PAWS: Prevention of alcohol withdrawal syndrome
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Symptoms of Alcohol Withdrawal Syndrome
Signs and symptoms of withdrawal from alcohol include two or more of the following, developing within several hours to a few days after cessation or reduction in heavy and prolonged use:

  • Nausea and vomiting
  • Increased hand tremor
  • Paroxysmal sweats
  • Anxiety
  • Agitation and irritability
  • Transient tactile disturbances and hallucinations (e.g.,itching, pins and needles sensations, burning, or numbness)
  • Transient auditory disturbances and hallucinations (e.g.,very aware of sounds or hearing things that do not exist)
  • Transient visual disturbances hallucinations or illusions (e.g.,sensitivity to light or seeing things that do not exist)
  • Headache and fullness of the head
  • Orientation and clouding of sensorium (e.g., disorientation with date and place)
  • Autonomic hyperactivity (e.g., diaphoresis, tachycardia, and elevated blood pressure)
  • Insomnia
  • Delirium tremens (DTs)
  • Psychomotor agitation
  • Grand mal seizures

The potential for alcohol withdrawal syndrome can be gauged only imprecisely by asking the patient the pattern, type, and quantity of recent and past alcohol use (such as screening with the AUDIT-C). Not all patients who are acutely intoxicated and/or physiologically dependent on alcohol will need pharmacological management of withdrawal symptoms.

The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) is the best known and most extensively studied scale for quantifiying alcohol withdrawal syndrome. It is a brief, empirically validated interview for assessing the severity of withdrawal risk.

Levels of Risk

The maximum score of the CIWA-Ar is 67. The higher the score, the greater the risk.

Scores of less than 8 to 10: Indicate minimal to mild risk of withdrawal symptoms. Patients that score less than 8 to 10 normally do not need to use additional medication for the managment of withdrawal.

Scores of 8 to 15: Indicate moderate risk of withdrawal symptoms.

Scores of 15 or more: Indicate that a patient is at increased risk for severe alcohol withdrawal.


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