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CIWA-Ar Calculator.

The Clinical Institute Withdrawal Assessment for Alcohol, Revised — the standard bedside score for alcohol withdrawal. Rate all ten items and get the aggregate (max 67), the severity band, and the symptom-triggered escalation approach. Item wording is transcribed from the original Sullivan 1989 scale; severity thresholds and the symptom-triggered medication approach follow the 2020 ASAM guideline. The score supports your judgment and your facility's protocol — it doesn't replace them.

Score the 10 CIWA-Ar items

Rate each item on the patient in front of you. Nine items score 0–7; orientation scores 0–4. The total updates as you go. Requires a communicative patient — see the caveat below for sedated or intubated patients.

Nausea & vomiting "Do you feel sick to your stomach? Have you vomited?"

Tremor Arms extended, fingers spread. Observation.

Paroxysmal sweats Observation.

Anxiety "Do you feel nervous?" Observation.

Agitation Observation.

Tactile disturbances "Any itching, pins-and-needles, burning, numbness, or bugs crawling on/under the skin?"

Auditory disturbances "More aware of sounds? Harsh? Frightening? Hearing things that aren't there?"

Visual disturbances "Light too bright? Colors different? Hurts your eyes? Seeing things that aren't there?"

Headache / fullness in head "Does your head feel different — a band around it?" Do not rate dizziness.

Orientation & clouding of sensorium "What day is this? Where are you? Who am I?"

0 / 67 · 0 of 10 items scored

Score all ten items to see the total and severity band.

Severity bands & what they mean [2][3]

CIWA-Ar	Severity	Typical approach (confirm with your protocol)
< 10	Minimal–mild	Patients scoring <10 do not usually need additional medication for withdrawal.[3]
10–18	Moderate (marked autonomic arousal)	At risk of severe/complicated withdrawal; symptom-triggered benzodiazepine per orders; reassess frequently.[2]
≥ 19	Severe (impending delirium tremens)	ASAM supports a front-loading benzodiazepine strategy at this level; high risk of seizures and DTs.[2]

The original ASAM-supplement form describes <8–10 as minimal/mild, 8–15 as moderate, and ≥15 as severe (impending DTs); a revised-scale study found patients scoring >15 were at increased risk of severe withdrawal (RR 3.72).[3] The bands above use the 2020 ASAM operating thresholds (≥10, ≥19).[2] Either way, the score guides — your facility's order set sets the actual triggers.

The 10 items at a glance [1]

Item	Range	How it's rated
Nausea & vomiting	0–7	Ask + observe
Tremor	0–7	Arms extended, observe
Paroxysmal sweats	0–7	Observe
Anxiety	0–7	Ask + observe
Agitation	0–7	Observe
Tactile disturbances	0–7	Ask + observe (1–3 paresthesias, 4–7 hallucinations)
Auditory disturbances	0–7	Ask + observe (1–3 harshness, 4–7 hallucinations)
Visual disturbances	0–7	Ask + observe (1–3 sensitivity, 4–7 hallucinations)
Headache / fullness in head	0–7	Ask; do not rate dizziness
Orientation & clouding of sensorium	0–4	Ask

Maximum possible score 67 (nine items ×7 + orientation ×4). The CIWA-Ar is not copyrighted and may be reproduced freely.[1]

Disclaimer: Educational tool only — not a clinical decision-support device, not a diagnosis, and not a substitute for your assessment, your provider's orders, or your facility's CIWA protocol and order set. The CIWA-Ar was validated in communicative patients; it can be unreliable in sedated, intubated, delirious, or non-English-speaking patients, and symptoms like tremor and sweats overlap with other conditions (sepsis, thyroid storm, stimulant toxicity) — never assume a high score is "just withdrawal." A low score never overrides clinical concern; escalate any patient who worries you. Enter de-identified values only; nothing is stored or transmitted. Confirm the trigger thresholds and dosing your unit actually uses.

References

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. doi:10.1111/j.1360-0443.1989.tb00737.x. (Original 10-item scale; item anchors and maximum score 67 transcribed from this instrument; not copyrighted.)
The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management. J Addict Med. 2020;14(3S Suppl 1):1–72. asam.org. (Symptom-triggered benzodiazepines preferred over fixed-dose; CIWA-Ar ≥10 = at least moderate / at risk of severe withdrawal; ≥19 supports front-loading; reassess every 1–4 h in moderate–severe withdrawal; extend monitoring once <10 for 24 h.)
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). Supplement to ASAM News, Vol. 16, No. 1, Jan–Feb 2001 (reproduced, U.S. Dept. of Veterans Affairs). ci2i.research.va.gov. (Band descriptions: <8–10 minimal/mild, 8–15 moderate, ≥15 severe/impending DTs; "patients scoring less than 10 do not usually need additional medication"; >15 RR 3.72 for severe withdrawal.)

Item wording and thresholds were transcribed directly from these primary sources. Your facility may use a locally adapted CIWA protocol and order set — those take precedence at the bedside.

Pairs well with

CIWA-Ar Calculator.

Score the 10 CIWA-Ar items

Severity bands & what they mean [2][3]

The 10 items at a glance [1]

References

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