The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) (Sullivan et al., 1989) is a 10-item scale that quantifies alcohol withdrawal severity. Score each item below — the total ranges from 0 to 67 and maps to a severity band used to guide symptom-triggered therapy decisions by clinicians.
| Score | Band | Usual meaning |
|---|---|---|
| < 10 | Minimal / absent | Withdrawal usually does not require medication; routine monitoring |
| 10 – 18 | Mild-to-moderate | Notify clinician; symptom-triggered therapy may be considered per protocol |
| 19 – 20 | Moderate — consider treatment | Treatment is generally considered at this level |
| > 20 | Severe | High risk of seizures / delirium tremens — urgent medical care |
Cutoffs vary slightly between institutions (some use 0–8 / 9–14 / 15–20 / >20). Always follow your local protocol. Primary source: Sullivan JT et al., Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar), British Journal of Addiction. 1989;84(11):1353–1357. PMID: 2597811.
The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised; Sullivan et al., 1989) is a 10-item clinical scale that quantifies the severity of alcohol withdrawal. Nine items (nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile, auditory and visual disturbances, headache) are rated 0–7 and orientation/clouding of sensorium is rated 0–4. It is an assessment aid used to guide symptom-triggered care decisions — not a diagnosis by itself.
The maximum total is 67 (nine items × 7 points plus 4 points for orientation). The minimum is 0.
Example: nausea 2, tremor 3, sweats 1, anxiety 2, agitation 1, tactile 0, auditory 0, visual 0, headache 2, orientation 0 gives a total of 11, which falls in the 10–18 band: “Mild-to-moderate withdrawal”. The usual next step is to notify the treating clinician.
Example: nausea 5, tremor 6, sweats 5, anxiety 6, agitation 5, tactile 4, auditory 4, visual 3, headache 6, orientation 2 gives a total of 46, which falls in the “Severe withdrawal” band (above 20). Scores above 20 carry a high risk of seizures and delirium tremens — seek urgent or emergency medical care.
No. The CIWA-Ar is a severity-rating aid, not a diagnostic test — withdrawal scales are explicitly not diagnostic tools. Alcohol withdrawal can be life-threatening (seizures, delirium tremens). If you or someone else may be in withdrawal, contact a clinician or emergency services.
Repeat scoring follows the clinician’s or institution’s protocol — scores can change rapidly during withdrawal, so reassessment is typically frequent while symptoms are active. This tool does not set monitoring intervals; follow your care team’s guidance.
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