CIWA-Ar Calculator — Alcohol Withdrawal Severity
Calculate the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) score to quantify the severity of alcohol withdrawal. Score 10 symptom domains to guide monitoring and treatment decisions.
Nausea / Vomiting
Tremor
Paroxysmal Sweats
Anxiety
Agitation
Tactile Disturbances
Auditory Disturbances
Visual Disturbances
Headache / Fullness in Head
Orientation / Clouding of Sensorium (0–4)
Total (0–67): higher scores indicate more severe withdrawal
- 1
Somatic subscale
Nausea 0 + Tremor 0 + Sweats 0 + Headache 0 = 0 - 2
Neuropsychiatric subscale
Anxiety 0 + Agitation 0 + Orientation 0 = 0 - 3
Perceptual subscale
Tactile 0 + Auditory 0 + Visual 0 = 0 - 4
CIWA-Ar total score
0 + 0 + 0 = 0
How does this calculator work?
CIWA-Ar sums 10 symptom scores (9 items 0–7 and 1 item 0–4) for a maximum of 67. Score ≤ 7: minimal withdrawal; 8–15: mild-to-moderate (consider benzodiazepines); 16–24: moderate-to-severe (medication required); ≥ 25: severe (high seizure/DT risk, likely ICU). Reassess every 1–8 hours based on severity.
Formula
How this is calculated
The CIWA-Ar scale, developed by Sullivan et al. (1989, British Journal of Addiction), is the most widely used validated tool for assessing alcohol withdrawal severity. It rates 10 symptom domains: nausea/vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache/fullness in head (each 0–7), and orientation/clouding of sensorium (0–4). The maximum possible score is 67.
Score interpretation: ≤ 7 indicates minimal withdrawal, which usually requires monitoring only and rarely necessitates pharmacotherapy. Scores of 8–15 indicate mild-to-moderate withdrawal where short-acting benzodiazepines are often considered. Scores of 16–24 represent moderate-to-severe withdrawal requiring close observation and medication. Scores ≥ 25 indicate severe withdrawal with high risk of seizures, delirium tremens, and life-threatening complications — these patients often require ICU-level care and aggressive benzodiazepine therapy.
The CIWA-Ar is designed for clinician use at the bedside with the patient present. It is not a telephone or proxy-rated instrument. Clinicians typically reassess every 1–8 hours depending on initial severity. This calculator displays informational results only; all treatment decisions must be made by a qualified healthcare professional.
Frequently asked questions
A score of 10 falls in the mild-to-moderate range (8–15). At this level, benzodiazepine therapy is generally considered to manage withdrawal symptoms and reduce the risk of seizures. The patient requires monitoring at regular intervals.
Most clinical protocols recommend initiating benzodiazepine therapy at a score of 8–10 or above. Severe withdrawal (score ≥ 16–20) typically warrants aggressive treatment; scores ≥ 25 are associated with high seizure and delirium tremens risk.
Reassessment frequency depends on severity. Patients with initial scores < 8 may be reassessed every 8 hours; those with scores of 8–15 every 4 hours; and those ≥ 16 every 1–2 hours or more frequently. Institutional protocols vary — follow your facility's guidelines.
TG we-Calculate Editorial Team. (2026). CIWA-Ar Calculator — Alcohol Withdrawal Severity [Online calculator]. TG we-Calculate. https://we-calculate.com/calculator/ciwa-calculator
TG we-Calculate Editorial Team. "CIWA-Ar Calculator — Alcohol Withdrawal Severity." TG we-Calculate. 2026. https://we-calculate.com/calculator/ciwa-calculator.
TG we-Calculate Editorial Team, "CIWA-Ar Calculator — Alcohol Withdrawal Severity," TG we-Calculate, 2026. [Online]. Available: https://we-calculate.com/calculator/ciwa-calculator
@misc{wecalculate_ciwa_calculator, title = {CIWA-Ar Calculator — Alcohol Withdrawal Severity}, author = {{TG we-Calculate Editorial Team}}, howpublished = {\url{https://we-calculate.com/calculator/ciwa-calculator}}, year = {2026}, note = {TG we-Calculate} }
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