4
Diagnosis
I. Identification and Diagnosis of Alcohol Withdrawal
A. Identification
Î Recommendation I.1: Incorporate universal screening for unhealthy
alcohol use into medical settings using a validated scale to help
identify patients with or at risk for alcohol use disorder and alcohol
withdrawal.
Î Recommendation I.2: For patients known to be using alcohol recently,
regularly, and heavily, assess their risk of developing alcohol
withdrawal even in the absence of signs and symptoms (see II. Initial
Assessment for risk factors and risk assessment scale).
Î Recommendation I.3: For patients who have signs and symptoms
suggestive of alcohol withdrawal, assess the quantity, frequency, and
time of day when alcohol was last consumed to determine whether the
patient is experiencing or is at risk for developing alcohol withdrawal.
For this assessment, it may be helpful to:
• Use a scale that screens for unhealthy alcohol use (e.g., Alcohol Use Disorders
Identification Test-Piccinelli Consumption [AUDIT-PC])
• Use information from collateral sources (i.e., family and friends)
• Conduct a laboratory test that provides some measure of hepatic function
Î Recommendation I.4: A biological test (blood, breath, or urine)
for alcohol use may be helpful for identifying recent alcohol use,
particularly in patients unable to communicate or otherwise give
an alcohol use history. When conducting a biological test, consider
the range of time (window of detection) in which the test can detect
alcohol use. Do not rule out the risk of developing alcohol withdrawal
if the result of a test is negative.
B. Diagnosis
Î Recommendation I.5: To diagnose alcohol withdrawal and alcohol
withdrawal delirium, use diagnostic criteria such as those provided by
the Diagnostic and Statistical Manual 5 (DSM-5). To diagnose alcohol
use disorder, use diagnostic criteria such as those provided by the
DSM-5.
Î Recommendation I.6: Alcohol withdrawal severity assessment scales
(including the Clinical Instrument Withdrawal Assessment for Alcohol,
Revised [CIWA-Ar]) should not be used as a diagnostic tool because
scores can be influenced by conditions other than alcohol withdrawal.
Î Recommendation I.7: Do not rule in or rule out the presence of
alcohol withdrawal for patients who have a positive blood alcohol
concentration.
