7
Î Recommendation II.7: Patients' risk for complicated withdrawal or
complications of withdrawal is increased by the presence of multiple
risk factors.
Î Recommendation II.8: In general, clinicians may consider patients
at risk of severe or complicated withdrawal if they are experiencing
at least moderate alcohol withdrawal on presentation (e.g., CIWA-Ar
score ≥10).
C. Risk Assessment Tools
Î Recommendation II.9: Clinicians can consider the use of a tool such
as The ASAM Criteria Risk Assessment Matrix to assess a patient's
risk of severe or complicated alcohol withdrawal as well as potential
complications of withdrawal.
Î Recommendation II.10: The following scales can be helpful for
assessing for the risk of severe alcohol withdrawal:
• Prediction of Alcohol Withdrawal Severity Scale (PAWSS)
• Luebeck Alcohol-Withdrawal Risk Scale (LARS)
D. Symptom Assessment Scales
Î Recommendation II.11: A validated scale should be used to assess
alcohol withdrawal severity.
Î Recommendation II.12: Assess the risk for scores on an alcohol
withdrawal severity assessment scale to be confounded by causes
other than alcohol withdrawal. If risk factors are present, interpret
the results of scales with caution. Use a scale that relies more
on objective signs of withdrawal (autonomic activity) if a patient
has difficulty communicating about their symptoms. See Alcohol
Withdrawal Scales Table for the features of different scales.
Î Recommendation II.13: A validated withdrawal severity assessment
scale can be used as part of risk assessment. A high initial score can
indicate risk of developing severe or complicated withdrawal, although
scores should not be the only information used to predict patient risk.
E. Identify Concurrent Conditions
Î Recommendation II.14: When assessing for concurrent medical
conditions, screen patients for medical conditions that could affect
the course of alcohol withdrawal or treatment of alcohol withdrawal,
as well as common chronic conditions that are associated with alcohol
use disorders.
Î Recommendation II.15: A pregnancy test should be obtained for
women of childbearing potential. For managing pregnant patients,
see VII.F. Patients who are pregnant.
