Modern Alcohol Detox and the CIWA

You have heard the old saying, “There’s more than one way to skin a cat.” Well, it’s unimaginable why someone would want to do something so horrible. But the principle contained in that old saying still rings true: there are a number of ways to reach any given objective. That is certainly the case with alcohol detox. There are a number of ways someone can be detoxed from alcohol.

In the old days, alcohol would be given intravenously in a hospital. Sadly, when this outdated method of alcohol detox was being used, some patients died of alcohol poisoning.

More recent detox protocols involve giving medications to prevent or treat alcohol withdrawal symptoms. These medications are usually from the class of benzodiazepines including Librium, Valium, Ativan and Serax. All of these medications work. They differ only in their half-life (which is a fancy way of saying how long they stay active in the body and how quickly they take effect). Arguably, any of these medications can be used effectively, as long as the physician is comfortable with how to properly administer them.

There are two general ways that benzodiazepines are used to detox from alcohol. The first way is to administer regular doses to “prevent” withdrawal and gradually taper over time. The doctor would usually start with high doses (causing a lot of sedation) and then decrease over a few days. While this method works, it takes a long time. In addition, over-sedation can lead to problems such as falls and infections like pneumonia. (It is also important to keep in mind that not everyone needs medicines for alcohol withdrawal symptoms.)

The “modern” detox protocol uses a very standardized approach. In this method, the signs and symptoms of alcohol withdrawal are recorded and scored according to the Clinical Institute Withdrawal Assessment. We refer to this as the CIWA (ky-a-wah) or (see-a-wah). The CIWA measures 10 items and a score is calculated. Medicines are then given according to the CIWA score.

Using the CIWA means that no matter where you are in the United States, you can be detoxed in a standard way. This has been shown to decrease the amount of medications given, the length of stay in a hospital setting, and the complications associated with benzodiazepines. In a residential setting like Stepworks for example, this means that the client can start going to groups sooner and get back to work sooner.

The take home message is this: If you are considering a facility for alcohol detox, ask if they use the CIWA. If they say “no,” then you should evaluate other places first. The CIWA is becoming the standard of care for alcohol detox, and facilities not using the CIWA are not up-to-date in their approach. If you are admitted to a facility using the CIWA, you will not be given a benzodiazepine right away. Don’t panic. This is good. Trust the process. The CIWA really does work.

—–

If you want to learn more about the CIWA and how it might apply to you or your loved one, call us toll-free at 1-888-982-1244 and speak with a member of the Stepworks team.