CIWA-Ar Calculator
Clinical Institute Withdrawal Assessment for Alcohol, Revised
A 10-item clinician-administered scale for monitoring alcohol withdrawal severity and guiding treatment.
Score the CIWA-Ar
Clinical scoring tool for practitioners. Enter observations to calculate the score.
No data stored. Scoring happens in your browser.
By using this tool you agree to our Terms of Service.
Unlimited on every paid planSample report
Example of the report delivered to practitioners when this assessment is administered inside Grounded Scribe. Fictional data.
Download sample (PDF)Licensing & Attribution
Source
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.
License
Not copyrighted. The CIWA-Ar may be reproduced freely. Sullivan et al. (1989).
Terms of Use
Free for individual clinical and educational use. See our Terms of Service.
What is the CIWA-Ar?
The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is a 10-item clinician-administered scale for monitoring alcohol withdrawal severity. It is the most widely used tool for guiding pharmacological management of alcohol withdrawal syndrome.
The CIWA-Ar rates ten domains: nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation/clouding of sensorium. Most items are scored 0-7, with a maximum total score of 67.
How CIWA-Ar Scoring Works
Items are scored by the clinician based on direct observation and brief patient interview. Nine items are scored 0-7 and one (orientation) is scored 0-4. Per Sullivan et al. (1989), the total score guides management:
Score ≤10: Mild withdrawal — may not require pharmacological treatment Score 11-15: Moderate withdrawal — consider symptom-triggered benzodiazepine protocol Score ≥16: Severe withdrawal — intensive monitoring and aggressive pharmacotherapy typically required
In symptom-triggered protocols, the CIWA-Ar is typically administered hourly. Benzodiazepines are given when scores exceed a threshold (commonly 8-10).
Clinical Applications
The CIWA-Ar is the standard of care for alcohol withdrawal management in emergency departments, medical wards, and detoxification units worldwide. It enables symptom-triggered therapy, which has been shown to reduce total benzodiazepine use and treatment duration compared to fixed-schedule dosing.
The scale should be administered by trained clinicians who can distinguish withdrawal symptoms from other medical conditions. Serial assessments allow tracking of withdrawal trajectory and treatment response.
CIWA-Ar in Australian Practice
The CIWA-Ar is included in Australian clinical guidelines for alcohol withdrawal management, including state health department protocols across NSW, Victoria, Queensland, and other jurisdictions. It is the standard assessment tool in Australian hospital emergency departments and medical detoxification units.
The instrument is not copyrighted and may be reproduced freely, making it universally available across Australian healthcare settings.
Use the CIWA-Ar inside Grounded Scribe
Registered practitioners can administer the CIWA-Ar to clients, track scores across sessions, and auto-document results into clinical notes.
Frequently Asked Questions About the CIWA-Ar
Related Clinical Calculators
Other validated instruments commonly used alongside the CIWA-Ar.
Send all of these bundled to your client
One link, multiple assessments completed in sequence — auto-scored back to you.
Related Diagnostic Codes
ICD-10-AM diagnostic codes commonly associated with the CIWA-Ar.
References
- 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.
Last updated: