Detoxing is when your body rids itself of all traces of alcohol. While this period can be quite uncomfortable depending on how dependent a person has become, it is the only way to get beat an alcohol addiction.
The symptoms of alcohol detox are caused by the brain being forced to create chemicals it had been previously relying on the alcohol to provide.
The initial stages can produce such withdrawal symptoms as irregular heartbeat, anxiety, headaches, fever, nausea, and even hallucinations. Detoxing is vital because it is the first step towards a full recovery.
To create a quick and efficient way to determine if someone will potentially suffer from alcohol withdrawal syndrome, along with what treatments they might require, some official signs and symptoms can be used to assess.
The American Psychiatric Association lists the following criteria in their Diagnostic and Statistical Manual of Mental Disorders for alcohol withdrawal.
The first criterion that must be met is that the person is reducing or entirely stopping their intake of alcohol after a significant period of heavy use.
The second criterion takes place within twelve to forty-eight hours after the absence of alcohol intake. It includes the introduction of two or more of the symptoms which are listed on the 10-point scale (later discussed below.)
The third criteria are if the symptoms listed cause distress in the individual, or issues with other areas of functioning in their life, including with friends, family, and at work.
The final criteria that must be met are if all of these cannot be explained away by a different mental issue or medical condition.
The Clinical Institute Withdrawal Assessment-Alcohol or CIWA is a score used to objectively determine the severity of alcohol withdrawal syndrome someone may potentially experience. This makes it easier to determine the course of action for treatment. Following CIWA guidelines saves lives, and these guidelines are far safer than attempting a so-called “cold turkey” alcohol detox
As previously mentioned, the revised CIWA-Ar scale has only ten listed symptoms. They are scaled from 0-7, except for the question on orientation, which is scaled 0-4.
Below are the ten things that the CIWA-Ar looks at to determine the level of alcohol withdrawal.
The CIWA score makes it possible for clinicians to determine the degree of alcohol withdrawal a person is most likely to go through and the speed at which it is expected to progress. This makes treatment much easier to determine and set in place.
In treatments, the goal is to give the least amount of medication over the shortest time possible, which will decrease the likelihood that the patient will become addicted to the medication being used to assist with the detox.
To expedite treatment and ensure reproducibility, the CIWA was revised to the Clinical Institute Withdrawal Assessment-Alcohol-revised (CIWA-Ar), which is a shortened version of the scale.
Instead of thirty different signs, the revised version only has ten symptoms and can be used to determine the development of alcohol withdrawal syndrome.
This makes it faster and easier to use, and the revised version is popular in detox units, hospitals, and clinics. The CIWA-Ar has also been more useful in being able to correctly determine which detoxing individuals will be more likely to suffer from hallucinations and seizures, which makes it very useful for doctors and nurses in the field.
For each of the ten symptoms on the CIWA-Ar list, there is a question that goes along with it that the doctor or nurse is supposed to ask to ensure that answers are within the correct range needed to fill out the scale.
Some of the symptoms, such as the presence of agitation, tremors, or sweating, can be visually assessed without a corresponding question.
Below are the questions are taken directly from the CIWA-Ar form:
They will then use the response to determine their next course of action, including what kind of medication and dose they should prescribe to the patient.
The revised scale is incredibly useful in determining how severe the symptoms are likely to be as the detox progresses.
Through use of the CIWA-Ar score, doctors and nurses are more likely to know if they will need to provide additional IV fluids or nutrition based on whether or not the patient will be experiencing severe sweating, vomiting, or other symptoms that may lead to dehydration.
Multivitamins, magnesium sulphate, thiamine, and glucose are all things regularly administered to assist someone through detox to help their system return to its natural balance as quickly as possible. The specific score returned by the CIWA-Ar scale will help doctors to know what they may need to prescribe.
There are two fundamental limitations to the CIWA-Ar scale. One, it is subjective in terms of what information is provided to the doctor. They must rely on the patient’s word for determining the score, which will be the basis of the entire treatment plan.
The second, related, limitation is the fact that if someone is already experiencing alcohol withdrawal symptoms, they will most likely have an impaired ability to communicate.
Whatever responses they give may be tainted by their deteriorating mental and physical state. Also, there is the chance that there might be a language barrier, and translations will not be as accurate, especially if the person answering the questions is already suffering from symptoms.
An example of a case using detoxification protocols that include CIWA-Ar would look something like the following. Each step followed up by professionals.
It can be perfectly safe for someone to detox at home if they are going to experience a very mild form of alcohol withdrawal. However, there are cases where professional services must be available 24/7 for the entirety of the detox process.
Some indicators that it might be best to be seen inpatient include no support system to assist through the recovery period, history of seizures or delirium tremens, several past detoxifications, and a history of mental illness or severe withdrawal symptoms.
These can all indicate that it could be unsafe and potentially lethal to spend a detox away from professional care.
Multiple studies have shown that when CIWA-Ar is used to score patients coming into medical centres for alcohol detox, it leads to better outcomes. There were shorter inpatient stays, fewer uses of restraints, and less of a chance they would end up in the ICU.
Also, when CIWA-Ar was used, it more accurately identified which people would end up suffering from delirium tremens, which made it easier to treat proactively.
No matter what treatment plan is used or which protocol is used to determine that plan, follow-up is very important. It will be a way for the patient to get support, resources, and encouragement.
Without a follow-up, the patient might return to their addiction, and the resulting detoxes afterwards will be all the worse for it. People are more likely to relapse if they do not have a steady support system in place after detoxification.
These support systems include twelve-step programmes, cognitive-behavioural therapy, family therapy, and regular doctor visits to check on their overall health.
We offer high-quality rehabilitation & detoxification services tailored to your individual needs.
To discover your road to recovery, call us today on 0800 140 4690.