3
Diagnosis
Table 1. Alcohol Withdrawal Severity
Severity Category
Associated CIWA-Ar
Range
a
Clinical Findings
Mild CIWA-Ar <10 Mild or moderate anxiety, sweating
and insomnia, but no tremor
Moderate CIWA-Ar 10–18 Moderate anxiety, sweating,
insomnia, and mild tremor
Severe CIWA-Ar ≥19 Severe anxiety and moderate to
severe tremor, but not confusion,
hallucinations, or seizure
Complicated CIWA-Ar ≥19 Seizure or signs and symptoms
indicative of delirium – such as
an inability to fully comprehend
instructions, clouding of the
sensorium or confusion – or new
onset of hallucinations
a
roughout this document, we provide examples for withdrawal severity using the CIWA-
Ar, although other scales can be used. Regardless of the instrument used, there is a wide
variety in the literature and in practice as to which scores best delineate mild, moderate and
severe withdrawal. Classification of withdrawal severity is ultimately up to the judgment
of clinicians and the choice of reference range may be based on their particular patient
population or capabilities.
