II. Indications

  1. Alcohol Withdrawal symptom monitoring (self rating scale)
    1. See Outpatient Alcohol Withdrawal Protocol

III. Criteria

  1. Anxious
  2. Feeling confused
  3. Restless
  4. Miserable
  5. Memory problems
  6. Tremors or shakes
  7. Nausea
  8. Heart pounding
  9. Sleep disturbance such as Insomnia
  10. Sweating

IV. Technique

  1. Patient self-scores the 10 symptom criteria above
  2. Assign each of the criteria with a score of 0-3
    1. Score 0: None
    2. Score 1: Mild
    3. Score 2: Moderate
    4. Score 3: Severe

V. Interpretation

  1. Score <12: Mild Alcohol Withdrawal
  2. Score 12 or more: Moderate to severe Alcohol Withdrawal

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