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Clinical Institute Withdrawal Assessment for Alcohol (CIWA -A) scale

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A) scale is a useful tool to assess severity of AWS (1)

  • the scale is not a diagnostic tool as it has not been found to be useful in differentiating between DT and delirium due to medical illnesses (2)
  • scale includes 10 common signs and symptoms of alcohol withdrawal with the notable exceptions of pulse rate and blood pressure, which must be a part of the assessment of alcohol withdrawal states
  • the 10-item revised form (CIWA-Ar) is described
  • CIWA-Ar scale requires limited patient cooperation to evaluate its ten symptoms


  • Score grading:
    • less than 8 indicate mild withdrawal,
    • 8–15 indicate moderate withdrawal (marked autonomic arousal)
    • and >15 indicate severe withdrawal and are also predictive of the development of seizures and delirium
  • Score interpretation:
    • if CIWA-Ar score is <8 pharmacological treatment is not necessary
    • if CIWA-Ar score 8-15 pharmacological treatment may be appropriate to prevent the progression to more severe forms of AWS
    • pharmacological treatment is strongly indicated in patients with CIWA-Ar score >15

The evaluation of CIWA-Ar score should be repeated at least every 8 hours. In patients with scores >8–10 or requiring treatment, CIWA should be repeated every hour to evaluate the response to treatments


  • Mirijello A et al. Identification and Management of Alcohol Withdrawal Syndrome Drugs. 2015 Mar; 75(4): 353–365.
  • Kattimani S, Bharadwaj B.Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J. 2013 Jul-Dec; 22(2): 100–108.

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