PAWS: Prevention of alcohol withdrawal syndrome
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Assessing Alcohol Intoxication
The potential for alcohol withdrawal syndrome (AWS) can be gauged only imprecisely by asking the patient the pattern, type, and quantity of recent and past alcohol use.

Recent intake of alcohol can be assessed from the history, physical examination (e.g., alcohol on the breath), or toxicological analysis of urine or blood. The specific clinical picture of alcohol intoxication depends on quantity and frequency of consumption, the duration of drinking at that level, tolerance, time since last drink, expectations of effects, and the environment or setting of drinking.

According to the DSM-IV (APA, 1994) substance intoxication is:

  • The development of a reversible, substance-specific syndrome due to recent ingestion of (or exposure to) a substance. Note: Different substances may produce similar or identical syndromes.
  • Clinically significant maladaptive behavioral or psychological changes that are due to the effect of the substance on the central nervous system (e.g., belligerence, mood lability, cognitive impairment, impaired judgment, and impaired social or occupational functioning) and develop during or shortly after use of the substance.
  • Note: The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

Other substance intoxication considerations:

  • The most common signs and symptoms involve disturbances of perception, wakefulness, attention, thinking, judgment, psychomotor behavior, and interpersonal behavior.
  • Patients should be medically observed at least until the blood alcohol level (BAL) is decreasing and clinical presentation is improving.
  • Highly tolerant individuals may not show signs of intoxication. For example, patients may appear "sober" (or even exhibit significant withdrawal symptoms) at BALs well above the legal limit (e.g., 80 or 100 mg percent), but will still need detoxification.

Table 1. Signs and Symptoms of Intoxication (APA, 1994)

Types of Intoxication

Signs and Symptoms


• Slurred speech
• Incoordination
• Unsteady gait
• Nystagmus
• Impairment in attention or memory
• Stupor or coma


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Course Overview Alcohol Intoxication Case Study Assessing Alcohol Intoxication CIWA-Ar Case Study #1 Symptoms of AWS & Levels of RIsk CIWA-Ar Case Study #2 Explore the CIWA-Ar Additional Resources & Information