What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (2023)

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Medical experts utilize the Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) to evaluate and identify the severity of alcohol withdrawal.

What is a CIWA Score?

Medical experts utilize the Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-AR) to evaluate and identify the severity of alcohol withdrawal. One of the most popular treatments for alcohol withdrawal is the CIWA-AR, frequently utilized by family doctors.

The CIWA Scores help medical professionals to assess the severity of alcohol withdrawal syndrome in patients, preventing further health issues and treating withdrawal syndrome as necessary.

The CWIA-Ar measures 10 signs and symptoms of alcohol withdrawal, including:

  • Agitation (From 0 to 7)
  • Anxiety (From 0 to 7)
  • Hearing disturbances (From 0 to 7)
  • Sensory clouding (From 0 to 7)
  • Headache (From 0 to 7)
  • Nausea/vomiting (From 0 to 7)
  • persistent sweating (From 0 to 7)
  • Tactile abnormalities (From 0 to 7)
  • Tremors (From 0 to 7)
  • Visual abnormalities (From 0 to 7)

Skip To:

  • What is a CIWA Score?
  • How Should the CIWA-Ar Assessment Be Used?
  • How is the CIWA-Ar Scored?
  • The CIWA-AR Screening Questions
  • CWIA Score Calculator
  • CWIA Score Interpretation
  • CWIA Score PDF
  • CWIA Score Protocol
  • CWIA Score Alcohol Withdrawal
  • CWIA Score and Treatment

Learn More:

  • Effective Treatment For Alcohol Withdrawal Symptoms

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How Should the CIWA-Ar Assessment Be Used?

A certified doctor should use the CIWA-AR evaluation in a formal medical setting. Doctors in inpatient and rehabilitative treatment programs and family doctors may use the CIWA-AR assessment in their services.

What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (1)

What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (2)

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How is the CIWA-Ar Scored?

What is CIWA score? The CWIA-Ar evaluates symptoms on a scale of 0 to 7 and takes less than two minutes to complete. Physicians can calculate the severity of a patient’s withdrawal syndrome by summing the ratings of all 10 symptoms.

(Video) Alcohol Withdrawal: When CIWA Isn't Enough

CIWA score meaning? What does a CIWA score 10 mean? Or a CIWA score 9? Less than 8 to 10 cumulative scores suggest mild withdrawal. Then, scores between 8 and 15 suggest a mild withdrawal, while scores above 15 indicate a severe withdrawal with potential delirium tremens.

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The CIWA-Ar Screening Questions

How to score CIWA? The medical professional must ask a few questions to ensure the responses fall within the range required to complete the scale. The CIWA score is then calculated to determine if a person is undergoing withdrawal.

1. Have you recently experienced nausea or vomiting?

[0] no vomiting or nausea

[1] little dizziness but no vomiting

[2,3,4] – occasional nausea and dry heaves

[5,6,7] persistent nausea, periodic dry heaves, and vomiting

2. Do you experience any itchiness, prickling, burning, numbness, or the impression of spiders crawling on or beneath your skin?

[0] no tactile abnormalities

[1] very slight itchiness, prickling, burning, or numbing

[2] little itchiness, prickling, burning, or numbness

[3] mild tingling, numbness, burning, or itching

[4] mild to moderate hallucinations

[5] severe hallucinations

[6] terrible hallucinations

[7] persistent, very bad hallucinations

3. Ask the patient to spread their fingers and extend their arms to check if they are trembling.
[0] no tremor

[1] it feels like it, but it isn’t visible

[2,3,4] mild, with the patient’s arms outstretched

[5,6,7] harsh, even with the arms at the sides

4. Do you hear things that are not there?
[0] not found

[1] very slight harshness or frightening potential

[2] slight roughness or frightening potential

[3] moderate harshness or frightening potential

[4] mild to moderate hallucinations

(Video) Evaluation and Management of Alcohol Withdrawal

[5] severe hallucinations

[6] terrible hallucinations

[7] persistent hallucinations

5. Persistent sweating (observe)

[0] no noticeable sweat

[1] hardly noticeable perspiration, wet palms

[2,3,4] show clear forehead sweat beads

[5,6,7] heavy sweats

6. Are there any things you see that concern you? Do you see any objects that you know are not true?

[0] not found
[1] extremely low sensitivity
[2] a slight sensitivity
[3] slightly more sensitive
[4] mild to moderate hallucinations
[5] severe hallucinations
[6] terrible hallucinations
[7] persistent hallucinations

7. Do you feel anxious?

[0] unnerved and at ease
[1] mildly uneasy
[2,3,4] guarded or moderately nervous
[5,6,7] same as acute panic states as those observed in severe delirium or acute schizophrenia symptoms

8. Does your head feel painful, or does anything feel off? Do you feel like there is a headband on your head?

[0] Not present
[1] very mild
[2] mild
[3] moderate
[4] moderate to serious
[5] serious
[6] very serious
[7] extreme

9. Irritability (observe)

[0] nothing irregular
[1] more activity than usual
[2,3,4] somewhat restless and fidgety
[5,6,7] thrashes around a lot or paces back and forth

10. Which day is it now? Where are you right now? Who am I?

[0] focused and oriented
[1] is unable to perform serial additions or is unsure of the date
[2] not more than two calendar days off of the date
[3] a date that is off by more than two calendar days
[4] confused about a person or place

What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (3)

The Validity & Reliability of the CIWA-Ar

Within the last ten years, researchers have questioned the validity and dependability of the CIWA-AR. For instance, according to one study, three of the ten assessment factors, sweat, tremors, and agitation, can be detected only by observation, while the other seven require patient interaction.

This can be challenging when there is a language barrier between the patient and the doctor, precluding the essential dialogues for precise and accurate scoring. Similarly, some patients might not be in the greatest frame of mind to answer questions about their condition while being evaluated and scored if they are required to discuss symptoms with individuals who are already battling with alcohol consumption.

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CIWA Score Calculator

When determining the clinical severity of alcohol withdrawal, the CWIA Score Calculator is the most frequently used scale. You can calculate your CIWA AR score and evaluate the signs of alcohol withdrawal due to it.

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(Video) Clinical Institute withdrawal assessment for Alcohol- CIWA Scale

CIWA Score Interpretation

What does a CIWA score mean? A CIWA-Ar score interpretation helps determine if a person is undergoing any sign of alcohol withdrawal. Ten symptoms can be measured on the CIWA Ar score interpretation. Components of CIWA score and CIWA score range from:

0-8 – Minimal to mild withdrawal (normal CIWA score)

8-15 – Moderate withdrawal (marked autonomic arousal)

15 or above – Severe withdrawal (delirium tremens)


Example of a typical CIWA score form:

What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (4)

CIWA Score Protocol

To evaluate and treat the signs and symptoms of alcohol withdrawal, the CIWA protocol score is used. Both inpatient and clinical settings can make use of it. Scores can be used to determine the level of treatment intensity.

CIWA score definition? In contrast to a patient with a score of 7 or lower, a patient with a score of 16 or above could need more intense care, such as IV fluids or drugs. The CIWA score sheet can evaluate the patient’s reaction to treatment and determine the severity of the patient’s symptoms.

CIWA Score Alcohol Withdrawal

What is a CIWA score used for? Due to a lack of established diagnostic and clinical monitoring tools that could direct and enhance treatment, CIWA-AR was developed to identify and treat alcohol withdrawal better. A low CIWA scale score interpretation means that a person most likely isn’t facing alcohol withdrawal. On the other hand, a high CIWA score scale means that a person needs proper treatment.

CIWA Score and Treatment

Treatment for an alcohol use problem requires more than just the CWIA score treatment. If you suspect a loved one may be experiencing alcohol abuse or consumption issues, consider relying on a reputable treatment center like We Level Up NJ. We do everything we can to help you move away from a life full of alcohol and substance abuse to help you lead a life of sobriety.

Our approach may include the usage of prescription drugs and other medical treatments. The staff at your treatment center will assist you in determining what gave rise to your addiction during rehab. They will also teach you techniques that will allow you to change your behavioral patterns and fight the negative ideas that contributed to your addiction. Sometimes the stresses and issues in your life drive you to resort to drugs or alcohol to forget about them temporarily.

Do not attempt to detox on your own. Without professional help, the detoxification process can be unpleasant and challenging. Detox, though, must be completed to continue receiving treatment. We Level Up offers proper care with a 24-hour medical staff to support your recovery through the program to treat alcohol addiction medically. So, take control of your life once more and give us a call to speak with a treatment expert. Our counselors will respond to your concerns since they understand what you are going through. Call us today to receive help as soon as possible.

What Is A Good CIWA Score? Useful For Alcohol Withdrawal? (5)
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What does a CIWA score of 36 indicate?

A CIWA and cows score of 36 means that that person is facing severe withdrawal and needs immediate treatment.

What is the CIWA score benzodiapines?

Depending on the dosage of benzodiazepines, your CWIA score won’t likely be affected.

What does a CIWA score 15 mean?

A CWIA score of 15 or above indicates a patient has severe withdrawal (delirium tremens).

(Video) Alcohol Withdrawal

What does a CIWA score 8 mean?

Cows and CIWA scores of 8 or below means a person has minimal to mild withdrawal.

What CIWA score to give Ativan? or what is the CIWA score Ativan dosing?

For patients with a CWIA score of 9-15, 1 mg of Ativan is given every 4 hours.

How often do you do CIWA score?

CWIA-Ar is done every 4-8 hours until the score is lower than 8 points.

What is a good CIWA score?

A normal CIWA score falls between 0 to 8, which means the person doesn’t need treatment since the person shows signs of withdrawal.

What is the max CIWA score?

What is the highest CIWA score? The highest CIWA score is 67.

What is a high CIWA score?

A CIWA score of 15 is high because it likely means the patient has severe alcohol withdrawal.

What was Andrew Davis Vsim CIWA score?

Andrew Davis had a CIWA score of 20-25, indicating he faced severe withdrawal (delirium tremens).


What is an acceptable CIWA score? ›

of Alcohol Scale, Revised (CIWA-Ar) The CIWA-Ar scale can measure 10 symptoms. Scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal (marked autonomic arousal); and scores of 15 or more indicate severe withdrawal (impending delirium tremens).

What is a CIWA of 4? ›

0 - none; 1 - mild nausea ,no vomiting; 4 - intermittent nausea; 7 - constant nausea , frequent dry heaves & vomiting. 0 - no tremor; 1 - not visible but can be felt; 4 - moderate w/ arms extended; 7 - severe, even w/ arms not extended.

What is the highest possible CIWA score? ›

The maximum score of the CIWA-Ar is 67. The higher the score, the greater the risk. Scores of less than 8 to 10: Indicate minimal to mild risk of withdrawal symptoms. Patients that score less than 8 to 10 normally do not need to use additional medication for the managment of withdrawal.

What is standard CIWA protocol? ›

What Is the CIWA Protocol? The goal of the CIWA protocol is to minimize the risk of complications and optimize the patient's recovery. It is also known as the Clinical Institute Withdrawal Assessment for Alcohol scale.

What is the DSM 5 criteria for alcoholism? ›

Craving, or a strong desire or urge to use alcohol. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

What does CIWA stand for alcohol? ›

Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) Br J Addict.

How much alcohol is needed for withdrawal? ›

Drinking 10 a day for a week will lead to minor withdrawal and 18 a day for a week to major life-threatening withdrawal as illustrated in Figure 2.

How often do we assess CIWA? ›

CIWA-Ar assessment every 4 hrs unless:

Score < 8 on 3 consecutive assessments = assess every 8 hrs. Score is 8-15 or higher = reassess in 2 hrs & medicate as below.

How do nurses use CIWA? ›

Clinicians use the CIWA-Ar tool to rate 10 signs/symptoms on numeric scales to determine the severity of signs and symptoms. The total score can range from 0 (no symptoms) to a maximum of 67. Any score over 18 indicates severe withdrawal. The tool takes approximately 5 minutes to administer.

When do you discharge CIWA? ›

The CIWA-Ar calls for patients to be assessed hourly and treated if the total score is 10 or greater. When two sequential scores are less than 10, discharge may be considered.

How is the alcohol dependence scale scored? ›

Scores range from 0 to 47, where 0 suggests no evidence of alcohol dependence. Scores of 1–13 reflect a low level of alcohol dependence, scores of 14–21 moderate levels, scores of 22–30 substantial levels, and scores of 31–47 severe alcohol dependence (H.A.

When should CIWA be used? ›

The CIWA-Ar should used in all patients suspected of being at risk to have alcohol withdrawal. Because it takes only a minute or two to administer, the scale can be used as frequently (i.e., every 1-2 hours) and can be used early when alcohol withdrawal is viewed only as a clinical risk.

What is CIWA in the ICU? ›

Background: The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate.

When do you reassess CIWA? ›

CIWA-Ar assessment every 4 hrs unless:

Score < 8 on 3 consecutive assessments = assess every 8 hrs. Score is 8-15 or higher = reassess in 2 hrs & medicate as below.


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