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

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

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).

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.

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.