Assessment of the alcohol withdrawal syndrome – validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-A)

University of Innsbruck, Innsbruck, Tyrol, Austria
Addiction (Impact Factor: 4.74). 11/1994; 89(10):1287-92. DOI: 10.1111/j.1360-0443.1994.tb03307.x
Source: PubMed


The alcohol withdrawal syndrome is a common phenomenon in psychiatric hospital care. Not only treatment strategies, but also the evaluation of the syndrome, are discussed controversially. The most widely used instrument is the Clinical Institute Withdrawal Assessment-Alcohol (CIWA-A) and the succeeding CIWA-Ar. We modified the CIWA-A and translated it into German. Validity and reliability of the modified and translated scale were analysed by several psychological tests as well as different somatic measures in 31 patients. The German version appears to be a valid and reliable instrument for the assessment of alcohol withdrawal syndrome useful for clinical routine as well as treatment trials.

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    • "Assessment Prior to the beginning of the study, alcohol-dependent subjects underwent a psychometric evaluation, which took place at the Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center. Possible withdrawal symptoms were evaluated by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA, Stuppaeck et al., 1994), a 10-item scale (cumulative score, range 0–67), in which higher scores are attended by more serious withdrawal symptoms (e.g., a score 420 poses a strong risk of delirium tremens). The Alcohol Abstinence Self-Efficacy Scale (AASE, DiClemente et al., 1994), a 20-item self-report (mean overall score, range 1–20) designed to estimate self-efficacy applied to alcohol abstinence, was used to rate the individual ability to abstain from drinking. "
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    • "Depressive symptoms were documented by means of the Beck Depression Inventory (BDI; Hautzinger et al., 1994) and symptoms of anxiety by means of the State Anxiety Inventory (STAI; Laux et al., 1981). The presence of withdrawal symptoms was measured with the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-A; Stuppaeck et al., 1994). "
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    ABSTRACT: After studying the sleep of alcohol-dependent patients at the beginning and over the course of abstinence in earlier studies, our interest in the current study focused on the direct effect of 2 doses of alcohol [0.03 and 0.1% blood alcohol level (BAL)] on healthy sleep. This is the first polysomnographic study testing the impact of 2 doses of alcohol ingestion (thus reflecting "normal" social drinking and alcohol abuse) in a single-blind randomized design in healthy volunteers. The study evaluated a short-term acute drinking period for 3 and 2 days of withdrawal from alcohol not only for polysomnographic variables but also for subjective estimates of sleep quality. In a crossover design with a 1-week interval, healthy subjects received alcohol to raise their blood alcohol to either 0.03 or 0.1% BAL at bedtime for 3 consecutive nights after an alcohol-free baseline night. Objective (polysomnography) and subjective sleep (questionnaires) was recorded each night. During the following 2 days, alcohol was discontinued with simultaneous measurements of sleep to gauge withdrawal effects. At a dose of alcohol leading to BAL of 0.03%, no clear effects could be detected. Following an evening BAL of 0.1%, a hypnotic-like effect (shortened sleep latency, reduced number of wake periods, decreased stage 1 sleep) occurred primarily during the first half of the night with signs of rebound effects being already present during the second half of the night (increased stage 1 sleep). At this dose, alcohol significantly increased slow-wave sleep (SWS) in the first half of the night and reduced REM density in the beginning of the night. After discontinuation of the higher alcohol dose, REM sleep amount increased. No significant withdrawal or rebound effects could be observed for parameters of sleep continuity during the 2 nights after discontinuation from alcohol at a BAL of 0.1%. Owing to the small sample size, the results of this study need to be interpreted with caution. Short-term moderate alcohol consumption (BAL 0.03%) did not significantly alter objective or subjective parameters of sleep. Higher doses of alcohol resulting in a BAL level of 0.10% immediately before going to bed mainly influenced sleep in the first half of the night, resembling the effects of a short-acting hypnotic drug, including a suppression of phasic aspects of REM sleep (REM density). Interestingly, analysis of the latter part of these nights indicated the immediate presence of withdrawal effects (increased light sleep). No statistically significant effects on sleep parameters were observable during the 2 nights of withdrawal from alcohol at the higher BAL. Interpreted carefully, our data indicate that negative effects on sleep occur already with short-term use of alcohol at doses of BAL of 0.10%, despite hypnotic-like effects during the first hours of sleep, especially during the latter part of the night.
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    • "When less information is needed or when assessment time is limited, the IAI may be used in place of the ASI. For client safety, the CIWA-AR should be administered at initial screening as a routine measure of alcohol related withdrawal symptomatology (Stuppaeck et al., 1994). The ACVAS (Johnson, Cloninger, Roache, Bordnick, & Ruiz, 2000) and the DrInC can be used to assess craving and the behavioral antecedents and consequences related to drinking (Lowman et al., 2000; Miller et al., 1995). "
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