CIWA-Ar Assessment
Rate each symptom from 0 to the indicated maximum. Combine patient-reported symptoms with clinician observation. The total score quantifies withdrawal severity and guides benzodiazepine dosing.
Nausea and vomiting
Ask patient how sick they feel. Observe retching or vomiting.
Tremor
Arms extended, fingers spread. Rate from no tremor to severe even with arms not extended.
Paroxysmal sweats
Observe palms and brow for perspiration.
Anxiety
Rate from no anxiety to panic states.
Agitation
Observe pacing, restlessness versus calm.
Tactile disturbances
Itching, pins and needles, burning, numbness, hypersenstivity.
Auditory disturbances
Sound sensitivity, hallucinations, voices.
Visual disturbances
Light sensitivity, visual hallucinations, illusions.
Headache or fullness in head
No headache to very severe incapacitating headache.
Orientation and clouding of sensorium
Ask day/date, patient location, reason for hospitalisation. Score 0–4.
Total CIWA-Ar score
0
Score range 0–67
Severity category
Minimal withdrawal
How to Use This Calculator
Perform clinical assessment
Combine patient self-report with direct observation of tremor, agitation, hallucinations, and orientation.
Score each item accurately
Use the detailed anchor descriptions (0–7 or 0–4) from CIWA-Ar documentation for consistency among staff.
Apply symptom-triggered therapy
Use hospital benzodiazepine protocols triggered by score thresholds (e.g., diazepam 10 mg for scores ≥10).
Formula
Total CIWA-Ar score = Sum of 10 item scores (9 items scored 0–7, orientation 0–4)
Severity guidance:
- 0–8: Minimal withdrawal
- 9–15: Mild to moderate withdrawal
- ≥16: Severe withdrawal, high risk for delirium tremens
Full Description
The CIWA-Ar tool quantifies the severity of alcohol withdrawal to guide benzodiazepine therapy and monitoring frequency. Higher scores correlate with complications such as seizures and delirium tremens. Implement the tool within a clinical protocol that includes vital sign monitoring, thiamine supplementation, electrolyte correction, and management of comorbid conditions. Ensure staff are trained to score consistently; patient safety relies on prompt recognition of escalating withdrawal.
Frequently Asked Questions
How often should CIWA-Ar be administered?
Typically every 1–2 hours in acute withdrawal, then spacing out once scores remain <8 for two consecutive readings.
Can CIWA-Ar be used outpatient?
Only in specialized settings with trained staff and rapid access to emergency services. Most moderate-severe cases require inpatient care.
Do benzodiazepines affect scoring?
Yes—treatment lowers symptoms and scores. Reassess 1 hour after dosing to evaluate response and need for additional medication.
What if the patient cannot communicate?
CIWA-Ar relies on patient input. In sedated or non-communicative patients, use alternative scales (e.g., MINDS) and clinical judgement.