CIWA-Ar Score Guidelines: Score < 10: Mild withdrawal / minimal treatment usually needed.Score 10–19: Moderate withdrawal (risk of complications; monitor closely).Score > 20: Severe withdrawal / high risk of delirium tremens or seizures. Select symptom ratings below.
CIWA-Ar Symptom Parameters Input
1. Nausea and Vomiting (0 = None to 7 = Constant nausea/vomiting)
0 - None 1 2 3 4 - Intermittent nausea with dry heaves 5 6 7 - Constant nausea, frequent dry heaves and vomiting
2. Tremor (0 = No tremor to 7 = Severe, even with arms unextended)
0 - None 1 - Not visible, but can be felt fingertip to fingertip 2 3 4 - Moderate, with arms extended 5 6 7 - Severe, even with arms unextended
3. Paroxysmal Sweats (0 = None to 7 = Drenching sweats)
0 - None 1 - Barely perceptible sweating, palms moist 2 3 4 - Beads of sweat obvious on forehead 5 6 7 - Drenching sweats
4. Anxiety (0 = None/mild to 7 = Acute panic states)
0 - None, at ease 1 - Mild anxious 2 3 4 - Moderately anxious, or guarded 5 6 7 - Equivalent to acute panic states as seen in severe delirium
5. Agitation (0 = Normal activity to 7 = Pacing constantly / restless)
0 - Normal activity 1 - Somewhat normal activity, more than usual 2 3 4 - Moderately restless and fidgety 5 6 7 - Paces around room most of time, or thrashes about
6. Tactile Disturbances (Itching, pins and needles, burning, numbness)
0 - None 1 - Very mild itching, prickling, or burning 2 - Mild itching, prickling, or burning 3 - Moderate itching, prickling, or burning 4 - Moderately severe hallucinations 5 - Severe hallucinations 6 - Extremely severe hallucinations 7 - Continuous hallucinations
7. Auditory Disturbances (Sounds harsh, frightening, or hallucinations)
0 - Not present 1 - Very mild harshness or ability to hear fright 2 - Mild harshness 3 - Moderate harshness 4 - Moderately severe hallucinations (frightening) 5 - Severe hallucinations 6 - Extremely severe hallucinations 7 - Continuous hallucinations
8. Visual Disturbances (Sensitivity or visual hallucinations)
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 (0 = Not present to 7 = Very severe)
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 (Can you where you are?)
0 - Oriented and can do serial additions 1 - 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
Calculate CIWA-Ar Score ⚠️ Not medical advice. For emergency medical and addiction psychiatry reference only. Alcohol withdrawal assessment and protocol management must be performed by a licensed physician or emergency medical team.
