[Alcohol withdrawal : benzodiazepines, neither automatic nor systematic]

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-revised) is the gold standard for assessing the severity of alcohol withdrawal. It allows the dosage of benzodiazepines to be adjusted according to symptom intensity rather than prescribing them at a fixed dose, with the aim of limiting prolonged use and the associated risk of dependence. Randomized trials have shown that this approach reduces both the total amount of benzodiazepines administered and the duration of treatment without compromising clinical efficacy or increasing alcohol withdrawal-related complications. However, CIWA-Ar use requires prior training of healthcare providers. Dosage is adjusted according to the score (<8: monitoring; 8-15: standard dose; >15: increased dose). The scale is contraindicated in uncooperative, confused, or intubated patients.