Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Monitoring the withdrawal syndrome

Page last updated: April 2004

The person should be monitored throughout the course of the withdrawal and various observation charts exist for this purpose. The Amphetamine Withdrawal Questionnaire (AWQ) is a 10-item self-report instrument designed to detect severity of amphetamine withdrawal symptoms based on the DSM-IV criteria for withdrawal and published literature (Srisurapanont et al., 1999b). Following a trial among a small sample of 102 amphetamine-dependent individuals undergoing withdrawal, the investigators reported good test-retest reliability (mean test-retest correlation score 0.77) and validity (r=0.62, p=0.00). A factor analysis revealed a three-factor model comprising a hyperarousal factor (craving, agitation and unpleasant dreams), a reversed vegetative factor (decreased energy, increased appetite, craving for sleep) and an anxiety factor (loss of interest or pleasure, anxiety and slowing of movement).

A scale for assessing severity of cocaine withdrawal has been developed by Kampman, Volpicelli, McGinnis, Alterman et al. (1998) and is reported to be a valid and reliable measure. The Cocaine Selective Severity Assessment instrument is an 18-item instrument designed for use by clinical staff to assess severity (0 = no symptoms to 7 = severe) of signs and symptoms of cocaine withdrawal. Domains measured include craving, depressed mood, appetite changes, sleep disturbance, lethargy, low pulse rate (bradycardia) and irritability.

It must be emphasised, however, that unlike withdrawal from alcohol or opioids, medication is not specifically or immediately administered in response to a specific score on a psychostimulant withdrawal scale (symptom-triggered treatment).The observations monitor the person's progress through detoxification, however a rating of the person's subjective experience of withdrawal symptoms, particularly agitation, sleep disturbance, depression and symptoms of psychosis, will inform the need for, or dose of, relevant medications during the course of withdrawal or aftercare. Irritability is very common and angry outbursts have been noted among some individuals experiencing withdrawal from psychostimulants. Clinical staff and carers should be mindful to provide appropriate support and adequate physical space during detoxification. The use of medications might be indicated in some instances.