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CIWA-Ar Alcohol Withdrawal

Clinical Institute Withdrawal Assessment for Alcohol, Revised (10 items, max 67).

Switch how results are explained

Nausea and vomiting
Tremor (arms extended, fingers spread)
Paroxysmal sweats
Anxiety
Agitation
Tactile disturbances (itching, numbness, burning)
Auditory disturbances (harshness, sound sensitivity)
Visual disturbances (light sensitivity, hallucinations)
Headache, fullness in head
Orientation and sensorium
Score0low risk
low riskmoderate riskhigh risk

Mild alcohol withdrawal (score < 10). Generally does not require pharmacological treatment unless patient has prior history of seizures or DTs.

Evidence grade
A

What it is and when to use it

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is a 10-item scale used to evaluate alcohol withdrawal severity.

How to interpret it

Scores <10 indicate mild withdrawal; 10–15 moderate withdrawal (symptom-triggered benzodiazepines recommended); >15 severe withdrawal (high risk for seizures and delirium tremens).

Limitations and when not to use it

CIWA-Ar requires patient participation. If the patient is uncommunicative or severely obtunded, rely on objective signs and intensive monitoring.

Frequently asked questions

How frequently should CIWA-Ar be reassessed?
Assessments are typically performed every 1 to 4 hours depending on symptom severity and protocol requirements.

Formulas and cut-offs are from the original authors of each score; see the references.

Last reviewed: June 2026

References
  1. 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). Br J Addict. 1989;84(11):1353-1357. PMID:2596802