced daily dose of diazepam without any apparent safety issues.

What Is the CIWA Protocol for Alcohol Withdrawal Used For?

The CIWA protocol is used to assess and manage the symptoms of alcohol withdrawal. It can be used in both inpatient andoutpatientsettings. Scores can be used to guide the intensity of treatment.

For example, a patient with a score of 16 or higher may require more intensive treatment—such as IV fluids or medications—than a patient with a score of 7 or lower. In addition to assessing the severity of symptoms, the CIWA protocol can also be used to monitor the patient’s response to treatment.

Below is a list of different uses for the CIWA protocol:

How Do You Score the CIWA?

The CIWA protocol items are scored on a scale of 0-7, with higher scores indicating more severe symptoms. The final item regarding orientation to time and place is rated from 0-4. The CIWA score is based on the patient’s self-reported symptoms and observable signs. It takes two minutes to administer the assessment. Below are the total score ranges and their meaning:

What Are the Treatment Guidelines for the CIWA Protocol?

The treatment guidelines for the CIWA protocol are based on the severity of the patient’s symptoms.

Impact of the CIWA Protocol for Alchohol Withdrawal

The CIWA protocol is a widely used tool for the assessment and treatment of alcohol withdrawal. It is simple to use and has been shown to be an effective way to manage the symptoms of withdrawal.

The impact of the protocol has shown to be positive, both in terms of the patient’s symptoms and the overall course of their treatment. Below are some specific examples of the positive impact of the CIWA protocol:

Tips for Using the CIWA Protocol

Here are some tips to keep in mind when using the CIWA protocol for alcohol withdrawal:

Potential Pitfalls of the Protocol

There are some potential pitfalls to be aware of when using the CIWA protocol for alcohol withdrawal. These include the following:

A Word From Verywell

If you or a loved one are struggling with alcoholism, it’s important to seek professional help. Withdrawal from alcohol can be dangerous, and the CIWA protocol is an effective way to manage the symptoms of withdrawal. Be sure to work with a trained healthcare professional and follow the treatment guidelines to ensure the best possible outcome.

5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Society of Addiction Medicine.Clinical Institute Withdrawal Assessmentof Alcohol Scale, Revised (CIWA-Ar).Eberly ME, Lockwood AG, Lockwood S, Davis KW.Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution.Hosp Pharm. 2016;51(9):752-758. doi:10.1310/hpj5109-752Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM.Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).Br J Addict. 1989;84(11):1353-1357. doi:10.1111/j.1360-0443.1989.tb00737.xSteel TL, Giovanni SP, Katsandres SC, et al.Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?.Addict Sci Clin Pract. 2021;16(1):21. Published 2021 Mar 24. doi:10.1186/s13722-021-00226-wBacon O, Robert S, VandenBerg A.Evaluating nursing satisfaction and utilization of the Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar).Ment Health Clin. 2016;6(3):114-119. Published 2016 May 6. doi:10.9740/mhc.2016.05.114

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Society of Addiction Medicine.Clinical Institute Withdrawal Assessmentof Alcohol Scale, Revised (CIWA-Ar).Eberly ME, Lockwood AG, Lockwood S, Davis KW.Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution.Hosp Pharm. 2016;51(9):752-758. doi:10.1310/hpj5109-752Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM.Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).Br J Addict. 1989;84(11):1353-1357. doi:10.1111/j.1360-0443.1989.tb00737.xSteel TL, Giovanni SP, Katsandres SC, et al.Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?.Addict Sci Clin Pract. 2021;16(1):21. Published 2021 Mar 24. doi:10.1186/s13722-021-00226-wBacon O, Robert S, VandenBerg A.Evaluating nursing satisfaction and utilization of the Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar).Ment Health Clin. 2016;6(3):114-119. Published 2016 May 6. doi:10.9740/mhc.2016.05.114

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Society of Addiction Medicine.Clinical Institute Withdrawal Assessmentof Alcohol Scale, Revised (CIWA-Ar).Eberly ME, Lockwood AG, Lockwood S, Davis KW.Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution.Hosp Pharm. 2016;51(9):752-758. doi:10.1310/hpj5109-752Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM.Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).Br J Addict. 1989;84(11):1353-1357. doi:10.1111/j.1360-0443.1989.tb00737.xSteel TL, Giovanni SP, Katsandres SC, et al.Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?.Addict Sci Clin Pract. 2021;16(1):21. Published 2021 Mar 24. doi:10.1186/s13722-021-00226-wBacon O, Robert S, VandenBerg A.Evaluating nursing satisfaction and utilization of the Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar).Ment Health Clin. 2016;6(3):114-119. Published 2016 May 6. doi:10.9740/mhc.2016.05.114

American Society of Addiction Medicine.Clinical Institute Withdrawal Assessment

of Alcohol Scale, Revised (CIWA-Ar).

Eberly ME, Lockwood AG, Lockwood S, Davis KW.Outcomes After Implementation of an Alcohol Withdrawal Protocol at a Single Institution.Hosp Pharm. 2016;51(9):752-758. doi:10.1310/hpj5109-752

Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM.Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar).Br J Addict. 1989;84(11):1353-1357. doi:10.1111/j.1360-0443.1989.tb00737.x

Steel TL, Giovanni SP, Katsandres SC, et al.Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?.Addict Sci Clin Pract. 2021;16(1):21. Published 2021 Mar 24. doi:10.1186/s13722-021-00226-w

Bacon O, Robert S, VandenBerg A.Evaluating nursing satisfaction and utilization of the Clinical Institute Withdrawal Assessment for Alcohol, revised version (CIWA-Ar).Ment Health Clin. 2016;6(3):114-119. Published 2016 May 6. doi:10.9740/mhc.2016.05.114

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