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Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar)

Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) Test

Assesses alcohol withdrawal severity in about 2 minutes. Ten quick ratings support safer decisions on meds and help track symptoms over time.

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Questions: 102 minutes

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08:30

October 2, 2025

October 2, 2025
Material has been updated

October 2, 2025
Material has been published

23,155 views

2,693 completions

2,253 likes

Verified by Daniel Hall

Psychologist with 25 years of experience

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How the Scales are Structured

example score

23/70

Severity Rating Scale (SRS)

Assesses the severity of alcohol withdrawal symptoms based on observed and reported signs.

None/Mild

Moderate

Severe

0 – 9: None/Mild | 10 – 19: Moderate | 20 – 70: Severe

A score of 23 falls in the Severe range, indicating high symptom severity consistent with significant alcohol withdrawal.

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DATA-BASED USER COHORTS

Who Usually Takes This Test?

ER and acute-care clinicians

46%OF USERS

Doctors and nurses in emergency or inpatient settings use it to quickly gauge withdrawal severity and guide medication decisions.

Addiction treatment providers

34%OF USERS

Clinicians in detox and substance-use programs use it to monitor symptoms over time and adjust care plans safely.

Medical trainees and students

20%OF USERS

Students and residents use it to learn structured assessment of alcohol withdrawal and practice consistent scoring.

BASED ON AGGREGATED, ANONYMIZED DATA FROM TENS OF THOUSANDS OF FREUDLY USERS.

RESULTS YOU CAN ACTUALLY USE

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Used in 52+ countries

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Once you complete the test, your results are compared with real-world data from people in your country.
Below is a preview of how scores are typically distributed across each scale.

Assessment Scale (AS)

Average

30.9

Normal range

20.2 — 41.6

min.

max.

Majority

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CLEAR ANSWERS TO COMMON QUESTIONS

Frequently Asked Questions

What does this scale measure?

It rates the severity of alcohol withdrawal symptoms based on observation and brief questions. The total score reflects overall withdrawal intensity.

What symptoms are assessed?

Items cover nausea or vomiting, tremor, sweating, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation. Each item is scored by severity.

How long does it take and how many items are included?

It includes 10 items and typically takes about 2 minutes to complete. Timing may vary with symptom severity and cooperation.

How are results used in care decisions?

Scores support decisions about monitoring level and the need for medication to reduce withdrawal complications. Repeated scoring can track response to treatment over time.

Who completes the scale and what information is needed?

A trained clinician completes it using direct observation and the patient’s brief responses. Vital signs and collateral history may be considered but are not required to score the items.

WHAT THE TEST MEASURES

About This Assessment

Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) Test - Symptoms and Signs

alcoholism addiction medicine

This rating scale is used to rapidly assess the severity of alcohol withdrawal symptoms in medically supervised settings. The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) supports structured clinical observation and brief patient queries to quantify key withdrawal features and guide monitoring.

The measure includes 10 items and typically takes about 2 minutes to complete. Items capture common withdrawal signs and symptoms (e.g., tremor, diaphoresis, nausea, anxiety), producing a total score that can inform decisions about level of care and the need for symptom-triggered intervention.

Developed by Sullivan, J., the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is commonly used for serial reassessment to track change over time and support documentation of withdrawal severity.

Author: Sullivan, J.

Literature: Sullivan, J. T., Sykora, K., Schneiderman, J., Naranjo, C. A., & Sellers, E. M. Assessment of alcohol withdrawal: The revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction. 1989.

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