CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised)

Rates the severity of alcohol withdrawal symptoms with 10 items (total 0 to 67)

10 items left

Nausea and vomiting

Ask "Do you feel sick to your stomach? Have you vomited?" and observe.

Tremor

Arms extended and fingers spread apart. Observe.

Anxiety

Ask "Do you feel nervous?" and observe.

0: no anxiety, at ease01: mildly anxious12: between 1 and 423: between 1 and 434: moderately anxious, or guarded, so anxiety is inferred45: between 4 and 756: between 4 and 767: equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions7

Agitation

Observe.

0: normal activity01: somewhat more than normal activity12: between 1 and 423: between 1 and 434: moderately fidgety and restless45: between 4 and 756: between 4 and 767: paces back and forth during most of the interview, or constantly thrashes about7

Tactile disturbances

Ask "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?" and observe.

0: none01: very mild itching, pins and needles, burning or numbness12: mild itching, pins and needles, burning or numbness23: moderate itching, pins and needles, burning or numbness34: moderately severe hallucinations45: severe hallucinations56: extremely severe hallucinations67: continuous hallucinations7

Auditory disturbances

Ask whether the patient is more aware of the sounds around them, whether the sounds are harsh or frighten them, whether they hear any sound that is disturbing to them, and whether they hear things they know are not there, and observe.

0: not present01: very mild harshness or ability to frighten12: mild harshness or ability to frighten23: moderate harshness or ability to frighten34: moderately severe hallucinations45: severe hallucinations56: extremely severe hallucinations67: continuous hallucinations7

Visual disturbances

Ask whether the light appears too bright, whether its color is different, whether it hurts the eyes, whether they see anything that is disturbing to them, and whether the patient sees things they know are not there, and observe.

Headache, fullness in head

Ask "Does your head feel different? Does it feel like there is a band around your head?" Do not rate for dizziness or lightheadedness. Otherwise, rate severity.

Orientation and clouding of sensorium

Ask "What day is this? Where are you? Who am I?" and ask the patient to do serial additions.

0: oriented and can do serial additions01: cannot do serial additions or is uncertain about date12: disoriented for date by no more than 2 calendar days23: disoriented for date by more than 2 calendar days34: disoriented for place and/or person4

Total score interpretation

Total	Interpretation
< 10 pts	Less than 10 (The note on the form says that patients scoring less than 10 do not usually need additional medication for withdrawal.)
≥ 10 pts	10 or more (The score is not below the "less than 10" guide in the note on the form. This calculator does not say whether additional medication is needed or how much; that depends on the facility protocol and the physician’s orders. The form has no cut points that divide scores above 10 into moderate, severe and so on, so none is given.)

Cautions

A form that scores the severity of alcohol withdrawal symptoms from questions and observation. It is not a diagnostic tool; it is for assessing the course of withdrawal symptoms repeatedly by the same method and recording it. The assessment takes approximately 5 minutes (note on the form).
Nine items are scored 0 to 7 and orientation and clouding of sensorium is scored 0 to 4, so the total is at most 67. On the form only some of the steps (0, 1, 4, 7 and so on) have wording, and there is no wording for the points in between (2, 3, 5, 6). The rater gives a point between the neighboring steps that have wording.
"Patients scoring less than 10 do not usually need additional medication for withdrawal" is the wording of the note on the form. Which treatment to start, and when, for a score of 10 or more is beyond this calculator. The form has no cut points that divide scores above 10 into mild, moderate and severe, so this calculator does not give them.
In the headache item, do not rate dizziness or lightheadedness (instruction on the form).
The pulse and blood pressure fields on the form are not part of the score (they are for recording).

References

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):1353-1357. (Abstract) (original not seen) PMID: 2597811, https://pubmed.ncbi.nlm.nih.gov/2597811/[Original article]
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) (the form, after Sullivan et al. 1989). (The whole form and the note at its end)[Review article]

Checked on: 2026-10-13

This calculation is intended to support the judgment of healthcare professionals. Results are for reference only; decisions about diagnosis and treatment must be made by the responsible healthcare professional. The values you enter never leave your device.

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised)

Cautions

References

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