Limitations of Withdrawal Scales

Scoring of alcohol withdrawal scales is typically highly variable in clinical practice and often not reproducible; clinicians should review scores before making management decisions. Staff training is required to yield more reproducible scores. Limit the duration of use to 48-72 hours unless there is ongoing withdrawal. 

Alcohol withdrawal rating scales are not to be used as diagnostic tools as many other conditions may produce similar signs and symptoms, for example: 

• • • medical conditions (such as sepsis, hepatic encephalopathy, severe pain, other causes of tremor) 

    • psychiatric conditions (such as anxiety disorder) 

    • other drug withdrawal syndromes (such as benzodiazepine, stimulant or opiate withdrawal). 

Using alcohol withdrawal rating scales in these cases can lead to inappropriate diagnosis of alcohol withdrawal or its severity. 

Withdrawal scales should not be used to direct medication (as for example, in symptom-triggered regimens) in patients with these conditions, including most hospitalised patients. Alcohol withdrawal scales have a limited role under these circumstances, and health professionals should consult a specialist drug and alcohol clinician about monitoring and management needs.  

The scale can be safely discontinued after benzodiazepine treatment has stopped and the scores fall to zero for 24 hours.