"Walking withdrawal" is a term used to describe ongoing, uncomfortable withdrawal symptoms that occur even while you're still regularly taking benzodiazepines as prescribed. This screener will help identify benzo withdrawal and how severe it is for you
CIWA-B (20-item) Patient Self-Report Clinical Institute Withdrawal Assessment Scale: Benzodiazepines
Please rate each symptom from 0 (none) to 4 (severe). Select one option per symptom. The total at the end provides information on the severity of your withdrawal. *For educational purposes only* Reccomended to also take it in the morning when you wake up before taking your medication
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Do you feel irritable?
*
0. not at all
1
2
3.
4. very much so
Do you feel fatigued (tired)?
*
0. Not at all
1.
2
3
4. unable to function due to fatigue
Do you feel tense?
*
0. not at all
1.
2
3
4. very much so
Do you have difficulties concentrating?
*
0. no difficulty
1.
2
3
4. unable to concentrate
WIth your arms extended with fingers apart, do you have a tremor?
*
0.. no tremor
1. not visible but you can feel it
2. visible but mild
3. moderate with arms extended
4. severe, with arms not extended
Do you have any loss of appetite?
*
0. No loss
1
2
3
4. no appetite, unable to eat
Have you any numbness or burning in your face, hands or feet?
*
0. No numbness
1
2
3
4. intense burning or numbness
Do you feel your heart racing (palpitations)?
*
0. no distrubance
1
2
3
4. constant racing
Does your head feel full or achy?
*
0. not at all
1
2
3
4. Severe Headache
Do you feel muscle aches or stiffness?
*
0. not at all
1
2
3
4. severe stiffness or pain
Do you feel anxious, nervous or jittery?
*
0. not at all
1
2
3
4. very much so
Do you feel upset?
*
0. not at all
1
2
3
4. very much so
How restful was your sleep last night?
*
0. very restful
1
2
3
4. not at all
Do you feel weak?
*
0. not at all
1
2
3
4. very much so
Do you think you had enough sleep last night?
*
0. Yes, very much so
1
2
3
4. Not at all
Do you have any visual disturbances? (sensitivity to light, blurred vision)
*
0. not at all
1
2
3
4. very sensitive to light, blurred vision
Are you fearful?
*
0. not at all
1
2
3
4. Very much so
20 Have you been worrying about possible misfortunes lately?
*
0. Not at all
1
2
3
4. Very much so
do you feel restlessness or agitation?
*
0. None. Normal activity
1
2. Restless
3
4. Pace back and forth, unable to sit still
are you sweating
*
0. no sweating visible
1. palms moist, barely perceptable
2. palms and forehead moist
3. beads of sweat on forehead
4. severe drenching sweat
total score: Interpretation of scores: 1–20 = mild withdrawal 21–40 = moderate withdrawal 41–60 = severe withdrawal 61–80 = very severe withdrawal
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