Alcohol Withdrawal — Assessment & CIWA

Alcohol withdrawal begins 6–24 hours after the last drink as the CNS, no longer suppressed by alcohol's GABA-enhancing effect, rebounds into hyperexcitability. Early symptoms include tremors, anxiety, diaphoresis, nausea, tachycardia, and hypertension. The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is a 10-item scored tool (max 67) that standardizes assessment. Scores below 8–10 (per institutional protocol) indicate mild withdrawal managed with supportive care. Scores 10–18 signal moderate withdrawal requiring symptom-triggered benzodiazepine dosing (typically chlordiazepoxide or lorazepam). Scores above 20 indicate severe withdrawal with seizure risk demanding aggressive pharmacologic intervention. You reassess CIWA-Ar every 1–2 hours during active withdrawal. Symptom-triggered dosing means the score drives the medication — you don't give benzos on a fixed schedule unless the client can't be reliably assessed. Withdrawal seizures peak at 24–48 hours. This atom covers the withdrawal trajectory up to but not including delirium tremens, which is a separate, later complication.