CIWA-Ar Calculator
Score the severity of alcohol withdrawal with the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised). Ten items — nine rated 0–7 and orientation rated 0–4 — add up to a total from 0 to 67 that tracks how severe the withdrawal is and is often used to guide symptom-triggered treatment. Rate each item to see the total and severity band.
About the CIWA-Ar
The CIWA-Ar quantifies alcohol withdrawal severity to support monitoring and symptom-triggered treatment. Source: 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),” British Journal of Addiction 1989;84(11):1353–1357.
Frequently asked questions
What is the CIWA-Ar?
The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) is a ten-item scale that quantifies the severity of alcohol withdrawal. Nine items — nausea/vomiting, tremor, sweats, anxiety, agitation, and tactile, auditory and visual disturbances, and headache — are each scored 0 to 7, and orientation/clouding of sensorium is scored 0 to 4, for a maximum of 67. It was published by Sullivan and colleagues in 1989 as a shortened revision of the original CIWA scale, and takes a couple of minutes to complete at the bedside. Each item is rated from what the patient reports together with what the assessor observes.
How is the score interpreted?
Common CIWA-Ar reference bands are: 8 or below = minimal or absent withdrawal; 9–15 = mild to moderate; 16–20 = moderate to severe; and above 20 = severe, with a higher risk of seizures and delirium tremens. Thresholds vary between protocols, so read the number against your local pathway. This calculator applies those same four bands, flagging anything above 20 as severe. A single score is only a snapshot — the trend across repeated assessments carries more information than any one total.
What is symptom-triggered treatment?
In symptom-triggered treatment, rather than fixed-schedule dosing, medication (usually a benzodiazepine) is given when the CIWA-Ar reaches a set threshold — often around 8–10 — and the score is repeated at intervals to decide further doses. This approach can reduce the total medication used and shorten treatment while keeping the patient safe, when applied with a protocol and trained staff. The alternative, fixed-schedule dosing, gives medication at set times regardless of the score and is still used where reliable repeated scoring is not practical. Either way the CIWA-Ar drives the monitoring interval, not the choice of drug or dose, which comes from the local protocol.
When is the CIWA-Ar not appropriate?
The CIWA-Ar relies on the patient being able to communicate, so it is unreliable in people who are intubated, heavily sedated, unable to report symptoms, or whose signs are driven by another illness. It measures withdrawal severity, not the diagnosis, and it should not replace clinical assessment of the airway, vital signs and other causes. Several items — nausea, anxiety, headache and the tactile, auditory and visual disturbances — rest on what the patient can describe, so the total can read falsely low in someone unable to communicate. It is also not a screening tool for alcohol use disorder and does not predict who will go on to develop withdrawal.
Does a low score mean no treatment is needed?
A low CIWA-Ar total alone does not mean treatment can be withheld. A low CIWA-Ar suggests mild withdrawal at that moment, but scores change over time and some patients (for example those with a history of withdrawal seizures) are treated regardless. The score is one input into a clinical decision. This calculator is an educational reference, not medical advice.
This is a reference tool, not a diagnosis or medical advice. Results depend on the laboratory, assay and clinical context, and reference intervals vary between labs and by age and sex — always read your result against the range printed on your own report and discuss it with a qualified healthcare professional.
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