Clinical Institute Withdrawal Assessment for Alcohol

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) revised is a 10-item, validated scale designed for use by trained inpatient nurses. CIWA-Ar scores below 10 are considered mild withdrawal; between 10 and 20 are moderate withdrawal, and above 20 are considered severe withdrawal. Patients with CIWA-Ar scores of more than 10 are considered to be at high risk of developing withdrawal complications if not medicated. 

Frequency of CIWA-Ar monitoring depends upon treatment setting and clinical condition of the patient. Patients with CIWA-Ar scores of more than 10 need frequent monitoring (at least 4 hourly), and patients with severe withdrawal (CIWA-Ar score of more than 20) should be monitored every 1-2 hours.