Clinical Institute Withdrawal Assessment for Alcohol, revised
A ten-item clinician-rated assessment of alcohol withdrawal severity, scored 0–67. Nine items are rated 0–7; orientation is rated 0–4. Commonly drives symptom-triggered benzodiazepine protocols; reassess at protocol-defined intervals.
For use by qualified clinicians as a decision-support aid. Scores support but do not replace clinical judgment. This is not a diagnostic instrument and no information is stored or transmitted.
Assess and rate each of the ten criteria. Record the time, total score, medication given, and the reassessment interval.
Score interpretation
Score
Severity
Guidance
0–7
Minimal
Minimal withdrawal; medication generally not required.
Moderate to severe withdrawal; treat and reassess frequently.
21–67
Severe
Severe withdrawal; high risk of seizures / delirium tremens — escalate care.
CIWA-Ar — Clinical Institute Withdrawal Assessment for Alcohol, revised
Clinician-rated · Completed
Patient: ______________________
DOB / ID: ______________________
Date: 2026-07-18
Clinician: ______________________
Assess and rate each of the ten criteria. Record the time, total score, medication given, and the reassessment interval.
1. Nausea and vomiting
☐0No nausea and no vomiting
☐1Mild nausea with no vomiting
☐2—
☐3—
☐4Intermittent nausea with dry heaves
☐5—
☐6—
☐7Constant nausea, frequent dry heaves and vomiting
2. Tremor
☐0No tremor
☐1Not visible but can be felt fingertip to fingertip
☐2—
☐3—
☐4Moderate, with arms extended
☐5—
☐6—
☐7Severe, even with arms not extended
3. Paroxysmal sweats
☐0No sweat visible
☐1Barely perceptible sweating, palms moist
☐2—
☐3—
☐4Beads of sweat obvious on forehead
☐5—
☐6—
☐7Drenching sweats
4. Anxiety
☐0No anxiety, at ease
☐1Mildly anxious
☐2—
☐3—
☐4Moderately anxious, or guarded, so anxiety is inferred
☐5—
☐6—
☐7Equivalent to acute panic states seen in severe delirium or acute schizophrenic reactions
5. Agitation
☐0Normal activity
☐1Somewhat more than normal activity
☐2—
☐3—
☐4Moderately fidgety and restless
☐5—
☐6—
☐7Paces back and forth, or constantly thrashes about
6. Tactile disturbances
☐0Not present
☐1Very mild itching, pins and needles, burning or numbness
☐2Mild itching, pins and needles, burning or numbness
☐3Moderate itching, pins and needles, burning or numbness
☐4Moderately severe hallucinations
☐5Severe hallucinations
☐6Extremely severe hallucinations
☐7Continuous hallucinations
7. Auditory disturbances
☐0Not present
☐1Very mild harshness or ability to frighten
☐2Mild harshness or ability to frighten
☐3Moderate harshness or ability to frighten
☐4Moderately severe hallucinations
☐5Severe hallucinations
☐6Extremely severe hallucinations
☐7Continuous hallucinations
8. Visual disturbances
☐0Not present
☐1Very mild sensitivity to light
☐2Mild sensitivity to light
☐3Moderate sensitivity to light
☐4Moderately severe hallucinations
☐5Severe hallucinations
☐6Extremely severe hallucinations
☐7Continuous hallucinations
9. Headache, fullness in head
☐0Not present
☐1Very mild
☐2Mild
☐3Moderate
☐4Moderately severe
☐5Severe
☐6Very severe
☐7Extremely severe
10. Orientation and clouding of sensorium
☐0Oriented and can do serial additions
☐1Cannot do serial additions or is uncertain about date
☐2Disoriented for date by no more than 2 calendar days
☐3Disoriented for date by more than 2 calendar days
☐4Disoriented for place and/or person
Total score: 0 / 67 — Minimal
Minimal withdrawal; medication generally not required.
Source: Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Br J Addiction. 1989;84(11):1353–1357.
For use by qualified clinicians as a decision-support aid. Scores support but do not replace clinical judgment. This is not a diagnostic instrument and no information is stored or transmitted.