CIWA-Ar Alcohol Withdrawal Scale: Score Calculator

What it measures

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is a 10-item, clinician-rated tool for the severity of acute alcohol withdrawal. Higher scores indicate more severe withdrawal and greater risk of seizures and delirium tremens. It is commonly used to guide symptom-triggered benzodiazepine dosing. It is validated for adults with known alcohol withdrawal and assumes the patient can communicate and is not heavily sedated. Patients with impaired consciousness, acute medical illness, or severe comorbidity such as hepatic encephalopathy or head trauma may need a fixed-dose regimen instead.

Items and scoring

Nine items are scored 0 to 7: nausea and vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, and headache or fullness in the head. Item 10, orientation and clouding of sensorium, is scored 0 to 4. The total is the sum, from 0 to 67. Each item shows the interview prompt and the anchor descriptions from the scale; for several items only some points are anchored and the rest are interpolated. Pulse and blood pressure can be entered for the record but do not count toward the score.

Score	Severity	Guidance shown by the tool
0–9	Minimal to mild withdrawal	Scores below 8–10 usually do not require medication; many symptom-triggered protocols begin benzodiazepine dosing at 8–10 or higher. Continue reassessment per protocol.
10–15	Moderate withdrawal	Marked autonomic arousal. Consider a benzodiazepine and frequent (q1h) reassessment.
16–67	Severe withdrawal	Increased risk of seizures and delirium tremens. Treat promptly with a benzodiazepine, monitor closely, and consider a higher level of care.

Incomplete ratings

Unanswered items count as 0, so a partial total can underestimate withdrawal. Until all 10 items are rated, the tool labels the score "Incomplete — partial score" and does not assign a severity band or guidance. An item grid below the form shows each item's score, with a dash for items not yet rated.

What the report includes

Generate Report copies a plain-text summary with the date, pulse and blood pressure if entered, the total out of 67, the severity band (or an incomplete warning with the number of items rated), each item score, the interpretation, the scoring note and the source citation: Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Br J Addict. 1989;84(11):1353-1357. Reset clears the ratings and vital signs after a confirmation.