Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised

The CIWA-Ar measures the current severity of the alcohol withdrawal syndrome. It covers ten symptoms: nausea and vomiting, tremor, sweating, anxiety, agitation, tactile, auditory and visual disturbances, headache, and orientation. Nine symptoms are rated from 0 to 7 and orientation from 0 to 4, giving a total score of up to 67. Pulse and blood pressure are recorded alongside but not scored.

Clinicians use the CIWA-Ar during alcohol withdrawal, for example in hospital, in a detox unit or in medically supervised outpatient withdrawal. Repeated ratings show how withdrawal develops over time. The scale is meant for a clinician to complete together with the patient.

The CIWA-Ar was developed by John T. Sullivan, Kathy Sykora, Jane Schneiderman, Claudio A. Naranjo and Edward M. Sellers at the Addiction Research Foundation in Toronto and published in 1989. It is a shortened, 10-item version of the earlier 15-item Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A).

The CIWA-Ar was developed to keep the reliability and validity of the longer CIWA-A while being quicker to use, and it shows high agreement between different raters. According to the official form, patients scoring less than 10 do not usually need additional medication for withdrawal. Other score bands for mild, moderate and severe withdrawal are used in practice, but they vary between sources and guidelines. German guidelines recommend the CIWA-Ar for monitoring withdrawal.

The CIWA-Ar must be used by trained staff and depends partly on the patient's ability to describe symptoms. It measures withdrawal symptoms, not their cause: other conditions, such as infections, other substances or medication, can cause similar symptoms. It does not reliably predict serious complications like seizures or delirium on its own, so clinical judgement is always needed. Different score bands are used in different settings.