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Assessing DSM-IV nicotine withdrawal symptoms: a comparison and evaluation of five different scales

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Abstract

Objective

This study evaluated four of the major scales used to measure nicotine withdrawal symptoms plus one new scale.

Methods

Eighty-three smokers were randomly assigned to continue smoking (n=37) or abstain completely for 24 h (n=46), by which time the symptoms should become manifest. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) withdrawal symptoms (irritability, depression, restlessness, insomnia, anxiety, hunger and poor concentration) plus craving were measured at baseline and after 24 h. The scales tested were the Minnesota Nicotine Withdrawal Scale (MNWS), the Mood and Physical Symptoms Scale (MPSS), the Shiffman Scale (SS), the Wisconsin Smoking Withdrawal Scale (WSWS) and the newly developed Cigarette Withdrawal Scale (CWS).

Results

Measurement of withdrawal symptoms was robust in the case of all scales for total withdrawal score, irritability, restlessness, poor concentration and craving. The MNWS and CWS were less sensitive to depression; the WSWS and MNWS were less sensitive to insomnia; the MPSS was less sensitive to anxiety and hunger; the CWS and WSWS did not include restlessness as a distinct symptom; the SS did not include insomnia, and its scores tended to decline over time during ad lib smoking. Longer scales, using multiple items to measure each symptom, did not yield more reliable or accurate measurement than briefer scales.

Conclusions

To measure total withdrawal discomfort or craving, all of the scales examined can be recommended, and there is little to choose between them apart from length. When it comes to assessing individual symptoms, different scales have different strengths and weaknesses. There would be merits in developing a new questionnaire that combined the best features of the scales tested.

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Correspondence to Robert West.

Appendix: Withdrawal symptom measures and relationship between items and symptom scores

Appendix: Withdrawal symptom measures and relationship between items and symptom scores

Item

DSM-IV symptom plus urge to smoke

Mood and Physical Symptoms Scale [MPSS; 5-point response scale (not at all, slightly, somewhat, very, extremely)]

 

 Irritable

Irritability

 Restless

Restlessness

 Depressed

Depression

 Hungry

Increased appetite

 Poor concentration

Difficulty concentrating

 Anxious

Anxiety

 Poor sleep at night

Insomnia

 Strength of urges of smoke

Urge to smoke

 Time spent with urges to smoke

Urge to smoke

Minnesota Nicotine Withdrawal Scale [MNWS; 5-point scale (none, slight, mild, moderate, severe)]

 

 Angry, irritable, frustrated

Irritability

 Restless, impatient

Restlessness

 Depressed mood, sad

Depression

 Increased appetite, hungry, weight gain

Increased appetite

 Difficulty concentrating

Difficulty concentrating

 Insomnia, sleep problems, awakening at night

Insomnia

 Anxious, nervous

Anxiety

 Desire, craving to smoke

Urge to smoke

Shiffman Scale

 

10-point scale (low to high)

 

 Irritable

Irritability

 Frustrated, angry

Irritability

 Restless

Restlessness

 Depressed

Depression

 Sad

Depression

 Blue

Depression

 Miserable

Depression

 Hungry

Increased appetite

 Eat more

Increased appetite

 Increased appetite

Increased appetite

 Hard to concentrate

Difficulty concentrating

 Mentally sharp (reversed)

Difficulty concentrating

 Anxious

Anxiety

 Tense

Anxiety

Wisconsin Smoking Withdrawal Scale [WSWS; 5-point scale (strongly disagree, disagree, neutral, agree, strongly agree)]

 

 I have been irritable, easily angered

Irritability

 I have been bothered by negative moods such as anger, frustration and irritability

Irritability

 I have felt frustrated

Irritability

 I have felt upbeat and optimistic (reverse)

Depression

 I have felt sad or depressed

Depression

 I have felt hopeless or discouraged

Depression

 I have felt happy and content (reverse)

Depression

 Food is not particularly appealing to me (reverse)

Increased appetite

 I want to nibble on snacks and sweets

Increased appetite

 I have been eating a lot

Increased appetite

 I have felt hungry

Increased appetite

 I think about food a lot

Increased appetite

 My level of concentration is excellent (reverse)

Difficulty concentrating

 It’s hard to pay attention to things

Difficulty concentrating

 It has been difficult to think clearly

Difficulty concentrating

 I am getting restful sleep (reverse)

Insomnia

 I awaken from sleep frequently during the night

Insomnia

 I am satisfied with my sleep (reverse)

Insomnia

 I feel that I am getting enough sleep

Insomnia

 My sleep has been troubled

Insomnia

 I have felt impatient

Anxiety

 I have been tense or anxious

Anxiety

 I have felt myself worrying about my problems

Anxiety

 I have felt calm lately (reverse)

Anxiety

 I have frequent urges to smoke

Urge to smoke

 I have been bothered by the desire to smoke a cigarette

Urge to smoke

 I have thought about smoking a lot

Urge to smoke

 I have trouble getting cigarettes off my mind

Urge to smoke

Cigarette Withdrawal Scale [CWS; 5-point scale (totally disagree, mostly disagree, more or less agree, mostly agree, totally agree)]

 

 I am irritable

Irritability

 I get angry easily

Irritability

 I have no patience

Irritability

 I feel nervous

Irritability

 I feel depressed

Depression

 My morale is low

Depression

 I am eating more than usual

Increased appetite

 My appetite has increased

Increased appetite

 I have put on weight recently

Increased appetite

 I find it difficult to think clearly

Difficulty concentrating

 I find it hard to concentrate

Difficulty concentrating

 I find it hard to focus on the task at hand

Difficulty concentrating

 I have difficulty sleeping

Insomnia

 I have trouble falling asleep at night

Insomnia

 I feel worried

Anxiety

 I feel anxious

Anxiety

 The only thing I can think about is smoking a cigarette

Urge to smoke

 I miss cigarettes terribly

Urge to smoke

 I feel an irresistible need to smoke

Urge to smoke

 I would like to hold a cigarette between my fingers

Urge to smoke

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West, R., Ussher, M., Evans, M. et al. Assessing DSM-IV nicotine withdrawal symptoms: a comparison and evaluation of five different scales. Psychopharmacology 184, 619–627 (2006). https://doi.org/10.1007/s00213-005-0216-z

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  • DOI: https://doi.org/10.1007/s00213-005-0216-z

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