The Short Opiate Withdrawal Scale (SOWS) is a self-administered test used for the assessment of opiate withdrawal symptoms. The scale contains ten items, which makes the tool easy and rapid to administer. Since withdrawal is one of the biggest challenges addicted individuals face on their journey to sobriety, having a reliable and brief scale to grade withdrawal symptoms is vital in research and treatment. Consequently, the Short Opiate Withdrawal Scale has become one of the most valuable research tools in medicine.
From prescribed medications to illicit drugs: opiate addiction is among the most severe health problems worldwide, with opiate withdrawal being a leading factor in thousands of fatal cases. In fact, withdrawal symptoms are defined as the main cause of relapse, overdose, and death. Therefore, having valid scales like the Short Opiate Withdrawal Scale can only help researchers, practitioners, and patients gain a clearer understanding of the opiate dependency and its severe consequences.
Addictions and withdrawal symptoms go hand in hand. Therefore, clinical instruments that help experts assess withdrawal symptoms can improve detox programs, psychological treatment, and health interventions, in both inpatient and outpatient settings. The Short Opiate Withdrawal Scale, in particular, is extremely beneficial as it is short, clear, and statistically powerful.
The Short Opiate Withdrawal Scale originates from the Opiate Withdrawal Scale (OWS) (Gossop, 1990). Note that the original Opiate Withdrawal Scale consists of 32 items. While OWS provides deep coverage of numerous withdrawal symptoms, research has revealed that the high intercorrelation of its items makes the original scale redundant. In the end, quantity does not mean quality.
In comparison, the Short Opiate Withdrawal Scale consists of ten items that help subjects understand all questions better. Consequently, these ten items help researchers analyze withdrawal profoundly. The Short Opiate Withdrawal Scale was created on the foundations of the 32-item Opiate Withdrawal Scale. The methods of the development of the Short Opiate Withdrawal Scale scale included a selection of 20 items out of the initial 32-item scale. Various items were dropped due to overlapping of statements. For instance, ‘vomiting’ and ‘feeling sick’ were perceived as similar, and as a result, ‘vomiting’ was excluded from the scale. Consequently, a new 12-item form was created based on the preliminary 20-item version of the tool. The 12-item test was administered to 96 people addicted to opiates, and analysis was performed based on peak withdrawal data (Gossop, 1990). Note that usually, heroin withdrawal occurs 12 hours after the last dose and peaks within 24-48 hours.
In the end, a 10-items scale was created. The scale was administered to 68 individuals undergoing methadone treatment for their opiate addiction. The assessments were performed during a period of 35 days, with testing occurring every two days. Note that methadone maintenance treatment is still a prevalent option for opiate dependency and abuse.
Figures showed that the correlation between the scores obtained on both 32-item and 10-item scales was high (r=.97), which means that the Short Opiate Withdrawal is as effective as the original 32-item self-assessment tool (Gossop, 1990).
Note that all scales (the original 32-item scale, the preliminary 20-items and 12-items scales, and the final 10-item Short Opiate Withdrawal Scale) were rated via a 4-point scale: 0 for ‘none,’ 1 for ‘mild,’ 2 for ‘moderate,’ and 3 for ‘severe.’
In today’s tech-driven society, online versions of the Short Opiate Withdrawal Scale facilitate assessment. In fact, it takes approximately a minute for most of the participants to complete the scale. This is extremely beneficial for people experiencing withdrawal symptoms, as testing doesn’t lead to frustration, cognitive overload, or lack of engagement. What’s more, platforms like Qolty provide an engaging and easy to navigate interface.
The Short Opiate Withdrawal Scale has numerous practical applications. The tool can help experts, individuals and society cope with the severe side effects and withdrawal symptoms of opiate addiction.
Note that although opiates, opioids, and narcotics are terms that are often used interchangeably, they refer to different substances. The term opiate usually refers to all the natural substances obtained from opium. Opiates, for instance, are drugs like morphine and codeine, which are the chemical compounds in the opium poppy. On the other hand, opioids are manufactured chemically: methadone and fentanyl are synthetic drugs, while oxycodone and hydrocodone are semi-synthetic. Narcotics, in general, refer to the wide range of substances that lead to dependency and abuse. Scales like the Short Opiate Withdrawal Scale can help researchers gain an insightful grasp of the complex causes and consequences of addiction.
Heroin addiction, in particular, is one of the most painful phenomena which leads to negative physical, emotional, cognitive, social, and financial consequences. Heroin binds to the opioid receptors in the brain and makes withdrawal painful and intense (Gossop, 1990). Therefore, self-assessment scales like the Short Opiate Withdrawal Scale can only help researchers and patients understand and deal with severe withdrawal symptoms effectively.
Also, the Short Opiate Withdrawal Scale can be beneficial for:
- The planning of individual counseling sessions
- The organization of group therapy and interventions
- The structure of detoxification programs and methods
- The in-depth understanding of all psychological and environmental factors of withdrawal
In other words, the 10-item Short Opiate Withdrawal Scale is a highly valuable clinical tool, in both outpatient and inpatient centers.
Since opiate addiction is a complex health problem worldwide, it affects individuals, families, and society as a whole. Therefore, many studies focus on substance abuse and dependency. In particular, there are various scales that are designed to help experts tailor withdrawal treatment according to individual needs.
Scales that assess the severity of opiate withdraw are crucial in the monitoring and treatment of withdrawal symptoms, as they can literally save lives. Some of the popular scales are the Objective Opiate Withdrawal Scale, the Subjective Opiate Withdrawal Scale, and the Clinical Opiate Withdrawal Scale. In fact, the Clinical Opiate Withdrawal Scale (COWS) can be used to track changes in withdrawal (Barbosa-Leiker et al., 2015). A recent study conducted by Barbose-Leiker and colleagues (2015) showed that the COWS scale correlates with the Clinical Institute Narcotic Assessment (CINA) and two visual analog scales (VAS) in opioid-dependent individuals undergoing a naloxone treatment. The Clinical Opiate Withdrawal Scale also showed good internal consistency metrics (Cronbach’s alpha= .78), which makes it a valid tool to study mild opiate withdrawal (Tompkins et al., 2009).
Another complex health concern experts target is the addiction in pregnant women and infants. As a result, scales like the Modified Finnegan Neonatal Abstinence Score Sheet have been created to monitor infants born to addicted mothers.
Results and Data Analysis
The Short Opiate Withdrawal Scale reveals that all 10 items included in the short version are correlated with the single main factor of withdrawal (r=.99) (Gossop, 1990).
Practice shows that some of the most common withdrawal symptoms are: yawning, muscle tension, runny eyes, muscle twitching, body aches, feeling of coldness/shaking, stomach cramps, insomnia, heart pounding, and feeling sick.
The Short Opiate Withdrawal Scale shows good psychometric properties. As explained above, results on the 10-item version of the test correlate with results on the 32-item version (r=.97), which means that the scale is short but highly effective.
All items on the 10-item version contribute to the main factor solution of the scale (r=.99).
Last but not the least, the Short Opiate Withdrawal Scale shows good criterion validity: scores are higher during the acute phase and return to normal after detox. In other words, the scale is a great instrument in the differentiation of withdrawal and post-withdrawal.
Strengths and Limitations
In general, opiate withdrawal scales can be used to study people’s physical and psychological dependence and withdrawal symptoms, prior and after treatment of opiate addiction.
However, with the new advancements in pharmacology, the application of the scale to different treatment options and substances need to be tested.
Still, clinical-rated items are crucial in the monitoring of withdrawal and treatment.
Summary & Key Points
- The Short Opiate Withdrawal Scale (SOWS) is a self-administered test.
- It can be used for the clinical assessment of opiate withdrawal symptoms prior and after treatment, in both inpatient and outpatient settings.
- The Short Opiate Withdrawal Scale originates from the 32-item Opiate Withdrawal Scale (OWS).
- The Short Opiate Withdrawal Scale contains ten items: yawning, muscular tension, runny eyes, muscle twitching, pains, and aches, feeling of coldness, stomach cramps, insomnia, heart pounding, and feeling sick.
- The tool has a 4-point rating scale: 0 for ‘none,’ 1 for ‘mild,’ 2 for ‘moderate,’ and 3 for ‘severe.’
- The Short Opiate Withdrawal Scale is short and easy to administer.
- The test reveals good psychometric properties.
- The tool can be used to show differences during the acute phase of withdrawal and post-withdrawal. It can be applied in both inpatient and outpatient settings, and also, it can help researchers plan detox and treatment sessions effectively.
Addiction is a global problem. In particular, opiate addiction is among the most severe dependencies with fatal withdrawal symptoms. Thus, the Short Opiate Withdrawal Scale has become one of the most valuable research tools in medicine. Online platforms like Qolty facilitate research and practice and help experts save lives.
Barbosa-Leiker, C., McPherson, S., Mamey, M., Burns, L., Layton, M., Roll, J., & Ling, W. (2015). Examining the factor structure of the Clinical Opiate Withdrawal Scale: A secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003. Drug and Alcohol Dependency, 152, p. 218-223.
Gossop, M. (2009). The development of a short opiate withdrawal scale (SOWS). Addictive Behaviors, 15, p. 487-490.
Tompkins, D., Bigelow, G., Harrison, J., Johnson, R., Fudala, P., & Strain, E. (2009). Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) Opioid Withdrawal Instrument. Drug and Alcohol Dependency, 105, p.154-159.