The CIWA-Ar scale for assessing alcohol withdrawal syndrome
| Symptom | Observation | Points |
|---|---|---|
| Nausea and vomitinga (Ask “Do you feel sick to your stomach? Have you vomited?”) | No nausea and vomiting | 0 |
| Intermittent nausea with dry heaves | 4 | |
| Constant nausea, frequent dry heaves, vomiting | 7 | |
| Tremora (Observe with arms extended and apart.) | No tremor | 0 |
| No tremor visible, but can be felt, fingertip to fingertip | 1 | |
| Moderate tremor with arms extended | 4 | |
| Severe tremor, even with arms not extended | 7 | |
| Paroxysmal sweatsa | No sweat visible | 0 |
| Beads of sweat obvious on forehead | 4 | |
| Drenching sweats | 7 | |
| Anxietya (“Do you feel nervous?”) | No anxiety (at ease) | 0 |
| Mildly anxious | 1 | |
| Moderately anxious or guarded, so anxiety is inferred | 4 | |
| Equivalent to acute panic states that occur in severe delirium or acute schizophrenic reactions | 7 | |
| Agitationa | Normal activity | 0 |
| Somewhat more than normal activity | 1 | |
| Moderately fidgety and restless | 4 | |
| Paces back and forth during most of interview or constantly thrashes about | 7 | |
| Tactile disturbances (“Do you have any itching, pins-and-needles sensations, burning, or numbness, or do you feel like bugs are crawling on or under your skin?”) | None | 0 |
| Very mild itching, pins-and-needles sensation, burning, or numbness | 1 | |
| Mild itching, pins-and-needles sensation, burning, or numbness | 2 | |
| Moderate itching, pins-and-needles sensation, burning, or numbness | 3 | |
| Moderately severe hallucinations | 4 | |
| Severe hallucinations | 5 | |
| Extremely severe hallucinations | 6 | |
| Continuous hallucinations | 7 | |
| Auditory disturbances (“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?”) | Not present | 0 |
| Very mild harshness or ability to frighten | 1 | |
| Mild harshness or ability to frighten | 2 | |
| Moderate harshness or ability to frighten | 3 | |
| Moderately severe hallucinations | 4 | |
| Severe hallucinations | 5 | |
| Extremely severe hallucinations | 6 | |
| Continuous hallucinations | 7 | |
| Visual disturbances (“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?”) | Not present | 0 |
| Very mild sensitivity | 1 | |
| Mild sensitivity | 2 | |
| Moderate sensitivity | 3 | |
| Moderately severe hallucinations | 4 | |
| Severe hallucinations | 5 | |
| Extremely severe hallucinations | 6 | |
| Continuous hallucinations | 7 | |
| Headache, fullness in head (“Does your head feel different? Do you feel like there is a band around your head?”) Do not rate for dizziness or lightheaded-ness. Otherwise, rate severity. | Not present | 0 |
| Very mild | 1 | |
| Mild | 2 | |
| Moderate | 3 | |
| Moderately severe | 4 | |
| Severe | 5 | |
| Very severe | 6 | |
| Extremely severe | 7 | |
| Orientation and clouding of sensorium (“What day is this? Where are you? Who am I?”) | Oriented and can do serial additions | 0 |
| Cannot do serial additions or is uncertain about date | 1 | |
| Date disorientation by no more than 2 calendar days | 2 | |
| Date disorientation by more than 2 calendar days | 3 | |
| Disoriented to place or person, or both | 4 | |
| Total CIWA-Ar score | Maximum possible: 67 |
↵a If symptoms lie between the point categories listed, it is acceptable to rate as a whole number in between. CIWA-Ar = revised Clinical Institute Withdrawal Assessment for Alcohol15
Based on Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for alcohol scale (CIWA-Ar). Br J Addict 1989; 84:1353–1357.