How it's calculated
9 symptom domains are each rated 0-7 by clinical assessment, plus a 10th domain (orientation/clouding of sensorium) rated 0-4, for a maximum total of 67.
Score interpretation
| CIWA-Ar | Interpretation |
|---|---|
| <10 | Minimal/no withdrawal — medication generally not needed |
| 10–18 | Moderate withdrawal — consider symptom-triggered dosing per local protocol |
| >18 | Severe withdrawal — higher risk of seizures and delirium tremens |
Clinical use
- Used to guide symptom-triggered benzodiazepine dosing in alcohol withdrawal, and to track withdrawal severity over time with serial reassessment.
- Designed to be repeated regularly (e.g. hourly to every few hours depending on severity and local protocol) rather than measured once.
- Not valid in patients who are unable to accurately self-report (e.g. significant delirium, other sedating comorbidities) — clinical judgement should guide management in those cases.
Frequently asked questions
What is CIWA-Ar used for?
The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar), quantifies the severity of alcohol withdrawal symptoms and is commonly used to guide symptom-triggered benzodiazepine dosing.
How often should CIWA-Ar be repeated?
It's designed to be reassessed serially — frequency depends on severity and local protocol, often hourly during active symptom-triggered treatment and less often as symptoms settle.
What CIWA-Ar score usually triggers treatment?
Many symptom-triggered protocols use a threshold around 8-10 to trigger a benzodiazepine dose, with scores above 18-20 indicating severe withdrawal and a higher risk of seizures or delirium tremens — exact local protocols vary, so follow your institution's specific threshold.
References
- Sullivan JT, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84:1353-1357.