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Calculator: CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol scale in adults


Calculator: CIWA-Ar Clinical Institute Withdrawal Assessment for Alcohol scale in adults

 
NAUSEA AND VOMITING: Ask "Do you feel sick to your stomach? Have you vomited?" Observation.

No nausea and no vomiting (0 points)

Mild nausea with no vomiting (1 point)

  (2 points)

  (3 points)

Intermittent nausea with dry heaves (4 points)

  (5 points)

  (6 points)

Constant nausea, frequent dry heaves, and vomiting (7 points)
TREMOR: Arms extended and fingers spread apart. Observation.

No tremor (0 points)

Not visible, but can be felt fingertip to fingertip (1 point)

  (2 points)

  (3 points)

Moderate, with patient's arms extended (4 points)

  (5 points)

  (6 points)

Severe, even with arms not extended (7 points)
PAROXYSMAL SWEATS: Observation.

No sweat visible (0 points)

Barely perceptible sweating, palms moist (1 point)

  (2 points)

  (3 points)

Beads of sweat obvious on forehead (4 points)

  (5 points)

  (6 points)

Drenching sweats (7 points)
ANXIETY: Ask "Do you feel nervous?" Observation.

No anxiety, at ease (0 points)

Mildly anxious (1 point)

  (2 points)

  (3 points)

Moderately anxious, or guarded, so anxiety is inferred (4 points)

  (5 points)

  (6 points)

Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions (7 points)
AGITATION: Observation.

Normal activity (0 points)

Somewhat more than normal activity (1 point)

  (2 points)

  (3 points)

Moderately fidgety and restless (4 points)

  (5 points)

  (6 points)

Paces back and forth during most of the interview, or constantly thrashes about (7 points)
TACTILE DISTURBANCES: Ask "Do you have any itching, pins and needles sensations, burning sensations, numbness, or the feeling of bugs crawling on or under your skin?" Observation.

None (0 points)

Very mild itching, pins and needles, burning, or numbness (1 point)

Mild itching, pins and needles, burning, or numbness (2 points)

Moderate itching, pins and needles, burning, or numbness (3 points)

Moderately severe hallucinations (4 points)

Severe hallucinations (5 points)

Extremely severe hallucinations (6 points)

Continuous hallucinations (7 points)
AUDITORY DISTURBANCES: Ask "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?" Observation.

Not present (0 points)

Very mild harshness or ability to frighten (1 point)

Mild harshness or ability to frighten (2 points)

Moderate harshness or ability to frighten (3 points)

Moderately severe hallucinations (4 points)

Severe hallucinations (5 points)

Extremely severe hallucinations (6 points)

Continuous hallucinations (7 points)
VISUAL DISTURBANCES: Ask "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?" Observation.

Not present (0 points)

Very mild sensitivity (1 point)

Mild sensitivity (2 points)

Moderate sensitivity (3 points)

Moderately severe hallucinations (4 points)

Severe hallucinations (5 points)

Extremely severe hallucinations (6 points)

Continuous hallucinations (7 points)
HEADACHE, FULLNESS IN HEAD: Ask "Does your head feel different? Does it feel as if there is a band around your head?" Do not rate for dizziness or lightheadedness. Otherwise, rate severity.

Not present (0 points)

Very mild (1 point)

Mild (2 points)

Moderate (3 points)

Moderately severe (4 points)

Severe (5 points)

Very severe (6 points)

Extremely severe (7 points)
ORIENTATION AND CLOUDING OF SENSORIUM: Ask "What day is this? Where are you? Who am I?" Count forward by 3.

Oriented and can do serial additions (0 points)

Cannot do serial additions or is uncertain about date (1 point)

Disoriented for date by no more than 2 calendar days (2 points)

Disoriented for date by more than 2 calendar days (3 points)

Disoriented for place and/or person (4 points)

 
Important: Inputs must be complete to perform calculation.

 
Total criteria point count:
 

 

CIWA score interpretation

 
0 to 9 points: Very mild withdrawal
10 to 15 points: Mild withdrawal
16 to 20 points: Modest withdrawal
21 to 67 points: Severe withdrawal

 

 

 
Only digits 0 to 9 and a single decimal point (".") are acceptable as numeric inputs. Attempted input of other characters into a numeric field may lead to an incorrect result.

Information on this page may not appear correctly if printed.

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