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.


  • When should the CIWA-Ar be used?

    The CIWA-Ar should only be used by a licensed health care provider who is specifically trained to perform this type of assessment. CIWA-Ar scoring should be used when initially assessing any patient who is suspected to have alcohol withdrawal symptoms or may be likely to develop alcohol withdrawal. The assessment should be repeated until withdrawal symptoms resolve or until the risk of withdrawal is minimal.

  • What should I know about using the CIWA-Ar?

    The CIWA-Ar assessment should only be performed by health care professionals. If you are a health care professional, you should understand how to correctly use the CIWA-Ar and how each item is scored. You should also be familiar with how to interpret the CIWA-Ar score and know what interventions to take based on the score.

  • What CIWA-Ar score would require medication to help with alcohol withdrawal?

    Each person withdrawing from alcohol will have different medication needs. These needs should be evaluated by a health care provider using more than just the CIWA-Ar. However, the CIWA-Ar score will play an important role in guiding the decisions. A patient with a score between nine and 19 may need medication to help with alcohol withdrawal, while an individual with a score of 20 or higher will almost definitely need withdrawal medications.

  • When should a patient seek medical help for alcohol withdrawal?

    Alcohol withdrawal is one of the most dangerous types of substance withdrawal a person can experience. Anyone who is undergoing alcohol withdrawal should seek medical help, but those who are experiencing tremors, confusion, seizures or fever should seek immediate medical care.

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 treatment plans and programs that can work well for your needs.

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