How to Gauge the Severity of Alcohol Withdrawal Symptoms

Alcohol Withdrawal Scale — The Recovery Village Drug and Alcohol Rehab

How to Gauge the Severity of Alcohol Withdrawal Symptoms

  • The CIWA-Ar is a tool used by health care professionals to evaluate the severity of alcohol withdrawal symptoms.
  • The CIWA-Ar uses ten different items, each scored on a scale of zero to seven to provide a score that indicates a patient’s risk.
  • A patient’s CIWA-Ar score can help determine if withdrawal medications are not needed, possibly needed or definitely needed.

The symptoms of alcohol withdrawal can be overpowering and unpleasant.

When someone is working to abstain from alcohol misuse, these withdrawal symptoms may lead them to stop the process and drink again.

Medications are sometimes prescribed to help treat symptoms. However, these drugs are very strong and may have side effects of their own. Additionally, it’s possible for the medications themselves to be addictive or cause dependence.

Using the CIWA-Ar for Alcohol Withdrawal Assessment

A standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol Scale Revised (CIWA-Ar) was created to help health care professionals assess the severity of alcohol withdrawal symptoms. This assessment allows them to determine whether medications are needed to ease or alleviate symptoms.

Because patients sometimes underreport alcohol consumption, physicians often overlook misuse. Potentially life-threatening consequences, such as delirium tremens or seizures, could be missed if alcohol withdrawal symptoms go unrecognized. For these reasons, the CIWA-Ar is also used to assess patients in various situations, such as general outpatient, emergency, surgical or psychiatric care.

Related Topic: Home remedies for alcohol withdrawal

How To Use the CIWA-Ar Alcohol Withdrawal Scale

The CIWA-Ar scale consists of 10 items (or conditions) that a health care provider reviews. Each item is evaluated separately and then combined to produce an aggregated score, which indicates the severity and potential for alcohol withdrawal symptoms. Any sign indicating patterns or side effects of excessive alcohol use could point to a possibility of severe withdrawal symptoms.

See Also: What helps with alcohol withdrawal

Each item is scored on a scale of zero to seven, with zero meaning no symptoms are present and seven meaning the worst possible symptoms are ly. Most items have specific questions that the health care provider will ask, but some are based solely on observation.

To ensure the results are consistent, the wording for each question is designed to be the same each time. The ten items include:

  1. Nausea and vomiting: The doctor asks, “Do you feel sick to your stomach? Have you vomited?
  2. Tremor: The doctor notes the presence and severity of the patient’s tremors.
  3. Paroxysmal sweats: The doctor notes the presence and amount of the patient’s visible sweat.
  4. Anxiety: The doctor asks, “Do you feel nervous?”
  5. Agitation: The doctor notes the patient’s level of agitation.
  6. Tactile disturbances: The doctor asks, “Do you have any itching, pins and needles sensations, burning sensations, numbness, or do you feel bugs crawling on or under your skin?”
  7. Auditory disturbances: The doctor asks, “Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?”
  8. Visual disturbances: The doctor asks, “Does the light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?”
  9. Headache, fullness in head: The doctor asks, “Does your head feel different? Does it feel there is a band around your head?”
  10. Orientation, clouding of sensorium: The doctor asks, “What day is this? Where are you? Who am I?”

CIWA-Ar Score Interpretation

After completing the assessment, the points are tallied and the level of alcohol withdrawal is calculated. The points are categorized as follows:

  • Nine points or less: Withdrawal is absent or minimal, and withdrawal medications are ly unnecessary.
  • Ten to 20 points: Mild to modest alcohol withdrawal may be present. Withdrawal medications may be necessary.
  • 21 points or higher: Severe alcohol withdrawal may be present. Withdrawal medications are almost definitely necessary.

Once the severity is calculated, the health care provider will address which withdrawal medications are necessary to treat withdrawal symptoms.


  • When should the CIWA-Ar be used?The CIWA-Ar should only be used by a licensed health care provider who is specifically trained to perform this type of assessment. CIWA-Ar scoring should be used when initially assessing any patient who is suspected to have alcohol withdrawal symptoms or may be ly to develop alcohol withdrawal. The assessment should be repeated until withdrawal symptoms resolve or until the risk of withdrawal is minimal.
  • What should I know about using the CIWA-Ar?The CIWA-Ar assessment should only be performed by health care professionals. If you are a health care professional, you should understand how to correctly use the CIWA-Ar and how each item is scored. You should also be familiar with how to interpret the CIWA-Ar score and know what interventions to take the score.
  • What CIWA-Ar score would require medication to help with alcohol withdrawal?Each person withdrawing from alcohol will have different medication needs. These needs should be evaluated by a health care provider using more than just the CIWA-Ar. However, the CIWA-Ar score will play an important role in guiding the decisions. A patient with a score between nine and 19 may need medication to help with alcohol withdrawal, while an individual with a score of 20 or higher will almost definitely need withdrawal medications.
  • When should a patient seek medical help for alcohol withdrawal?Alcohol withdrawal is one of the most dangerous types of substance withdrawal a person can experience. Anyone who is undergoing alcohol withdrawal should seek medical help, but those who are experiencing tremors, confusion, seizures or fever should seek immediate medical care.

If you or a loved one is struggling with alcohol addiction and experiencing withdrawal symptoms, The Recovery Village can help. Contact us today to learn more about alcohol treatment plans and programs that can work well for your needs.

  • SourcesAmerican Society of Addiction Medicine. “Addiction Medicine Essentials: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar).” January 2001. Accessed August 12, 2021.Knight, Erin. “Clinical Institute Withdrawal Assessment for Alcohol–Revised might be an unreliable tool in the management of alcohol withdrawal.” Canadian Family Physician, September 2017. Accessed August 12, 2021.Merck Manuals. “CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol scale.” 2020. Accessed August 12, 2021.U.S. National Library of Medicine. “Delirium tremens.” MedlinePlus, August 5, 2021. Accessed August 12, 2021.
  • Medical DisclaimerThe Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.View our editorial policy or view our research.

Share on Social Media:


Alcohol Withdrawal Symptoms, Signs & Timeline // OYNB

How to Gauge the Severity of Alcohol Withdrawal Symptoms

In this blog post we are going to discuss alcohol withdrawal symptoms: the typical symptoms and stages of withdrawal, what brings on alcohol withdrawal, and what you can do if you are experiencing alcohol withdrawal.

If you are dependent on alcohol, it is recommended by the NHS to seek medical advice to manage your withdrawal.

Withdrawal symptoms are ly to occur among people who consume alcohol in large quantities for a prolonged period and then stop abruptly. Symptoms tend to begin 6 to 24 hours after the last alcoholic drink. There are typically three stages of alcohol withdrawal:

Symptoms: anxiety, tremors, headaches, palpitations, gastrointestinal disturbances

Symptoms: mild symptoms and abnormal sweating, increased blood pressure, abnormally rapid breathing or heart rate, confusion, mild hyperthermia

Symptoms: moderate symptoms and disorientation, impaired attention, visual and/or auditory hallucinations, seizures

It is recommended to seek urgent medical advice if you are experiencing any of these alcohol withdrawal symptoms, and to manage your withdrawal.

The first stage of alcohol withdrawal symptoms starts with 6 to 12 hours after your last drink. The The early stage symptoms of alcohol withdrawal are changes in behaviour and mood as well as some minor physical side effects, mimicking a hangover. 

It is easy for loved ones to look over these signs of alcohol withdrawal as the are just having a hangover. For an individual that has consumed a large amount of alcohol over a prolonged period of time it is important not to ignore these initial signs. 

The symptoms experienced in stage 1 can feel the same as  with a hangover and you may not experience anything more severe. However those who have been more regularly for a longer period of time may experience symptoms from stages 2 or 3. 

The first stage of alcohol withdrawal symptoms include: 

  • Headaches
  • Dilated pupils
  • Unclear thinking 
  • Alcohol cravings
  • Loss of appetite 
  • Vomiting 
  • Hand tremors

Signs of alcohol withdrawal in stage 1 

As well as the symptoms listed above the first stage withdrawal symptoms can also have you feeling anxious or stressed. You may be experiencing mood swings, restlessness and a real lack of energy. Sleeping can be difficult with insomnia and nightmares very common in this stage of alcohol withdrawal symptoms. 

After 12 to 48 hours after your last drink you will start to experience stage 2, mild symptoms of alcohol withdrawal. These alcohol withdrawal symptoms are more intense and now you will be showing clear signs of alcohol withdrawal. 

The second stage of alcohol withdrawal symptoms include: 

  • Irregular blood pressure
  • Irregular heart beat
  • Fever 
  • Breathing difficulties 
  • Seizures 

Signs of alcohol withdrawal in stage 2  

The signs of alcohol withdrawal in stage 2 are far more severe. As seizures may start during this period of time it is important to seek the help and advice of a medical professional. It is common to become easily confused and extremely irritable. 

During this time loved ones will be able to see clear signs of alcohol withdrawal. 

In your alcohol withdrawal timeline, normally between 48-72 hours you will start to experience severe symptoms. This period can be fatal due to the fact that “delirium tremens” (also known as DTs), a potentially life threatening condition and seizures can both occur without warning.

The third stage of alcohol withdrawal symptoms include: 

  • Delirium tremens
  • Seizures
  • Hallucinations
  • Fever 
  • Excessive sweating  

Signs of alcohol withdrawal in stage 3

During this period, 48 to 73 hours after your last drink, the signs of alcohol withdrawal are very clear for all to see. Seizures and hallucinations are quite ly at this stage in the alcohol withdrawal symptoms timeline.

It is estimated that roughly 3 – 5% of individuals in alcohol withdrawal will experience DTs. 

If you feel you are experiencing the symptoms from stage 3, get in touch with a medical professional for guidance on how to manage your withdrawal. 

Please note this is only a rough alcohol withdrawal timeline and it is important to note that withdrawal symptoms and signs vary from person to person.

If you continue to drink excessively and regularly you may find your symptoms get more and more severe. 

If your nightly glass of wine or beer has turned into several or even a bottle or two or it may be at a stage more your alcohol dependence  is negatively affecting your:

  • Home life
  • Work / career 
  • Relationships

You may be wondering what to expect once you start to give up drinking and if you are ly to have any alcohol withdrawal symptoms. 

You may even have a loved one who drinks heavily and you're urging them to pursue sobriety and you want to know what he or she might be facing on the journey there.

OYNB is a community of people that have changed their relationship with alcohol for the better and are on hand to support you through this change in lifestyle. Taking the preventative step today to avoid even suffering from alcohol withdrawal symptoms today could be the best answer.  

If you want answers to the most common alcohol withdrawal questions such as:

  • How much do you have to drink to experience alcohol withdrawal
  • When does alcohol withdrawal start
  • How long does alcohol withdrawal start for
  • What does alcohol withdrawal feel
  • How to deal with alcohol withdrawal symptoms

Then look no further, we have answered these questions that help you determine the signs of alcohol withdrawal. Click the drop downs below. 

The symptoms of alcohol withdrawal tend to start within 6 to 24 hours after the person's last drink of alcohol.

The more that you drink per day and the more consecutive days and weeks that you drink alcohol, the more ly you are to go through alcohol withdrawal. 

Chances of alcohol withdrawal if you are a man:

  • Drinking 8 standard drinks a day for a month, you are in danger of minor withdrawal symptoms. 
  • 13 alcoholic drinks a day for a month then you have about a fifty-fifty chance of having major life threatening withdrawals. 
  • Drinking 10 standard alcoholic drinks a day for a week will lead to minor withdrawal.
  • 18 drinks a day for a week to major life-threatening alcohol withdrawal.

Chances of alcohol withdrawal if you are a woman:

  • 6 standard alcoholic drinks every day for a month then you have about a 50% chance of going through minor withdrawal. 
  • A woman who has been drinking 11 standard drinks a day for a month has about a 50% chance of going through major life threatening withdrawal. 
  • A woman who has 8 standard drinks per day for a week has about a 50% chance of having minor withdrawal. 
  • a woman who drinks around 15 standard drinks a day everyday for a week has about a 50% chance of having major alcohol withdrawal.

Please note this information and data is only a guide and the answer to “How much do you have to drink to get alcohol withdrawal?” varies from person to person.

Alcohol withdrawal symptoms such as tremors and/or seizures can last anywhere between three days to several weeks. 

Typically, alcohol withdrawal symptoms begin within hours to a day or two after your last drink and are usually at their worst around 24 to 72 hours after you stop drinking as explained in the alcohol withdrawal timeline above. 

However certain alcohol withdrawal symptoms : 

  • Changes in your sleep patterns
  • Fatigue
  • Mood swings

These symptoms can last for weeks or even months. You'll ly begin to feel better around five days to a week after you stop drinking, your body will thank you! 

The exact experience and severity of alcohol withdrawal varies from person to person. With this in mind what alcohol withdrawal for each person feels , can be vastly different for each person. 

It is important to deal with alcohol withdrawal symptoms this should be done in a methodical manner and by seeking help from professionals. 

If you have regular alcohol withdrawal symptoms you will potentially need:

  • Medical supervision
  • A prescription medication

Both are required to avoid the danger of having a fit, which could result in permanent injury or death. 

Although severe withdrawal symptoms can take up to a year to fully recover from, most people feel better within 3-7 days of stopping drinking. The first 48 hours are ly to be the worst. 

For some people, insomnia caused by giving up drinking can be challenging, resulting in the urge to start drinking again in the hope that the alcohol will help make you sleep.  

If you experience this, remember that your sleep patterns will almost certainly start to return to normal once your brain recovers its normal functions.

Here is what to do instead to help ease alcohol withdrawal symptoms

  • Keep yourself hydrated with plenty of non-alcoholic drinks (but avoid caffeine)
  • Try to eat regularly
  • Your GP may prescribe medication to help relieve your withdrawal symptoms 

If you believe you are heavily alcohol dependant, seek medical advice when quitting drinking.

Time to take a break 

If you think you could benefit from a break from alcohol then join One Year No Beer on one of our challenges today. 

Alcohol withdrawal symptoms occur when you abruptly stop consuming alcohol after a prolonged period of excessive drinking. These withdrawal symptoms can range from acute(severe) too mild.

Severe withdrawal symptoms form alcohol can be very serious and in some instances they can be fatal. Since withdrawal symptoms get wore with time it is a good idea to understand whether your alcohol withdrawal symptoms are getting more severe and if that is the case you should be seeking help from professionals.

The most severe symptoms usually occur between two and five days after you give up drinking. That means that the first couple of days may NOT be a good indicator of your risk of more serious health related problems.

Moderate vs. Excessive Drinking

It is a good idea to first understand the differences between moderate and excessive alcohol consumption.

Moderate drinking

First of all, moderate drinking is: up to one drink per day for women and up to two drinks per day for men.

Two, moderate drinking is considered safe for most people over the age of 21.

Finally, A (one) drink is commonly defined as:

  • 12 ounces of beer
  • 8 ounces of malt liquor
  • 5 ounces of wine containing
  • 1.5 ounces of 80-proof distilled liquor or spirits, such as whiskey, gin, rum, or vodka

Excessive drinking

Excessive drinking or heavy drinking and sometimes called binge drinking (Binge drinking means you've been consuming multiple drinks during one occasion), or drinking that's done by anyone who is pregnant or under the age of 21.

So excessive drinking for women, is four or more drinks and for men, it's five or more alcoholic drinks.

Heavy drinking occurs when women have eight or more drinks a week and men have 15 or more drinks per week.

An important note to remember is, the majority of people who drink excessively do NOT have an alcohol disorder and/or aren't dependent on alcohol.

How exactly does alcohol withdrawal work?

If you're a heavy drinker even if you're not an alcoholic you are ly to experience at least some symptoms if you stop drinking all of a sudden .

Alcohol is commonly used around the world by people to help them relax and overcome stress or anxiety. Alcohol increases the effects of GABA on the body to produce this exact outcome. GABA is a neurotransmitter responsible for:

  • creating feelings of calm and euphoria.
  • decreases glutamate, another neurotransmitter that creates excitability.

One of the reasons people find themselves drinking more and more is because it becomes more difficult to increase our levels of GABA and decrease our levels of glutamate. 

As a result you need to drink more alcohol to get the same outcome. 

Your body becomes accustomed to these changes and responds by producing more glutamate and less GABA.

When you quit drinking alcohol all of a sudden, you are no longer impacting these two neurotransmitters, but your body is still over producing glutamate and underproducing GABA. As a result, you may become hyper excited: anxious, restless, and shaky.

If you were a heavy drinker, your symptoms may be much more severe, progressing to:

  • tremors
  • seizures
  • serious high blood pressure


Добавить комментарий

;-) :| :x :twisted: :smile: :shock: :sad: :roll: :razz: :oops: :o :mrgreen: :lol: :idea: :grin: :evil: :cry: :cool: :arrow: :???: :?: :!: