CIWA Assessment

Rate each symptom based on your current experience. Be honest about your symptoms for accurate assessment.

1. Nausea and Vomiting

Rate your experience of nausea and vomiting

0 - None

1 - Mild nausea with no vomiting

2 - Intermittent nausea with dry heaves

3 - Constant nausea, frequent dry heaves and vomiting

4 - Severe nausea and vomiting

5 - Severe nausea and vomiting

6 - Severe nausea and vomiting

7 - Severe nausea and vomiting

2. Tremor

Rate the severity of your hand tremor

0 - No tremor

1 - Not visible, but can be felt fingertip to fingertip

2 - Moderate, with patient's arms extended

3 - Severe, even with arms not extended

4 - Severe, even with arms not extended

5 - Severe, even with arms not extended

6 - Severe, even with arms not extended

7 - Severe, even with arms not extended

3. Paroxysmal Sweats

Rate your experience of sudden sweating episodes

0 - No sweat visible

1 - Barely perceptible sweating, palms moist

2 - Beads of sweat obvious on forehead

3 - Drenching sweats

4 - Drenching sweats

5 - Drenching sweats

6 - Drenching sweats

7 - Drenching sweats

4. Anxiety

Rate your level of anxiety

0 - Normal, no anxiety

1 - Mildly anxious

2 - Moderately anxious, or guarded, so anxiety is inferred

3 - Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

4 - Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

5 - Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

6 - Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

7 - Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions

5. Agitation

Rate your level of agitation

0 - Normal activity

1 - Somewhat more than normal activity

2 - Moderately fidgety and restless

3 - Paces back and forth during most of the interview, or constantly thrashes about

4 - Paces back and forth during most of the interview, or constantly thrashes about

5 - Paces back and forth during most of the interview, or constantly thrashes about

6 - Paces back and forth during most of the interview, or constantly thrashes about

7 - Paces back and forth during most of the interview, or constantly thrashes about

6. Tactile Disturbances

Rate any tactile (touch) disturbances

0 - None

1 - Very mild itching, pins and needles, burning or numbness

2 - Mild itching, pins and needles, burning or numbness

3 - Moderate itching, pins and needles, burning or numbness

4 - Moderately severe hallucinations

5 - Severe hallucinations

6 - Extremely severe hallucinations

7 - Continuous hallucinations

7. Auditory Disturbances

Rate any auditory (hearing) disturbances

0 - Not present

1 - Very mild harshness or ability to frighten

2 - Mild harshness or ability to frighten

3 - Moderate harshness or ability to frighten

4 - Moderately severe hallucinations

5 - Severe hallucinations

6 - Extremely severe hallucinations

7 - Continuous hallucinations

8. Visual Disturbances

Rate any visual disturbances

0 - Not present

1 - Very mild sensitivity

2 - Mild sensitivity

3 - Moderate sensitivity

4 - Moderately severe hallucinations

5 - Severe hallucinations

6 - Extremely severe hallucinations

7 - Continuous hallucinations

9. Headache, Fullness in Head

Rate your headache or head fullness

0 - Not present

1 - Very mild

2 - Mild

3 - Moderate

4 - Moderately severe

5 - Severe

6 - Very severe

7 - Extremely severe

10. Orientation and Clouding of Sensorium

Rate your orientation and mental clarity

0 - Oriented and can do serial additions

1 - Cannot do serial additions or is uncertain about date

2 - Disoriented for date by no more than 2 calendar days

3 - Disoriented for date by more than 2 calendar days

4 - Disoriented for place and/or person

5 - Disoriented for place and/or person

6 - Disoriented for place and/or person

7 - Disoriented for place and/or person

Calculate CIWA Score Reset

About CIWA Calculator

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is a validated tool used by healthcare professionals to assess alcohol withdrawal severity.

Withdrawal Timeline:

• 6-12 hours: Mild symptoms begin
• 12-24 hours: Peak symptoms
• 24-48 hours: Delirium tremens risk
• 3-7 days: Symptoms typically resolve

Risk Factors for Severe Withdrawal:

• • Previous withdrawal seizures
• • History of delirium tremens
• • Heavy, prolonged alcohol use
• • Concurrent medical conditions
• • Older age
• • Poor nutritional status

Medical Treatment Options:

• • Benzodiazepines (diazepam, lorazepam)
• • Thiamine supplementation
• • Fluid and electrolyte management
• • Monitoring for complications
• • Supportive care

When to Seek Emergency Care:

• • Seizures
• • Severe confusion
• • Hallucinations
• • High fever
• • Severe agitation
• • Rapid heart rate
• • High blood pressure

Prevention:

• • Medical supervision for withdrawal
• • Gradual tapering of alcohol
• • Proper nutrition and hydration
• • Treatment of underlying conditions
• • Long-term addiction treatment