When a person comes to a doctor’s office, two things will point toward a diagnosis of alcohol withdrawal: the first is long-term alcohol use with sudden cessation, and the second being symptoms typical of withdrawal (these will be explained in the following paragraphs). For the symptoms, physicians use a largely accepted algorithm known as the CIWA-Ar (Clinical Institute Withdrawal Assessment) protocol. This survey takes a snapshot of a patient to determine how severe their withdrawal is at a point in time during their visit.
What doctors look for when determining severity of alcohol withdrawal: The categories assessed by the patient include nausea and vomiting, tremor (often in the hands), auditory, tactile or visual hallucinations, sweats, anxiety, headache, agitation, and disorientation. Additionally, the doctor will measure heart rate, blood pressure, and do a physical exam. Each category is measured out of 7 points, with 7 being the worst (the exception to this is disorientation, which is measured out of 4 points). The maximum score in the assessment is a 67, with patients under 10 usually being safe without medication, and with any number over 20 being considered severe withdrawal. However, this scale is meant to determine the severity of withdrawal, and is not as helpful in laying out a timeline of when these symptoms will present. For that, it is more helpful to understand the body’s reaction to the cessation of alcohol use.