CIWA-Ar
Tool: CIWA-Ar (download)
Context: When it’s appropriate / not appropriate
Authority: ASAM Alcohol Withdrawal Management Guideline
When to Use CIWA-Ar
The Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) is a validated tool for assessing the severity of alcohol withdrawal and guiding symptom-triggered treatment in alert, cooperative patients who can reliably answer questions and follow instructions. It is most appropriate in medically stable settings where patients are able to communicate symptoms such as nausea, anxiety, and hallucinations. CIWA-Ar should be used in conjunction with clinical judgment and routine monitoring of vital signs.
When CIWA-Ar May Not Be Appropriate
CIWA-Ar may be less reliable or inappropriate for patients who cannot meaningfully participate in the assessment, including those with severe delirium, altered mental status, intubation, significant cognitive impairment, language barriers, or concurrent medical conditions that confound symptom reporting. In such cases, alternative assessment strategies or fixed-dose protocols may be more appropriate, based on clinical context and institutional guidance.
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