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Psychiatry Emergency Medicine Critical Care A

CIWA-Ar — Alcohol Withdrawal Scale

Clinical Institute Withdrawal Assessment for Alcohol — Revised. Guides benzodiazepine dosing in alcohol withdrawal.

How to use & interpret

CIWA-Ar quantifies the severity of alcohol withdrawal across ten domains (e.g. tremor, sweating, anxiety, agitation, nausea, sensory disturbances, headache, orientation) to guide symptom-triggered benzodiazepine treatment.

Lower scores (commonly <8–10) suggest minimal withdrawal needing monitoring only; higher scores prompt medication and closer observation. It requires a co-operative, communicative patient and is unreliable in delirium, intoxication or significant comorbidity — where fixed-dose regimens and senior input are safer.

Score interpretation

Absent/Minimal Withdrawal 0–8

Score 0–8: Minimal or no withdrawal

→ Supportive care; monitor closely; no benzodiazepine indicated

Mild Withdrawal 9–14

Score 9–14: Mild withdrawal

→ Consider oral benzodiazepine PRN; close monitoring

Moderate Withdrawal 15–19

Score 15–19: Moderate withdrawal

→ Oral/IV benzodiazepine; frequent reassessment every 1–2 hours

Severe Withdrawal / Delirium Tremens Risk 20–67

Score ≥20: Severe withdrawal; high risk of seizures/delirium tremens

→ IV benzodiazepines; ICU-level monitoring; seizure precautions

Interpretation bands for the CIWA-Ar. Apply clinical judgement and local guidance.

Frequently asked questions

When is CIWA-Ar not appropriate?

Avoid relying on it in patients who cannot communicate (intubated, severe delirium, language barrier) or who have severe comorbidity; use a fixed-dose regimen with specialist input instead.

References

Related

Curated clinical cross-links plus same-class fallbacks.

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Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.