ASAM Pocket Guidelines and Patient Guide

Alcohol Withdrawal Management

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3 Diagnosis Table 1. Alcohol Withdrawal Severity Severity Category Associated CIWA-Ar Range a Clinical Findings Mild CIWA-Ar <10 Mild or moderate anxiety, sweating and insomnia, but no tremor Moderate CIWA-Ar 10–18 Moderate anxiety, sweating, insomnia, and mild tremor Severe CIWA-Ar ≥19 Severe anxiety and moderate to severe tremor, but not confusion, hallucinations, or seizure Complicated CIWA-Ar ≥19 Seizure or signs and symptoms indicative of delirium – such as an inability to fully comprehend instructions, clouding of the sensorium or confusion – or new onset of hallucinations a roughout this document, we provide examples for withdrawal severity using the CIWA- Ar, although other scales can be used. Regardless of the instrument used, there is a wide variety in the literature and in practice as to which scores best delineate mild, moderate and severe withdrawal. Classification of withdrawal severity is ultimately up to the judgment of clinicians and the choice of reference range may be based on their particular patient population or capabilities.

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