CIWA-Ar for Alcohol Withdrawal

The CIWA-Ar objectifies severity of alcohol withdrawal.

CIWA-Ar Alcohol Withdrawal Score Calculator

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is a 10-item scale used to assess and guide treatment of alcohol withdrawal symptoms.

1. Nausea and Vomiting:

0 – None 1 – Mild nausea with no vomiting 2 – Occasional dry heaves or retching 3 – Frequent dry heaves or retching 4 – Constant nausea, frequent vomiting 7 – Constant vomiting

2. Tremor (Arms extended, fingers spread apart):

0 – None 1 – Not visible but can be felt 2 – Barely visible 3 – Moderate, obvious tremor 4 – Severe tremor 7 – Whole body tremor

3. Paroxysmal Sweats:

0 – None 1 – Barely perceptible sweating, palms moist 2 – Obvious sweating on face/hands, needs wiping 3 – Beads of sweat on face/forehead 7 – Drenching sweats

4. Anxiety (Ask patient: “Do you feel nervous?”):

0 – None, at ease 1 – Mildly anxious 2 – Moderately anxious, restless 3 – Severely anxious, panicky 7 – Extreme panic attacks

5. Agitation:

0 – Normal activity 1 – Somewhat restless 2 – Moderately restless, fidgety 3 – Very restless, pacing 7 – Pacing, or unable to sit still

6. Tactile Disturbances (Ask patient: “Do you feel bugs crawling on you?”):

0 – None 1 – Very mild itchiness, numbness or tingling 2 – Mild hallucinations (e.g. pins and needles) 3 – Moderate hallucinations (e.g. burning, crawling) 4 – Severe hallucinations (e.g. bugs crawling on them) 7 – Continuous hallucinations

7. Auditory Disturbances (Ask patient: “Are you hearing things that are not there?”):

0 – None 1 – Very mild sensitivity to sound (e.g. startling) 2 – Mild hallucinations (e.g. distinct but not disturbing) 3 – Moderate hallucinations (e.g. disturbing but recognized as unreal) 4 – Severe hallucinations (e.g. real, disturbing, not recognized as unreal) 7 – Continuous hallucinations, cannot be reasoned with

8. Visual Disturbances (Ask patient: “Are you seeing things that are not there?”):

0 – None 1 – Very mild sensitivity to light (e.g. blurred vision) 2 – Mild hallucinations (e.g. fleeting images) 3 – Moderate hallucinations (e.g. disturbing but recognized as unreal) 4 – Severe hallucinations (e.g. real, disturbing, not recognized as unreal) 7 – Continuous hallucinations, cannot be reasoned with

9. Headache, Fullness in Head (Ask patient: “Do you have a headache or feel as if your head is full?”):

0 – None 1 – Very mild headache 2 – Mild headache 3 – Moderate headache 4 – Severe headache 7 – Very severe headache

10. Orientation and Clouding of Sensorium (Ask patient: “What day is this? Where are you? Who am I?”):

0 – Oriented, able to identify time, date, place, person 1 – Cannot identify time, date, or place but can identify person 2 – Disoriented to time, date, and/or place 3 – Disoriented to time, date, place, and/or person 4 – Disoriented to time, date, place, and person