Clinical Institute Withdrawal Assessment for Alcohol

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Clinical Institute Withdrawal Assessment of Alcohol scale, revised (CIWA-Ar) scoring sheet, as commonly encountered in a hospital setting for bedside use, designed to allow the rater to access each individual item and arrive at an aggregate score.

The Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA-Ar (revised version), is a ten item scale used in the assessment and management of alcohol withdrawal.[1] Each item on the scale is scored independently, and the summation of the scores yields an aggregate value that correlates to the severity of alcohol withdrawal, with ranges of scores designed to prompt specific management decisions such as the administration of benzodiazepines. The maximum score is 67; Mild alcohol withdrawal is defined with a score less than or equal to 15, moderate with scores of 16 to 20, and severe with any score greater than 20. The ten items evaluated on the scale are common symptoms and signs of alcohol withdrawal, and are as follows:

All items are scored from 0-7, with the exception of the orientation category, scored from 0-4. The CIWA scale is validated and has high inter-rater reliability. A randomized, double blind trial published in JAMA in 1994[2] showed that management for alcohol withdrawal that was guided by the CIWA scale resulted in decreased treatment duration and total use of benzodiazepines. The goal of the CIWA scale is to provide an efficient and objective means of assessing alcohol withdrawal. Studies have shown that use of the scale in management of alcohol withdrawal leads to decreased frequency of over-sedation with benzodiazepines in patients with milder alcohol withdrawal than would otherwise be detected without use of the scale, and decreased frequency of under-treatment in patients with greater severity of withdrawal than would otherwise be determined without the scale.[3]


  1. ^ Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). Br J Addict 1989;84:1353–7
  2. ^ Saitz M, Mayo-Smith MF, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA 1994;272:519-23.
  3. ^ Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997 Jul 9;278(2):144-51. PubMed PMID 9214531.