The CIWA-Ar rates ten signs of alcohol withdrawal, from tremor to orientation. Its total, from 0 to 67, measures how severe withdrawal is right now and guides symptom-triggered treatment. See the ten signs and their ranges, what each score means, and record the result with the free template.
CIWA-Ar result template
FreeCIWA-AR RESULT Date and time: [Date, 24-hour time] Patient: [Name or ID, age] Setting: [Emergency department, medical ward, withdrawal unit, or outpatient program] Assessed by: [Name, credentials] CONTEXT Last drink: [Date and time; hours since] Usual drinking: [Standard drinks a day, and for how long] Breath alcohol: [Reading and time, or not done] Past withdrawal: [Seizures, delirium, or hospital stays in past withdrawal, or none] Other substances and medicines: [Benzodiazepines, other sedatives, opioids, beta-blockers, clonidine, or none] Able to communicate: [Yes, with interpreter if used; or the reason not and the scale used instead] VITAL SIGNS Pulse: [Beats per minute] Blood pressure: [Systolic/diastolic] Temperature: [Degrees] Breathing: [Respiratory rate, oxygen saturation] SCORES Nausea and vomiting: [0 to 7] Tremor: [0 to 7] Paroxysmal sweats: [0 to 7] Anxiety: [0 to 7] Agitation: [0 to 7] Tactile disturbances: [0 to 7] Auditory disturbances: [0 to 7] Visual disturbances: [0 to 7] Headache: [0 to 7] Orientation: [0 to 4] Total: [0 to 67] Band: [Mild, moderate, or severe, by your protocol's ranges] Previous total: [Time and score, or first assessment] MEDICATION Given under protocol: [Drug, dose, route, and time; or none, with the reason] Thiamine: [Dose, route, and time] Total in 24 hours: [Running total of the protocol drug] REASSESSMENT AND ESCALATION Next CIWA-Ar: [Time, and the interval the protocol sets] Escalation triggers: [Score limit, seizure, hallucinations, confusion, vital sign limits] Triggers met: [None, or which one, who was told, at what time, and the plan]
Use it for
Record the context first. It tells you whether the symptoms are likely to be withdrawal, and how much risk sits behind the number.
Avoid: Scoring before you know when the patient last drank. The same total means something different at 8 hours and at 4 days.
Rate each sign as it is now. Tremor, sweats and agitation are scored by watching; nausea, anxiety, headache, the three kinds of disturbance and orientation are scored by asking as well.
Avoid: Rating anxiety or agitation from a glance through the door. Talk with the patient before you score.
Add the ten scores for a total from 0 to 67. Your protocol’s bands decide what follows.
Avoid: Acting on bands from another hospital’s protocol. Record the score, and follow the thresholds your own protocol sets.
Medication is given when the score reaches the protocol’s threshold, and the score is repeated to see whether it worked.
Avoid: Symptom-triggered dosing for a patient who can’t report symptoms. A fixed schedule and a different scale suit them better.
Some findings need a medical review whatever the total.
Avoid: Waiting for the next scheduled check when the patient looks worse. Score them now.
Each one follows the recording template. Use them to judge how much to write.
Medical ward, day 2 of an admission for pneumonia, assessed by the ward nurse
52-year-old man. About 12 beers a day for 10 years. Last drink yesterday at 12:00, 20 hours before this check. Breath alcohol 0.00 at 07:50. Shakes and sweats when he has cut down before; no past withdrawal seizures or delirium. No other sedatives. Talking clearly in English.
08:00: pulse 108, BP 158/94, temperature 37.6 °C, respiratory rate 20, oxygen saturation 95% on room air.
08:00: nausea and vomiting 2, tremor 3, sweats 3, anxiety 3, agitation 2, tactile 1, auditory 0, visual 1, headache 2, orientation 1. Total 18, moderate, at the top of the range. Previous: 8 at 04:00, below the protocol threshold.
Diazepam 20 mg by mouth at 08:10 under the ward’s symptom-triggered protocol: 20 mg for a score of 10 or more, repeat the score 1 hour after each dose. Thiamine 100 mg IV at 08:15. Diazepam in 24 hours: 20 mg.
09:10: nausea 1, tremor 2, sweats 1, anxiety 2, agitation 1, tactile 0, auditory 0, visual 0, headache 2, orientation 0. Total 9, mild; pulse 94, BP 142/86. No further dose. Next CIWA-Ar at 13:10, every 4 hours while under 10. Triggers: a score of 19 or more, hallucinations, confusion, a seizure, or pulse over 120. None met; the medical resident was told of the response at 09:15.
Outpatient withdrawal program, day 1, in person at the clinic
45-year-old woman. About 8 standard drinks a day for 4 years. Last drink at 21:00 last night, 13 hours before this check. Breath alcohol 0.00. Mild shakes when she has stopped for a day before; no past withdrawal seizures or delirium. No benzodiazepines, other sedatives, or opioids. Lives with her partner, who will stay with her for the next 4 days.
10:00: pulse 92, BP 136/86, temperature 36.9 °C, respiratory rate 16.
Nausea and vomiting 1, tremor 1, sweats 1, anxiety 2, agitation 0, tactile 0, auditory 0, visual 0, headache 1, orientation 0. Total 6, mild. First assessment.
No benzodiazepine: below the program’s threshold of 10, with no past seizures or delirium. Thiamine 100 mg by mouth daily, first dose at 10:15. Naltrexone discussed for after withdrawal; liver tests sent.
Withdrawal at home with a daily clinic check, CIWA-Ar and vital signs, for 4 days; next check tomorrow at 10:00. Start medication under the program protocol if the score reaches 10, and move to inpatient withdrawal management if it keeps rising. She and her partner know the warning signs: worse shakes, vomiting, hallucinations, confusion. Call the clinic the same day if worse; call emergency services for a seizure or confusion. No driving this week.
A sedated, delirious, or non-verbal patient scores low on the signs they can’t report, while withdrawal carries on. Use a sedation-agitation scale instead.
Withdrawal seizures can come early, often within 6 to 48 hours of the last drink, and before the score is high. Record past seizures and delirium, and plan around them.
Tremor, sweating, and confusion also come from infection, low blood sugar, head injury, liver failure, thyroid disease, and other drug withdrawal. Look for them when the picture doesn’t fit.
A score means little without the time of the last drink, the time it was taken, the dose that followed, and the next check. Record all four.
Vero Scribe records the CIWA-Ar result in your template from the visit, with the patient’s consent, or from your dictation: the time since the last drink, the vital signs, each score, the dose given, and the next check. You review and edit every line, then copy it into your record. Vero works in 60+ languages.
Rate ten signs: nausea and vomiting, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, and orientation. The first nine score 0 to 7 and orientation scores 0 to 4. Add them for a total from 0 to 67. The official form describes what each level looks like.
Under the 2020 ASAM guideline, a total under 10 is mild withdrawal, 10 to 18 moderate, and 19 or more severe. Many hospital protocols use four bands instead: 0 to 9, 10 to 15, 16 to 20, and 21 or more. Most start medication at 8 or 10. Follow your own protocol’s thresholds.
As often as your protocol says. Symptom-triggered protocols usually repeat it about an hour after each dose, then every 4 to 8 hours once the score stays under the threshold, until it has stayed low for a day or so. Outpatient programs usually check once a day.
No. Withdrawal seizures can happen early, often within 6 to 48 hours of the last drink, sometimes while the score is still low. A past withdrawal seizure or delirium, years of heavy daily drinking, and other sedative use raise the risk whatever the score. Risk tools such as the PAWSS help decide who needs closer care.
The CIWA-Ar measures alcohol withdrawal that is happening now. The COWS does the same job for opioid withdrawal. The PAWSS is asked before withdrawal starts, to predict who is likely to have severe or complicated withdrawal. The CIWA-Ar itself is a shorter, revised version of an earlier scale, the CIWA-A.
Not reliably. Most of the signs depend partly on what the patient tells you. For a patient who is sedated, intubated, delirious, or unable to talk with you, use a sedation-agitation scale such as the RASS and clinical judgment. When language is the barrier, use an interpreter.
Nurses give most CIWA-Ar assessments, along with physicians, nurse practitioners, and trained withdrawal management staff. It takes a few minutes. Training, and occasional checks against a second rater, keep scores consistent between staff.
Yes. The form published with the scale says it isn’t copyrighted and may be reproduced freely. Get the official form, with the wording for each level, from the 1989 paper by Sullivan and colleagues or from your service’s protocol. The recording template on this page is free to copy or download too.
Three questions on how often and how much someone drinks, scored 0 to 12: positive at 4 or more for men, 3 or more for women.
The WHO’s 10 questions on drinking, dependence, and harm, scored 0 to 40 into four zones that each come with an intervention.
Four yes-or-no questions on drinking problems at any point in life: positive at 2 or more of 4.
Eleven withdrawal signs, from pulse to gooseflesh, rated by a clinician: opioid withdrawal severity from 0 to 48.
A teen alcohol and drug screen for ages 12 to 21: days of use, then six yes-or-no questions scored 0 to 6, high risk at 2 or more.
The full assessment: use history, withdrawal risk, diagnosis, and level of care.
Every dose signed for, with PRN effects and doses not given.
Assessments, follow-up notes, and care plans for addiction teams.
Every tool, by area, with what its scores mean.
Vero records scores, findings, and plans in the templates you choose, so you review instead of type.
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