Alcohol Withdrawal Treatments and the CIWA

 

 

Introduction

Alcohol withdrawal treatments are done to people who are dependent on alcohol. This happens following a planned or an unplanned reduction of alcohol intake. The CIWA is a ten-item scale that is used to assess and manage alcohol withdrawal. Every item on the scale is recorded independently and the total sum of the scores generates the total value that connects to how the alcohol withdrawal is severe. The ranges of the scores are developed to come up with specific management decisions. The alcohol withdrawal process is followed using the CIWA.

 The diagnostic markers that indicate Mark has an acute withdrawal syndrome are nausea and vomiting, tremors, anxiety, agitation, paroxysmal sweats, auditory disturbances, visual disturbances, and a headache. This was all recorded on the CIWA scale for Mark. The CIWA is among the most used withdrawal assessment scale and according to Kattimani & Bhardwaj (2013) it is used to measure the severity of the withdrawal syndrome. Mark’s total CIWA- Ar score was 25 points and a score that is more than 20 points is an indicator of a severe withdrawal syndrome.

The appropriate course of action for Mark should be withdrawal management and this will include medical and psychological care. This because withdrawal management will help to reduce Mark’s discomfort and show compassion which will help to build trust between him and his treatment staff. Because withdrawal management does not lead to sustained sobriety, after the completion of the withdrawal, Mark should be followed up and should be engaged in psychosocial interventions.  According to Clinical Guidelines for Withdrawal Management (2009), these interventions will involve cognitive and behavioral therapy which will help him get more knowledge on the symptoms and withdrawal impacts and how to deal with them. They will also help him know how to take care of himself and how to interact with other people around him. These interventions which include therapies will help Mark to change his thoughts and hence change his behaviors too. System triggered therapy will be important for Mark because he has been his scores have been assessed by the CIWA and therefore the right help and medication will be administered to him according to the scores. Mark will require medical treatment and close observation so that he cannot go back to the drinking behavior again and because his life is in danger.

Mark will also require drug treatment because the symptoms that Mark has shown that he is suffering from severe withdrawal syndrome. Enough sedatives should be given to him to calm him as early as possible and bring down the symptoms he has (Kattimani & Bhardwaj 2013). Fluids should be administered to him because the withdrawal causes dehydration which is brought about by sweating vomiting. The objective of the treatment for Mark is to be able to contain the symptoms of alcohol withdrawal that he has and prevent them from progressing to serious medical complications. Treatment will also help him to be able to maintain a long term recovery.

Since Mark has severe symptoms, pharmacologic interceding will be of help to him. Mark will need nutritional support because most patients with acute withdrawal syndrome most likely don’t check their diets. This results in nutritional deficiencies making them weak. Mark should be supplemented with folic acid and thiamine routinely (Kattimani & Bhardwaj 2013). This will help to reduce the chances of him getting other serious conditions. He will need magnesium supplements because for a person who is having an alcohol withdrawal normally has low magnesium levels. Administering these drugs will help to suppress the withdrawal symptoms

Symptom triggered therapy for Mark will be important because it is a treatment of alcohol withdrawal that requires a patient to be given medication only when they have the symptoms. This means giving therapy to a patient only when they need it. According to Hoffman & Weinhouse (2019), research shows that symptom triggered therapy attains superior clinical results while lower total doses of sedatives are required. The time spent in the hospital and the treatment period is short for the patient too. Research shows that this method of therapy is effective and yields better clinical results. It decreases the occurrences of severe and life-threatening withdrawal syndrome which will work best for Mark.

DSM is the quality classification of mental disorders used for clinicians, researchers, and policy comorbid makers (Hassin & O’Brian et al). It is important for Mark because it will help to diagnose and treat him. Mark will be diagnosed with substance dependence and this is because there is a need to focus on the severity of dependence over the abuse diagnosis. The objective of DSM is to make sure that patients get the best and needed care and also improve the convenience of the clinicians and the researchers. It is of great importance and impacts how disorders are diagnosed, treated, and explored. When DSM is included in Mark’s diagnosis it will help to contribute to giving details that will pave the way for more appropriate treatment. The DSM process includes balancing of needs that are normally in competition. The process also requires experts with different backgrounds and points of view and to come together to get solutions.

A combination of elements is highly encouraged in DSM to enable further studies and clinical experience (Regier, Kuhl & Kupfer 2013). The patient and clinician completed strategies that make the clinicians evaluate the symptom areas that are relevant to most mental disorders. There is another level of strategies that are particular to more in-depth evaluation when a specified area is validated. In case the criteria for diagnosis is fulfilled, another level of dimensional evaluation may help to initiate severity. Withdrawal symptoms are particular to the physiological impact of the substance. In DSM, withdrawal is demonstrated by a person having the typical withdrawal symptoms for a substance. Another manifestation is when a person uses the same substance to keep the particular substance withdrawal symptoms.

Conclusion

Alcohol withdrawal treatments are important and are done for individuals who are dependent on alcohol like Mark. The CIWA helps to come up with a score showing the severity of the symptoms of alcohol withdrawal. This helps to guide the withdrawal treatments that are recommended for a patient. Acute withdrawal syndrome is represented by severe symptoms and is represented at the final score of the CIWA. Fluids should be given to a patient undergoing withdrawal treatments due to dehydration. Nutrition for the patients should also be checked because most alcohol withdrawing patients have nutritional deficiencies. DSM helps to diagnose mental disorders caused by alcohol withdrawal. It has a great effect on how different disorders are diagnosed and treated.

 

References

Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed

Settings. Geneva: World Health Organization; 2009. 4 Withdrawal Management.

Available from: https://www.ncbi.nlm.nih.gov/books/NBK310652/

Hasin, D. S., O'Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale. The American journal of psychiatry, 170(8), 834–851.

Kattimani, S., & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A

systematic review. Industrial psychiatry journal, 22(2), 100–108

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM-5: Classification and criteria changes. World psychiatry : official journal of the World Psychiatric Association (WPA), 12(2), 92–98.