Clinical institute withdrawal assessment scale for alcohol, revised (CIWA-Ar)

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Scoring

Total score is a simple sum of each score item (maximum is 67)
<10: Very mild withdrawal
10-15: Mild withdrawal
16-20: Modest withdrawal
>20: Severe withdrawal

Nausea and vomiting

0 No nausea and vomiting
1
2
3
4 Intermittent nausea with dry heaves
5
6
7 Constant nausea, frequent dry heaves and vomiting

Paroxysmal sweats

0 No sweats visible
1 Barely visible sweating, palms moist
2
3
4 Beads of sweat obvious on forehead
5
6
7 Drenching sweats

Anxiety

0 No anxiety
1
2
3
4 Moderately anxious, guarded
5
6
7 Acute panic state, consistent with severe delirium or acute schizophrenia

Agitation

0 Normal activity
1 Somewhat more than normal activity
2
3
4 Moderately fidgety and restless
5
6
7 Paces back and forth during most of the interview or constantly thrashes about

Tremor

0 No tremor
1 Not visible, but can be felt at fingertips
2
3
4 Moderate when patient's hands extended
5
6
7 Severe, even with arms not extended

Headache

0 Not present
1 Very mild
2 Mild
3 Moderate
4 Moderately severe
5 Severe
6 Very severe
7 Extremely severe

Auditory 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

Visual disturbances

0 Not present
1 Very mild photosensitivity
2 Mild photosensitivity
3 Moderate photosensitivity
4 Moderately severe visual hallucinations
5 Severe visual hallucinations
6 Extremely severe visual hallucinations
7 Continuous visual hallucinations

Tactile disturbances

0 None
1 Very mild paresthesias
2 Mild paresthesias
3 Moderate paresthesias
4 Moderately severe hallucinations
5 Severe hallucinations
6 Extremely severe hallucinations
7 Continuous hallucinations

Orientation and clouding of sensorium

0 Orientated and can do serial additions
1 Cannot do serial additions
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 patient

Acknowledgements

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