It is estimated that close to 15% of ED visits are due to alcohol intoxication. Some of these patients will require further treatment, such as detoxification from alcohol. Although alcohol withdrawal can be objectively diagnosed with a physical exam, there are no set criteria for diagnosis. The Clinical Institute Withdrawal Assessment (CIWA) scale helps doctors and nurses diagnose alcohol withdrawal symptoms in an objective manner, leading to better patient care. Below is a guide to the CIWA calculator and how it can be used in any emergency room.

What is alcohol withdrawal?

Alcohol withdrawal is a collection of symptoms that can appear when someone quits drinking alcohol. Unlike cigarettes, alcohol can in fact cause physical addiction. These symptoms are most likely to occur in individuals with a prolonged history of alcohol abuse. A CIWA score calculator is used to assess the severity of these symptoms, which may include hallucinations and seizures.

This scale was developed so that healthcare providers could easily and consistently assess the clinical condition of a patient undergoing alcohol withdrawal management. As you will see in this article, it’s also useful for relatives or friends who may have someone going through the process. If you want to find out what is the CIWA protocol in regards to alcohol withdrawal treatment, keep reading!

What does CIWA stand for? CIWA scale – assessment of symptoms of alcohol withdrawal

CIWA stands for the Clinical Institute Withdrawal Assessment Alcohol Scale. It is a quick and efficient way to record the symptoms of alcohol withdrawal. This allows for more consistent communication between medical staff, and more effective treatment.

Its scale consists of ten symptoms:

  • Nausea/Vomiting
  • Tremors
  • Sweating
  • Anxiety/Restlessness
  • Depressed Mood or Apathy (this can be different from how you feel when sober)
  • Hallucinations/Delirium (visual or auditory)
  • Tachycardia (rapid heart rate)
  • Bradycardia (slow heart rate)

Symptoms of alcohol withdrawal

Among others, they include:

  • Sweating
  • Shaking
  • Nausea/vomiting
  • Diarrhea
  • Stomach cramping
  • Weakness/loss of coordination
  • Nervousness/anxiety
  • Confusion/disorientation


Sweating is a common occurrence during alcohol withdrawal, but it can be severe and can even cause harm if not treated. Sweating can be caused by a variety of factors, including medications used to treat substance use disorders.

If you’re sweating profusely or at night and are experiencing other symptoms of alcohol withdrawal, contact your health care provider right away so they can evaluate your condition and determine whether additional treatment is needed.

Alcohol withdrawal symptoms vary from person to person based on how much they drank and how long they used alcohol before they stopped drinking completely (or attempted to quit).


Shaking is a common symptom of alcohol withdrawal, as well as other substances. It’s also a sign that the body is experiencing distress, struggling to maintain its normal state.

It could be caused by any number of things: anxiety over withdrawal symptoms becoming more intense; the desire to avoid impending health complications; panic from being unable to control your situation or emotions. Since these symptoms aren’t always related directly to addiction itself—many people who have never been addicted still experience them—it’s important not to assume that shaking means you’re in danger or should seek help immediately.


Nausea and vomiting are common symptoms of alcohol withdrawal. They can occur as soon as 6 hours after drinking alcohol. The severity of nausea and vomiting can vary, but they can be severe enough to require a trip to an emergency room. Often, nausea and vomiting are accompanied by fever (usually 102°F or higher).


Diarrhea is a common symptom of alcohol withdrawal. It can also be a sign of a more serious condition, so if you experience diarrhea during or after your detox, it’s important to speak with your doctor.

It is not caused by the disease itself but rather by dehydration and electrolyte imbalances that occur as part of the withdrawal process and often resolve once alcohol dependence has been successfully treated. Diarrheal-like symptoms may continue for several days after drinking stops due to residual effects on the gut lining known as “ketosis”.

Diarrhea can be managed with over-the-counter medications such as Imodium (loperamide), Pepto Bismol (bismuth subsalicylate), and Kaopectate (kaolin/pectin), but if you’re experiencing severe symptoms or persistent diarrhea lasting longer than 24 hours, consult with your health care provider before self-treating.

Stomach cramping

Stomach cramping is another symptom of alcohol withdrawal. It can also be caused by other factors, including illness or the use of other drugs. Stomach cramping often occurs after taking over-the-counter medications such as aspirin or ibuprofen (Advil). In addition, nausea and vomiting are common symptoms that accompany stomach cramping in people who have undergone alcohol withdrawal.

In order to relieve your stomach aches and pains, you may try antacids such as Tums or Mylanta. These medications contain calcium carbonate which neutralizes stomach acid and will help ease your discomfort.

Doctors often treat abdominal pain with over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil). If you have been diagnosed with abdominal pain due to alcohol withdrawal, your doctor may prescribe medication as well. The most common prescription drugs used for treating severe abdominal cramps are chlordiazepoxide (Librium), lorazepam (Ativan), and diazepam (Valium).


Confusion is one of the most common symptoms of alcohol withdrawal. It can range from mild to severe, and it can occur at any point during withdrawal. Confusion can be dangerous for you and others around you, so it’s important to seek medical attention if you have any confusion symptoms.

Confused thinking is a frequent symptom of alcohol use disorder (AUD). People experiencing confused thinking may experience difficulty concentrating or making decisions, which may cause them to make mistakes at work or at home. They may also have trouble remembering things they’ve done recently, such as paying bills on time or cooking dinner for their family.

Confusion is caused by changes in the brain due to heavy drinking over time; these changes affect how well nerve cells communicate with each other. When someone stops drinking alcohol suddenly after years of heavy consumption, this sudden change causes nerve cell communication problems—which leads right to confusion!

CIWA score range

The CIWA score is easy to interpret. Essentially, the higher it is, the higher the chances of withdrawal. Based on the aforementioned 10 symptoms of alcohol withdrawal, the maximum possible score is 67. The scale has three basic levels:

  • Mild alcohol withdrawal – 0 – 10
  • Moderate alcohol withdrawal – 11 – 15
  • Severe alcohol withdrawal – 16+

CIWA Ar – a revised version of the alcohol withdrawal scale

The CIWA Ar is similar to the CIWA scale, with a few noteworthy differences. It was developed back in 1989. and the main change was the removal of 5 criteria (from 15 down to 10).

How to use the CIWA calculator to obtain an alcohol withdrawal score?

In our CIWA calculator, there are 9 criteria you need to fill out:

  • Nausea/vomiting
  • Tremor
  • Paroxysmal sweats
  • Anxiety
  • Agitation
  • Tactile disturbances
  • Auditory disturbances
  • Visual disturbances
  • Headache/fulness in head
  • Disorientation/clouding of sensorium

If you want to check out more alcohol-related calculators, you can check out our Audit-C Calculator (Am I an Alcoholic?) and Audit Score Calculator – WHO Alcohol Test.

Keep in mind, that you should always consult a medical professional, and should never take these test results as the final verdict.


How does alcohol affect the human body?

Alcohol interferes with the brain’s communication pathways and can affect the way the brain looks and works. Along with these short-term effects, it also has many long-term effects on the human body.

What does CIWA-AR stand for?

It stands for “The Clinical Institute Withdrawal Assessment Alcohol Scale-Revised”.

Who developed the CIWA scale?

The CIWA scale was originally developed by Dr. Robert Swift in 1980.