Free clinical tool · De-addiction & rehab monitoring
Score alcohol withdrawal (CIWA-Ar) and opioid withdrawal (COWS) severity in real time, using the exact validated scales, for use at the bedside by trained clinical staff.
Complete all 10 items to see an interpretation.
Complete all 11 items to see an interpretation.
Not a substitute for clinical judgment. These are validated observation scales for use by trained staff, not self-assessment or diagnostic tools, and treatment thresholds (e.g. when to give symptom-triggered medication) should follow your facility's clinical protocol. Nothing entered here is stored, transmitted, or saved by MindFlow; the calculator runs entirely in your browser.
The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, Revised) is a 10-item scale developed by Sullivan, Sykora, Schneiderman, Naranjo and Sellers (1989) at the Addiction Research Foundation. It is not copyrighted and may be reproduced freely. It remains the most widely used bedside tool for quantifying alcohol withdrawal severity and guiding symptom-triggered benzodiazepine dosing.
The COWS (Clinical Opiate Withdrawal Scale) is an 11-item scale developed by Wesson and Ling (2003), rating signs that are directly observable by a clinician, pulse, sweating, tremor, pupil size, and similar, alongside a few patient-reported items. It may be copied and used clinically without permission.
Published CIWA-Ar literature is not perfectly uniform on where "moderate" ends and "severe" begins, some protocols draw the line at 15, others at 19–20. This tool uses the commonly cited convention of <10 mild, 10–18 moderate, ≥19 severe, but always defer to your facility's own protocol for medication and escalation thresholds.
Serial CIWA-Ar or COWS scores, taken every few hours during acute withdrawal, are usually what actually drives symptom-triggered dosing decisions, which is also what an inspector or auditor will look for in your records. MindFlow's in-patient module logs these scores directly against the bed and timestamp, alongside the substitution-therapy dispensing log and the NDPS register, so the full withdrawal-management trail sits in one place instead of a separate paper chart. See MindFlow's de-addiction & ward tools →