CIWA-Ar Calculator (Alcohol Withdrawal)
Score the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) — 10 items from nausea and tremor to orientation — total 0–67 with withdrawal severity.
How it works
CIWA-Ar = items 1–9 scored 0–7 + orientation scored 0–4; maximum 67. Commonly used bands: ≤ 8 absent or minimal · 9–15 moderate · ≥ 16 severe withdrawal.
The revised Clinical Institute Withdrawal Assessment for Alcohol (Sullivan et al., 1989) is a 10-item scale that nurses and doctors use to measure alcohol withdrawal and to drive symptom-triggered benzodiazepine dosing. Each item is rated from observation and the patient’s answers, with written anchors at selected points and the clinician choosing in between. In the original study, patients scoring under 10 usually did not need additional medication; most protocols treat 8–10 as the threshold for medication and 15 or more as severe withdrawal. The CIWA-Ar is not valid for patients who cannot communicate, and its symptoms overlap with other illnesses.
Worked example
A patient with mild nausea (1), moderate tremor with arms extended (4), moist palms (1), moderate anxiety (4), slight restlessness (1), no perceptual disturbances (0, 0, 0), a mild headache (2) and normal orientation (0) scores 1 + 4 + 1 + 4 + 1 + 2 = 13 / 67 — moderate withdrawal, usually treated per the local symptom-triggered protocol.
Sources: Sullivan JT et al. Assessment of alcohol withdrawal: the revised CIWA-Ar. Br J Addict 1989
Frequently asked questions
What CIWA score needs treatment?
Most symptom-triggered protocols give medication at a score of 8–10 or more and reassess every 1–4 hours. Scores of 16 or more indicate severe withdrawal with higher risk of seizures and delirium tremens. Follow your hospital’s protocol.
How often is the CIWA-Ar repeated?
Typically every 1–2 hours while scores are high and every 4–8 hours once they settle, according to local policy, until the score stays low for about 24 hours.
What is the maximum CIWA-Ar score?
67: nine items scored 0–7 and orientation scored 0–4.
Can CIWA-Ar be used in intubated or delirious patients?
No. It needs a patient who can describe symptoms. Sedation scales such as RASS are used in intensive care instead.
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Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.