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CIWA-Ar alcohol withdrawal scale

Also called CIWA, Clinical Institute Withdrawal Assessment for Alcohol, revised, alcohol withdrawal score

Ten-item bedside rating of alcohol withdrawal severity (0–67) used for symptom-triggered benzodiazepine dosing.

Nausea and vomiting

Rate with the anchor wording on the official form.

Tremor

Rate with the anchor wording on the official form.

Paroxysmal sweats

Rate with the anchor wording on the official form.

Anxiety

Rate with the anchor wording on the official form.

Agitation

Rate with the anchor wording on the official form.

Tactile disturbances

Rate with the anchor wording on the official form.

Auditory disturbances

Rate with the anchor wording on the official form.

Visual disturbances

Rate with the anchor wording on the official form.

Headache, fullness in head

Rate with the anchor wording on the official form.

Orientation and clouding of sensorium

Rate with the anchor wording on the official form.

Fill 10 more fields to see the result.

Formula and scoring

Nine items 0–7 plus orientation 0–4; maximum 67. ASAM commentary: <8–10 minimal to mild, 8–15 moderate, ≥15 severe. Form: <10 usually needs no additional medication.

Exam and ward pearls

  • Maximum score 67 (nine items × 7 + orientation 4).
  • Sources differ on bands: ASAM uses 8–15 moderate and ≥15 severe; the Australian alcohol treatment guidelines use 10–20 moderate and >20 severe.
  • Rate each item with the anchor wording on the official form; this page takes the number only.

When not to rely on it

  • Requires a patient who can answer questions. Other illness (sepsis, hepatic encephalopathy, hypoglycaemia, head injury) can raise the score.
  • Treatment thresholds are set by local protocol, not by the scale.

Source

  1. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353-7. doi:10.1111/j.1360-0443.1989.tb00737.x · PMID 2597811
  2. CIWA-Ar form with ASAM commentary (Addiction Medicine Essentials, ASAM News 2001;16(1)), reproduced by the US Department of Veterans Affairs. Link
  3. Guidelines for the Treatment of Alcohol Problems (Australia), chapter 8: Clinical Institute Withdrawal Assessment for Alcohol. Link

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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