Nausea or vomiting
No (0p)
Tremor
No tremor (0p)
Paroxysmal sweats
No sweat visible (0p)
Anxiety
No anxiety, at ease (0p)
Agitation
Normal activity (0p)
Tactile disturbances
None (0p)
Auditory disturbances
Not present (0p)
Visual disturbances
Not present (0p)
Headache
Not present (0p)
Orientation
Oriented (0p)
Results
CIWA-Ar score
0
Mild alcohol withrawal. Pharmacological treatment is not indicated for score < 10.

The CIWA calculator helps you assess the symptoms of alcohol withdrawal. What does CIWA stand for? It stands for Clinical Institute Withdrawal Assessment for Alcohol; however, our CIWA calculator uses a revised version (CIWA-Ar) - a shortened and improved scale created by the Centre for Addiction and Mental Health. This tool is the most commonly used scale in the clinical quantification of the severity of alcohol withdrawal. Read the article below to find out more about the CIWA protocol and alcohol withdrawal score.

If you're interested, check out our other addiction medicine calculators 🚫:

We try our best to make our Omni Calculators as precise and reliable as possible. However, this tool can never replace professional medical advice.

What does CIWA stand for? CIWA scale - assessment of symptoms of alcohol withdrawal

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) is a withdrawal severity assessment scale containing 15 items. Shaw et al. developed the CIWA protocol in 1981 to quantify and follow the clinical course of alcohol withdrawal.

The scale was revised eight years later and now it's one of the most commonly used tools in alcohol withdrawal. Our CIWA calculator uses the revised version of the tool - CIWA-Ar.

CIWA Ar - a revised version of alcohol withdrawal scale

Suvillan et al. revised the CIWA protocol in 1989, and they shortened the number of items from 15 to 10. They include:

  • Nausea and vomiting;
  • Tremor;
  • Paroxysmal sweats;
  • Anxiety;
  • Agitation;
  • Tactile disturbances;
  • Auditory disturbances;
  • Visual disturbances;
  • Headache; and
  • Orientation and clouded sensorium.

CIWA-Ar offers an increase in efficiency while at the same time retaining the clinical usefulness, validity, and reliability. Competent nurses are able to carry out the evaluation in less than two minutes. The authors suggest that revised CIWA assessment should be incorporated into the usual clinical care of patients undergoing alcohol withdrawal, so the optimal pharmacotherapy can be instituted.

One of the randomized trials published in 1994 showed that management of alcohol withdrawal handled with the use of the CIWA scale resulted in decreased use of benzodiazepines and treatment duration.

The scale can also be used as a validated outcome criterion in clinical trials involving alcohol withdrawal syndrome.

CIWA score range

Each of the 10 items in CIWA-Ar scores from 0 to 7 points, except the 'orientation' category, which can score from 0 to 4 points. Therefore, the maximal alcohol withdrawal score the patient can obtain is 67.

CIWA score range interpretation:

  • A score lower than 10 - pharmacological treatment is not indicated;
  • A score from 10 to 20 - patients need a clinical judgment to establish if they require pharmacological treatment; and
  • A score higher than 20 - indicative of severe alcohol withdrawal.

How to use the CIWA calculator to obtain an alcohol withdrawal score?

CIWA calculator contains 10 items that you can find in the revised CIWA scale. Each item has 8 possible answers that score from 0 to 7 points. The last section "Orientation" is the exception as it only contains 5 possible answers that can score from 0 to 4 points.

Choose the appropriate answer for each category and check the overall result with the CIWA score interpretation at the bottom.

Joanna Michałowska, PhD candidate