Alcohol withdrawal scales help doctors learn more about a patient’s level of alcohol use and prescribe medications to help relieve withdrawal symptoms.

Article at a Glance:

  • The CIWA-Ar is a tool used by health care professionals to evaluate the severity of alcohol withdrawal symptoms.
  • The CIWA-Ar uses ten different items, each scored on a scale of zero to seven to provide a score that indicates a patient’s risk.
  • A patient’s CIWA-Ar score can help determine if withdrawal medications are not needed, possibly needed or definitely needed.

The symptoms of alcohol withdrawal can be overpowering and unpleasant. When someone is working to abstain from alcohol misuse, these withdrawal symptoms may lead them to stop the process and drink again.

Medications are sometimes prescribed to help treat symptoms. However, these drugs are very strong and may have side effects of their own. Additionally, it’s possible for the medications themselves to be addictive or cause dependence.

Using the CIWA-Ar for Alcohol Withdrawal Assessment

A standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol Scale Revised (CIWA-Ar) was created to help health care professionals assess the severity of alcohol withdrawal symptoms. This assessment allows them to determine whether medications are needed to ease or alleviate symptoms.

Because patients sometimes underreport alcohol consumption, physicians often overlook misuse. Potentially life-threatening consequences, such as delirium tremens or seizures, could be missed if alcohol withdrawal symptoms go unrecognized. For these reasons, the CIWA-Ar is also used to assess patients in various situations, such as general outpatient, emergency, surgical or psychiatric care.

Related Topic: Home remedies for alcohol withdrawal

How To Use the CIWA-Ar Alcohol Withdrawal Scale

The CIWA-Ar scale consists of 10 items (or conditions) that a health care provider reviews. Each item is evaluated separately and then combined to produce an aggregated score, which indicates the severity and potential for alcohol withdrawal symptoms. Any sign indicating patterns or side effects of excessive alcohol use could point to a possibility of severe withdrawal symptoms.

See Also: What helps with alcohol withdrawal

Each item is scored on a scale of zero to seven, with zero meaning no symptoms are present and seven meaning the worst possible symptoms are likely. Most items have specific questions that the health care provider will ask, but some are based solely on observation.

To ensure the results are consistent, the wording for each question is designed to be the same each time. The ten items include:

  1. Nausea and vomiting: The doctor asks, “Do you feel sick to your stomach? Have you vomited?
  2. Tremor: The doctor notes the presence and severity of the patient’s tremors.
  3. Paroxysmal sweats: The doctor notes the presence and amount of the patient’s visible sweat.
  4. Anxiety: The doctor asks, “Do you feel nervous?”
  5. Agitation: The doctor notes the patient’s level of agitation.
  6. Tactile disturbances: The doctor asks, “Do you have any itching, pins and needles sensations, burning sensations, numbness, or do you feel bugs crawling on or under your skin?”
  7. Auditory disturbances: The doctor asks, “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?”
  8. Visual disturbances: The doctor asks, “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?”
  9. Headache, fullness in head: The doctor asks, “Does your head feel different? Does it feel like there is a band around your head?”
  10. Orientation, clouding of sensorium: The doctor asks, “What day is this? Where are you? Who am I?”

CIWA-Ar Score Interpretation

After completing the assessment, the points are tallied and the level of alcohol withdrawal is calculated. The points are categorized as follows:

  • Nine points or less: Withdrawal is absent or minimal, and withdrawal medications are likely unnecessary.
  • Ten to 20 points: Mild to modest alcohol withdrawal may be present. Withdrawal medications may be necessary.
  • 21 points or higher: Severe alcohol withdrawal may be present. Withdrawal medications are almost definitely necessary.

Once the severity is calculated, the health care provider will address which withdrawal medications are necessary to treat withdrawal symptoms.

If you or a loved one is struggling with alcohol addiction and experiencing withdrawal symptoms, The Recovery Village can help. Contact us today to learn more about alcohol detox and addiction treatment plans and programs that can work well for your needs.

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Editor – Jonathan Strum
Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more
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Medically Reviewed By – Benjamin Caleb Williams, RN
Benjamin Caleb Williams is a board-certified Emergency Nurse with several years of clinical experience, including supervisory roles within the ICU and ER settings. Read more

American Society of Addiction Medicine. “Addiction Medicine Essentials: Clinical […]e, Revised (CIWA-Ar).” January 2001. Accessed August 12, 2021.

Knight, Erin. “Clinical Institute Withdrawal Assessment[…]f alcohol withdrawal.” Canadian Family Physician, September 2017. Accessed August 12, 2021.

Merck Manuals. “CIWA-Ar Clinical Institute Withdrawal As[…]nt for Alcohol scale.” 2020. Accessed August 12, 2021.

U.S. National Library of Medicine. “Delirium tremens.” MedlinePlus, August 5, 2021. Accessed August 12, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.