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CIWA-Ar

Clinical Institute Withdrawal Assessment for Alcohol, revised

10 items
Score 0–67
current state
All scales

A 10-item clinician-administered scale quantifying severity of alcohol withdrawal. Drives symptom-triggered benzodiazepine protocols and helps decide level of care.

Your responses are scored in your browser and are never sent to or stored on our servers.

Rate each item based on patient observation and interview. Scores should reflect findings over the most recent brief assessment window (e.g., the prior hour). Re-administer at protocol-defined intervals.

0 / 10 answered
CIWA-Ar items
1.

1. Nausea and vomiting — "Do you feel sick to your stomach? Have you vomited?"

2.

2. Tremor — Arms extended and fingers spread apart.

3.

3. Paroxysmal sweats

4.

4. Anxiety — "Do you feel nervous?"

5.

5. Agitation

6.

6. Tactile disturbances — "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?"

7.

7. Auditory disturbances — "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.

8. Visual disturbances — "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.

9. Headache, fullness in head — "Does your head feel different? Does it feel like there is a band around your head?"

10.

10. Orientation and clouding of sensorium — "What day is this? Where are you? Who am I?"

Licensing

Developed by Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM (1989). Widely reproduced for clinical use. Treated here as public domain.

Citation

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 Nov;84(11):1353-7.

This tool is for education and clinical decision support — it does not substitute for a full clinical evaluation. Always interpret results in the context of a complete history and exam.

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