For healthcare professionals

CIWA-Ar alcohol withdrawal calculator

The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) rates the severity of alcohol withdrawal from 10 signs and symptoms. Nine are scored 0 to 7 and orientation is scored 0 to 4, for a total of 0 to 67. Sullivan and colleagues published it in 1989 as a shortened version of the original CIWA-A. This calculator is written for clinicians and is not a diagnosis.

Last reviewed: 2026-11-01 By the uncovermyrisk.com editorial team Educational only, not medical advice.

Seizure, confusion, hallucinations or trouble breathing: call 911 now.General safety advice (not part of the published scale). Alcohol withdrawal can become an emergency; do not wait for a score.

Score each item

Ask the questions shown and observe the patient. The scale prints descriptions for some scores only; the numbers in between are for symptoms between those descriptions. Nothing you enter leaves this page.

Nausea and vomiting (0 to 7)

"Do you feel sick to your stomach? Have you vomited?" Observation.

Tremor (0 to 7)

Arms extended and fingers spread apart. Observation.

Paroxysmal sweats (0 to 7)

Observation.

Anxiety (0 to 7)

"Do you feel nervous?" Observation.

Agitation (0 to 7)

Observation.

Tactile disturbances (0 to 7)

"Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?" Observation.

0: none1: very mild itching, pins and needles, burning or numbness2: mild itching, pins and needles, burning or numbness3: moderate itching, pins and needles, burning or numbness4: moderately severe hallucinations5: severe hallucinations6: extremely severe hallucinations7: continuous hallucinations

Auditory disturbances (0 to 7)

"Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?" Observation.

0: not present1: very mild harshness or ability to frighten2: mild harshness or ability to frighten3: moderate harshness or ability to frighten4: moderately severe hallucinations5: severe hallucinations6: extremely severe hallucinations7: continuous hallucinations

Visual disturbances (0 to 7)

"Does the light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?" Observation.

Headache, fullness in head (0 to 7)

"Does your head feel different? Does it feel like there is a band around your head?" Do not rate for dizziness or lightheadedness. Otherwise, rate severity.

Orientation and clouding of sensorium (0 to 4)

"What day is this? Where are you? Who am I?"

0: oriented and can do serial additions1: cannot do serial additions or is uncertain about date2: disoriented for date by no more than 2 calendar days3: disoriented for date by more than 2 calendar days4: disoriented for place or person

Result appears here

What you will see

The total from 0 to 67, the score for each item and the note printed on the scale form.

Educational only, not medical advice. Not a diagnosis. The scale rates withdrawal symptoms; it does not decide treatment.

Source

Sullivan JT and colleagues, British Journal of Addiction 1989. Item wording and anchors are from the scale form as reproduced by the US Department of Veterans Affairs; the form states that the CIWA-Ar is not copyrighted and may be reproduced freely. The tests check the 10 items, their ranges, the maximum of 67 and the form's cut-point note.

Validated in

Developed as a shortened 10-item scale for rating alcohol withdrawal in clinical care and in drug trials (Sullivan 1989). Later studies used it in 201 inpatients withdrawing from alcohol in India (Bakhla 2014) and, as the reference scale, in men aged 18 to 65 seen for alcohol withdrawal in a Mexican emergency department (Suárez-Cuenca 2022).

Limits

Seven of the 10 items depend on what the patient reports, so the scale needs a patient who can answer questions. It rates symptoms, which other conditions and medicines can cause or mask. Scores between the printed descriptions depend on the rater. It takes more time to apply than some newer short scales (Suárez-Cuenca 2022).

CIWA-Ar items and ranges

Each of the 10 items is rated separately and the ratings are added. Nine items run from 0 to 7 and orientation and clouding of sensorium runs from 0 to 4, so the maximum is 67 (CIWA-Ar form (VA copy)) (Bakhla 2014).

Item	Range	Descriptions printed for
Nausea and vomiting	0 to 7	0, 1, 4, 7
Tremor	0 to 7	0, 1, 4, 7
Paroxysmal sweats	0 to 7	0, 1, 4, 7
Anxiety	0 to 7	0, 1, 4, 7
Agitation	0 to 7	0, 1, 4, 7
Tactile disturbances	0 to 7	0, 1, 2, 3, 4, 5, 6, 7
Auditory disturbances	0 to 7	0, 1, 2, 3, 4, 5, 6, 7
Visual disturbances	0 to 7	0, 1, 2, 3, 4, 5, 6, 7
Headache, fullness in head	0 to 7	0, 1, 2, 3, 4, 5, 6, 7
Orientation and clouding of sensorium	0 to 4	0, 1, 2, 3, 4
Total	0 to 67

Source: the CIWA-Ar scale form (CIWA-Ar form (VA copy)), after Sullivan and colleagues, 1989 (Sullivan 1989).

What the total means

The scale form carries one note on the total: patients scoring less than 10 do not usually need additional medication for withdrawal (CIWA-Ar form (VA copy)). A review of delirium tremens describes the CIWA-Ar as frequently used to gauge the severity of withdrawal and to anticipate the onset of delirium tremens (Kaye 2024). The scale was shortened from the earlier CIWA-A, and it is the most widely used version (Suárez-Cuenca 2022).

Repeat the score

Withdrawal changes over hours. In one study, CIWA-Ar ratings were repeated every six hours until the score fell below 10, and the mean score was 13.3 at 24 hours and 20.4 at 36 hours of abstinence (Bakhla 2014). The same study found that the 10 items group into three factors, which the authors named delirious, autonomic and nonspecific (Bakhla 2014).

Related calculators

To screen for unhealthy drinking, use the AUDIT-C alcohol check. For liver tests often seen with heavy drinking, see the AST/ALT ratio calculator. For level of consciousness, see the Glasgow Coma Scale calculator. Other bedside scores are listed under For healthcare professionals.

Sources

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. PMID 2597811. Abstract (a shortened 10-item scale for clinical quantitation of alcohol withdrawal severity, for clinical care and drug trials). pubmed.ncbi.nlm.nih.gov/2597811/
Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar), scale form, after Sullivan et al. 1989, as reproduced by the US Department of Veterans Affairs (PAWS). The form states: "The CIWA-Ar is not copyrighted and may be reproduced freely." Item wording, anchors, maximum 67 and the note on scores under 10. www.ci2i.research.va.gov/paws/pdfs/ciwa-ar.pdf
Bakhla AK, Khess CR, Verma V, Hembram M, Praharaj SK, Soren S. Factor structure of CIWA-Ar in alcohol withdrawal. J Addict. 2014;2014:745839. doi:10.1155/2014/745839. PMID 24826372. Open access (CC BY). 201 inpatients; item ranges, six-hourly ratings, mean scores at 24 and 36 hours, three factors. pmc.ncbi.nlm.nih.gov/articles/PMC4006624/
Kaye AD, Staser AN, Mccollins TS, et al. Delirium tremens: a review of clinical studies. Cureus. 2024;16(4):e57601. doi:10.7759/cureus.57601. PMID 38707114. Open access (CC BY 4.0). Table 1 (CIWA-Ar items and ranges, total 0-67). pmc.ncbi.nlm.nih.gov/articles/PMC11069634/
Suárez-Cuenca JA, Toledo-Lozano CG, Espinosa-Arroyo MD, et al. Diagnostic performance of AST scale in Mexican male population for alcohol withdrawal syndrome. Int J Environ Res Public Health. 2022;19(15):9208. doi:10.3390/ijerph19159208. PMID 35954565. Open access (CC BY 4.0). Men aged 18 to 65 in an emergency department, CIWA-Ar as the reference scale. pmc.ncbi.nlm.nih.gov/articles/PMC9367724/

Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-01. Spotted an error? See About.