Alcohol Withdrawal; How Serious Are Your Symptoms? Do You Need Medical Care? Take This Test to Find Out
85How Serious Are Your Symptoms?
Am I in alcohol withdrawal? And if so, how serious are my symptoms…Do I need to go to the hospital or not?
Any serious drinker has felt the mild effects of alcohol withdrawal – after all, acute alcohol withdrawal is a large part of what makes up a hangover. But when a regular heavy drinker stops completely for long enough (Time measured in hours) that person may be at risk for harmful or life-threatening alcohol withdrawal symptoms.
To put it simply – if you are physically addicted to alcohol, and you stop drinking, you will feel some degree of alcohol withdrawal symptoms.
If you have been drinking heavily enough, and you are very physically addicted, the severity of these withdrawal symptoms can put your life at risk. If you are in severe withdrawal – you NEED to get medical care.
Do you need to go to the hospital?
But how do you know if what you are feeling is serious enough to warrant going to the hospital?
The answer is probably yes. If you are feeling the effects of withdrawal, and you are wondering if you need medical care, then you probably do – and even if you are in no danger of life-threatening symptoms, alcohol withdrawal symptoms are very unpleasant. Doctors have medications that will make you feel much much better.
Secondly, since the dangers of alcohol withdrawal are real (it can kill you) then you don’t want to play around either – and safe is always better than sorry.
But if you want to get a sense of the severity of your symptoms, you can attempt a quick self diagnosis using a clinical scale that your doctor is very likely going to use to assess you when you go in for help.
This test is called the CIWA-AR and though it should not be used as a substitute for medical advice and care, if you score highly on the test it should definitely compel you to go and get some immediate help.
CIWA-AR Diagnostic Test of Withdrawal
This test is a series of questions you will ask yourself, in order to rate your symptoms on a scale 1-7. The test is written for use by a clinician, and so is slightly adapted here from the original for use as a self test. This should not be used in any way as a substitute for medical advice or care.
Nausea/Vomiting
Are you feeling sick to your stomach, or have you vomited? How bad is it?
- 0 not feeling sick
- 1 Mild feelings of nausea
- 2
- 3
- 4 some nausea and dry heaving
- 5
- 6
- 7 continual nausea, dry heaving and vomiting
Tremor
Do you have a tremor? Stand with your arms extended to the side, and your fingers spread out straight.
- 0 no tremor
- 1 no visible tremor, but you can feel it a bit in the fingertips
- 2
- 3
- 4 moderate tremor, only when arms and fingers are extended
- 5
- 6
- 7 severe tremors even when arms are not extended
Sweating
Are you sweating?
- 0 no sweat
- 1 a very little bit, palms are a little moist
- 2
- 3
- 4 sweat is beading on forehead
- 5
- 6
- 7 Heavy and profuse, drenching sweat
Anxiety
How anxious do you feel?
- 0 no anxiety
- 1 mild anxiety
- 2
- 3
- 4 moderately anxious
- 5
- 6
- 7 in a panic
Tactile Disturbances (feelings on skin)
Do you feel any unusual sensations (pins and needles, itching, bugs on skin, burning, numbness) on or under skin?
- 0 no
- 1 very mild
- 2 mild
- 3 moderate
- 4 moderately severe
- 5 severe hallucinations
- 6 very severe hallucinations
- 7 continual hallucinations
Auditory Disturbances
Do things sound different; are you more aware of sounds around you than normal? Do things sound harsher, or do you hear things that are not present? Do sounds frighten you?
- 0 no difference
- 1 sounds are very mildly harsh or frightening
- 2 sounds are mildly harsh or frightening
- 3 sounds are moderately harsh or frightening
- 4 sounds are moderately severe in harshness, some auditory hallucinations
- 5 severe hallucinations
- 6 very severe auditory hallucinations
- 7 continual severe auditory hallucinations
Visual Disturbances
Are you noticing anything different visually? Is the light too bright or does the light hurt your eyes? Is the light disturbing? Are you seeing things that you know are not there (hallucinations)?
- 0 no change
- 1 very mild
- 2 mild
- 3 moderate
- 4 moderate with hallucinations
- 5 severe hallucinations
- 6 very severe hallucinations
- 7 continual visual hallucinations
Headache
Do you have a headache? Does it feel like a tight band around the head? Rate the severity of your headache (Do not rate dizziness)
- 0 none
- 1 very mild
- 2 mild
- 3 moderate
- 4 moderately severe
- 5 severe
- 6 very severe
- 7 extremely severe
Agitation
Do you feel agitated or fidgety?
- 0 no
- 1 a very little bit
- 2
- 3
- 4 moderately fidgety and agitated
- 5
- 6
- 7 can't stop pacing or moving (thrashing)
Orientation
- 0 you know where you are, the date, and can do serial additions (Add 2 + 2 + 2)
- 1 Not sure of date or can't so serial additions
- 2 Don’t know date (Off by less than 2 calendar days)
- 3 Don't know date (off by more than 2 calendar days)
- 4 Don't know where/when you are
Scoring
If you score less than 8, you are in mild withdrawal, and probably do not need any medication at this time. If you score between 10 and 20, you are in moderate withdrawal, and would benefit from medication and medical management. If you score 20 or more, you are in a more serious withdrawal, and need medical care.
Withdrawal symptoms will change over time, and although you may not demonstrate severe symptoms now, you may feel more serious symptoms as time passes. If you decide not to get medical help, you should re-evaluate your condition regularly, to ensure that you are not putting yourself in any danger. Remember too, that symptoms are more easily controlled if you receive appropriate medication before you allow withdrawal symptoms to grow too severe.
This test is not designed to diagnose withdrawal, but used only to gauge the severity of symptoms, and to gauge the severity of symptoms over time and in response to medication/treatment.
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Gone through this and did not know I was.
Excellent hub. I've talked about some of these symptons in a couple of my hubs about addiction.
and he likes carrots
Nice hub. "If you are feeling the effects of withdrawal, and you are wondering if you need medical care, then you probably do" I second that. I've been through severe withdraw several times and even called 911 on one occasion. It more than likely saved my life. Alcohol withdraw can be extremely serious.
I dont not have the problem. i was actually doin some research for a friend that i was worried about and this article is really good. although my friend was having only moderate symptoms she was still the headache nd the hand tremors. but not enough to go to the doctor.
Relly interesting hub. I've looked after a few people in withdrawal. We don't use this set of guidelines, but it's really useful, thanks.
I have seen some people have terrible withdrawals from alcohol. You can die, however most just end up wishing they would. The aches and anxiety are sometime the most visible, but not the most serious of side effects. Thanks for all the great info and the check list!
- Brian
What a great hub. Very serious topic. Nicely done.
wow that is one great post. I have seen my friends pass through such phases myself. What I think is that more than psychological counseling, what these guys need is some cheerful, lively company. Because friends can actually help you combat loneliness and depression - the two main factors for such addictions.
Btwn, you may also like to check out my hubs on similar topics.
Regards,
Phil.
well done very infomational im a recovering addict i faced very hard with draws and had to be hospitalized this hub gives great info to the horror of withdraws and what you should do very helpfull
Well done for this hub. When I finally kicked the drinking I was really sick, and most definitely should have been seeking medical treatment. If only people knew how dangerous it is!
im quitting! i don't have withdrawal but im dependent on it.
smoke crack it s the best
I find the scoring system interesting. Basically you would have to have zero points to NOT be in withdrawal. If you score 1 or 2 you ARE in withdrawal as they say "If you score less than 8, you are in "mild withdrawal" meaning if you went out on the town and woke up with even one of those symptoms you are withdrawing from alcohol. Such a scoring system would have us all labeled as alcoholics!!!
To sally2, the reason you wake up with those negative symptoms (hangover) IS alcohol withdrawal. Alcohol is an extremely strong and short-acting drug, and when it wears down, you go into immediate withdrawal. It's extremely mild compared to the withdrawal after addiction, but it's the same basic concept.
In a detox hospital setting, you would be scored on the CIWA-AR every 90 minutes. If you score 11 or more, you get 20mg Diazepam syrup. This can be up to 180mg in 24 hours. Most people are asleep after 4 doses but need watching because they can wake up in a hell of a state.
UK doctors who have not specialised in alcohol detox are totally clueless and will give one 5mg tablet and send you home, possibly to die.
For patients who are actively seeking Diazepam, Phenobarbitone syrup can be given. It's not popular because it hasn't got a "head" on it.
A very necessary hub. I have detoxed myself probably 8 times or so, and each time I felt sure I was going to die. My withdrawals are an absolute hell. The anxiety is indescribable. Like having a 48 hour long panic attack. I've also been through a week of medical detox in the hospital, where I had hallucinations, among other things. I really appreciate this hub. The information needs to be out there.
Sam -- You miss her point, which is a good one. A person could have moderate itching for reasons unrelated to alcohol withdrawal, and still be in "mild withdrawal" according to these guidelines.
japtaker u know what ur talking about!
I've had severe panic attacks and thought i was dying on several occasions and been in hospital for withdrawal 3 times. My best advice to anyone is if u don't want to go to hospital, ween urself down slowly eg. 40 units a day to 35 to 30, then drop from spirits to beer/cider and gradually reduce the amount. U will feel like shit during this but at least u won't be risking ur life!
If u do go to hospital make sure u get them to give u a reducing dose of librium!Even though u can't really feel any effects straight away it really does take the edge off.
Omg, thank you for this web post. I went through absolute hell after a 8 day drink binge. Sweating, shaking, puking, insomnia, hallucinating, extreme headaches, basically everything on this list; this post convinced me to seek medical attention, I was embarrassed at first but luckily I had a great doctor that took the time to listen and gave me something to get over the withdrawals, I would have to say alcohol withdrawals is the most painful feeling/experience I have ever had! Seek help, it may be embarrassing but it's worth it! Thanks again for this post.
my score iz thirty seven im stuggling with mental health issues dont know where to turn
My Dr told me I should have been in intensive care for my alcohol withdrawal, but librium and a helpful taxi driver saved my life recently. You will c why if u read on i hope?
I have drunk heavily for 15 yrs. I have been diagnosed with depression or mental health problems as they like to call it. It's the booze that causes that.
Here is my story....
I recently stopped drinking suddenly, and after 2 days and not following advice to reduce down daily, had a very serious withdrawal 'episode'.
The day began with tremors, like my body was vibrating all over, and severe vomiting.
My hands were shaking a lot. As the day continued, i could not get up properly. My legs kept buckling at the knee, and the shakes got bad enough i could not pick a drink up or cutlery without dropping them. It looked like i was doing it through a big earthquake! Most of the day i had to be held up by people to walk.
I began sweating heavily. At 1 point i managed to stand alone. After just 1 small step i became paralysed, knowing i'd lost control of my legs totally.
I flopped down onto the chair, i immediately began to have pins and needles and numbness down my whole left side and even in my head. My right side cramped totally, even through my stomach.
I then had a convulsion followed by hyperventilating and a serious panic attack. I was getting hysterical.
THIS IS WHY I WANTED TO SHARE THIS WITH YOU.. There is an ironic msg for drinkers in my story.
When it happened to me i was at the wedding of a close friend. Everyone was getting progressively drunk.
I was probably the only sober person.
I had to ask a guest to carry me outside in the middle of the wedding party. AND The fact i had to beg for several people to call an ambulance as they were not coherent enough to know what was happening me gave me the wake up call i needed. I kept being told not to worry, i'd be ok. I found they had lost their sense of judgment and were endangering my life because drink made them lose their real senses. A taxi driver took me to hospital and carry me in.
If this helps someone it is worth it.
My advice? Decided to stop. Seek alcohol withdrawl advice from a specialist. Do it slowly and with help of a friend who wont judge if possible. It's usually a quick call to a local service for a specialist to get help. Ur GP can get councilling but you sometimes need to insist. Get to AA meetings. If you don't do it properly and
If you get these symptoms, get youself to a Dr or hospital for LIBRIUM!! It eased my symptoms almost immediately, and calmed me down.
Never think that going back to drink is the only thing you can do or that you won't get support.
Good luck to all that need it x
To shelly, who said she has mental health problem. I hope you have asked for help hun? Just know that if you are on here due to alcohol, it is the worst offender of the cause. Usually has a trigger event that started it of course. Just remember 'mental health problem' doesn't mean you are mental! It just means your mind needs a spring clean using professionals, B that a GP, medicine, hospital, books you can read etc. I know my issue has been simply based on low self esteem since childhood. The Dr still put 'mental health' on my sick note. Be nice to know how you are doing? I thought i couldn't get help or had to pay. You don't X
This has been very helpful. Thanks for all of the input everyone! And God bless!
anxiety alcohol..... all i have to say both hungover closer to death then mother nature.
One reason that helps to keep me sober is remembering my last withdrawral and vowing to never put myself through it again,the shakes,puking,sweating,palpitations like my heart was going to explode.Every bender has to end sometime and I just don't want to do it again.
If your drinking up to 2 ltrs a day in a day in a half i recommended the hospital.
I'm trying to give up myself i cant do it gradually because 1 beer always leads to 15. So I've gone cold turkey for the last 6 days. I've been withdrawn in the past but this is terrible. I'm getting pin and needles in my hands,cold sweats, headaches, shakes and worst of all is the dizziness i feel like I'm moving at 1000mph all the time. I've not had a fit yet the possibility of it scares the shit out of me. Bad to the doctor i think.
I scored 27 when thinking about my most severe symptoms.
I've been off alcohol for 34 days. Symptoms come and go.
Mostly it's severe anxiety but with also a level of
constant background anxiety.
I've been to A&E recently two times (w different hospitals) and they just said I was having a panic attack and sent me home. I mentioned the alcohol and they said it had been too long for this to be a big concern. Bit it is a big convern as I can barely function when it gets really bad. When it peaks it comes in waves over a few minutes. I just keep telling myself it will end eventually but it scares the living daylights out of me.
Surely I'm well past the acute phase now anyway. I think with me it's mostly an anxiety disorder.
Holding out for the next few months living in hope that things will gradually get better.
Thanks for all who shared their experiences. I did not score very high, but haven't been able to stop for very long before I take a drink to relieve the nausea. I like the concept of "if you think you might need medical attention, you probably do.." I'm just scared to call. Keep thinking I can do it myself, but it doesn't work!
Jason... Don't worry about the length of time. When I stopped drinking for almost 3 months in September (because I passed out unconscious from a bender), you won't believe this, but I counted 6 weeks until I felt normal. It really does take that long (not physically but more chemically) for the alcohol to leave your system. I was weak in the gym, running and everything for 6 weeks. Even 1 month later I was still having panic attacks, so it takes time and I would say around 6 weeks.
I started drinking again over Christmas and promised myself I wouldn't carry on, i.e. drink the following day. That soon went out of the window, I hate to admit that I may never be able to drink socially again, but it may be the only way. I went on another bender this weekend and carried on drinking all Monday, passed out Monday night (I don't remember going to sleep), woke up and literally ran to the offlicense for beer to take the edge off.
Luckily, a family member turned up and forced me to go to AA. I was sitting at the back, feeling like I was going to die, listening to other horrible stories. All day yesterday I had mild (felt like severe but I wasn't hallucinating or vomitting) but the anxiety was awful, heart a million miles per hour, sure I was going to die, that's what I felt. Friend stayed over last night because I've woken up before with complete numbness and also I panick myself in my sleep so I wake up where I've obviously been axfixiating myself, so I wake up so dizzy and not having a clue where I am.
Today I feel like sh1t but MUCH better, and I don't feel like I am going to die anymore. Your body completely becomes dependant on alcohol, more so than any other drug I know. I mean if you are into c0ke, or pills, yes of course it's addictive, but I've not known of withdrawal to be so bad for any other drug, compared to alcohol.
The hard thing to work out, is that it probably is best to have a couple and taper yourself off of alcohol. No doctor, or mature sober person would ever recommend that, but with the withdrawal's I've had, it may be the best way. Obviously being alcoholic, the problem is that you probably can't just have a few throughout the day. So I/we may have to admit, that a life of abstinance is probably the way forward in terms of alcohol.
There are a lot of people here going 'cold turkey' after a long period of abuse. Can I please re-enforce that this is extremely dangerous. PLEASE avoid doing this. You are putting yourself at risk of not only seizure and death, but you are also opening yourself up to condition called 'Kindling'. That is, it could eventually only take a withdrawal from a 4-pack of beer to lead you into extreme withdrawal.
The last two times I've withdrawn, I have tapered off. I have reduced my drinking by 2 UK units a day(equiv to 2 x 100ML shots of Vodka). Yes, it can take 10 / 20 / 30 days, but everyday is a win and it really, really makes it a lot simpler. And get yourself some support while you do it. When you're only accountable to yourself, you'll give in way to easily. Let people know what you're doing and you're far more likely to succeed.
Tapering CAN be achieved. It could save your life.
ive been in the hospital 3 x's in the past 2 yrs from withdraw from booze. ive had a seizure, terrible hallucinations, panic attacks, constant vomiting, shakes... literakky almost died on several occasions. still havent been able to quit. im so scared that i will die if i dont stop. i dont have a death wish but yet i continue to drink daily. please help.
I was abusing alcohol heavy for about 8 years. Now ive been sober around 3 weeks. The withdrawal is not fun. Anxiety. Body feels heavy. Shakes. Fevers. On and on... Ive read enough and heard enough that some of the symptoms may last from months to years. Alcohol is the most dangerous drug to get addicted to out there. As it can basically kill you when you go cold turkey.
Only been drinking for 4 years, heavily for a bit over 3 years. After turning 21, I'd get 2 40s every evening 7 days a week. That went up to 3 40s a night. Soon I was eating nothing but hot dogs and beer, and got an ulcer. Stopped drinking so much and eating like crap for a while, ulcer healed, then the drinking resumed.
For a while I would drink in the evenings/night after I had gotten things done, but soon I started to lapse into whole day binges where I'd black out and have no recollection of what happened (or where I had misplaced important things). Then I almost got a DUI and paraphernalia charge, but while handcuffed in the back of the cop car I somehow talked my way out of both. A small miracle, but I didn't learn squat from it and several months later I got a DUI; blew 2.5 the limit, 3 days after winning the 1,000 grand prize for rare book collecting at my university. Went from a real high to a real low. For a year afterward my girlfriend was really on my case about drinking so she kept the consumption down to what I could sneak/chug on the way back to our apartment.
Zoom forward several years and I'm drinking pretty much a 12 pack of 5.9% beers every night, smoking a pack or more a day, and really letting things slide. Quite addicted at this point, acknowledge it, and try to get off it. I've always been an insomniac, so now sleeping is almost impossible. A day or 3 off alcohol and I will literally have sleepless nights and be up for 40+ hours straight, until I am so exhausted that I am finally able to sleep for 4 or 5 fitful hours total. The anxiety, body tension, profuse sweating when trying to sleep, racing thoughts, jitteryness, and general weakness is crippling to me and the growth of my internet businesses. Got some clonazepam from a friend to try to help, and it did for a while, but I ended up just binging even harder and taking 4-5mgs of that stuff on top. Very stupid. Easily could have killed myself several times, either from alcohol poisoning or aspirating my vomit while passed out cold for 12+ hours. At least I haven't driven drunk once since the DUI (no other traffic violations either in the past 3 years) so at least I learned to be more responsible about my irresponsible drinking. I want help but beer is so much easier, especially with a shop a 3 minute walk from my house. Need to move out to the country or something. Gunna call my psychiatrist soon and try to get something worked out. Good luck people.
After a couple of heavy night I feel terrible. Unlike anything I have felt before. But worse is the aches and pains like the flu and feel I want to collapse. I don't feel sick or have any diarreah but I have no appettite and don't even feel thirsty I am scared.
Hi all. It's been really helpful reading all the comments here, really made me realise I'm not the only one going through this. Hope previous posters are doing okay! I've been having panic attacks for a few years now. Finally made the decision to quit for good after a really bad one in Thailand. The problem was, I've felt so bad since stopping drinking- tight chest, dizziness, fatigue, sudden chest pain (though not all at once, and not all the time)- that it's hard to do daily stuff, especially work. I've been to the hospital three times- they all say I'm fine (nothing wrong with heart, liver not serious etc.). Part of the problem is that I live in Asia and that the hospitals here are not so great- so I wondered if I was indeed okay or maybe they just couldn't find the problem. But I kept reminding myself: "If there is something wrong with me apart from withdrawl, alcohol is not going to help. If it's alcohol withdrawl, alcohol is not the solution." So- either way- no alcohol for me. Anyway, this week for the first time I can say I actually feel quite good. I keep reminding myself that I drank for about 15 years and my body's chemical structure is going through a big change now... that doesn't happen overnight. So, I'm going to push on. I can honestly say I'm done with alcohol. The last couple of years or so hasn't been about having fun, it's been about self-medicating. I needed to drink because I drank. Like Homer Simpson said: "Beer, the cause of- and the solution to- all life's problems." Now that I'm coming up on 5 weeks sober (a miracle! 3-4 days used to be a challenge!) I really have no desire to drink at all. Now that I'm starting to feel better there's no reason to drink or self-medicate. I love waking up in the morning not worrying how much I drank yesterday and how it's going to affect me today. I love the small things like eating breakfast (couldn't eat without alcohol in the past- it would set off a panic attack). It's not easy, but it's getting better all the time, and I can see the light at the end of the tunnel now. I hope previous posters who are still going through the worst part can get some solace from this. Don't give up!
Research Analyst 2 years ago
This is an interesting topic because I am sure that alcohol withdrawal is not something that is talked about much, especially from those who like to drink a glass of wine every night with dinner, besides the health benefits, I wonder if it can classify as a alcohol addiction.