Protocol - Withdrawal from Tobacco Use
Description
The Minnesota Withdrawal Scale - Revised offers a self-report protocol which reviews symptoms of withdrawal. This protocol has been validated for use with adults and adolescents. It has also been found to be a reliable and valid measure for changes in withdrawal symptoms during smoking cessation.
Specific Instructions
Instructions for Use of the Minnesota Withdrawal Scale - Revised
1. There are two scales: a self-report and an observer scale. Several items do not appear in the observer scale because observers cannot reliably rate them.
2. On the self-report scale, the first nine items are the well-validated items and are the ones to be used if calculating a total withdrawal discomfort score. The other six are promising candidate items.
3. See the attached table to further compare the content of the scales with the criteria for DSM-V and ICD-10 nicotine/tobacco withdrawal and the contents of other withdrawal scales.
4. We have participants complete the scale both before and after quitting.
5. We have participants rate over the last 24 hours and observers rate over the last week. We usually require observers to see the participant on average 2 hours/day.
6. We use the 0-4 response option so that we can have verbal anchors for each response. Larger response options (e.g., 0-100) are likely more sensitive but may be more difficult to interpret.
7. The scale is not labeled a withdrawal scale because subjects (1) are confused by filling out a "withdrawal" scale prior to cessation, and (2) will sometimes not report a symptom during abstinence if they do not believe it is the result of withdrawal.
8. We encourage readers to read recent reviews of methodological issues in measuring tobacco withdrawal (see references 3 & 4).
Availability
Protocol
Behavior Rating Scale - Self-Report
Please rate yourself for the period for the last _______________
1. Angry, irritable, frustrated
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
2. Anxious, nervous
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
3. Depressed mood, sad
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
4. Desire or craving to smoke
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
5. Difficulty concentrating
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
6. Increased appetite, hungry, weight gain
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
7. Insomnia, sleep problems, awakening at night
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
8. Restless
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
9. Impatient
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
10. Constipation
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
11. Dizziness
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
12. Coughing
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
13. Dreaming or nightmares
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
14. Nausea
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
15. Sore throat
0[ ]none
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
Behavior Rating Scale - Observer-Rating
Rate the subject on the following symptoms according to whether you observed the symptom in the subject in the last ________________. It does not matter whether the subject complained of the symptom. We want to know whether you noticed the symptom.
a. Angry/irritable/frustrated
0[ ]not at all
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
b. Anxious/tense
0[ ]not at all
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
c. Depressed
0[ ]not at all
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
d. Restless/Impatient
0[ ]not at all
1[ ]slight
2[ ]mild
3[ ]moderate
4[ ]severe
1. How confident are you that this rating is accurate?
0[ ]not at all
1[ ]somewhat confident
2[ ]moderately confident
3[ ]very confident
Personnel and Training Required
None
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Self-administered questionnaire and clinical assessment
Lifestage
Adult
Participants
Adults 18 and over
Selection Rationale
The Minnesota Withdrawal Scale is a widely used validated instrument which measures withdrawal symptoms.
Language
English, Other languages available at source
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| caDSR Form | PhenX PX721001 - Withdrawal From Tobacco Use | 6238748 | caDSR Form |
Derived Variables
None
Process and Review
The Tobacco Regulatory Research (TRR) Content Expert Panel (CEP) reviewed the measures in the Tobacco Regulatory Research collection in February 2024.
Guidance from the TRR CEP includes:
- Updating of the description and general references
Previous version in Toolkit archive (link)
Protocol Name from Source
The Minnesota Withdrawal Scale - Revised (MWS-R)
Source
www.med.uvm.edu/behaviorandhealth/research/minnesota-tobacco-withdrawal-scale
Hughes, J. R., & Hatsukami, D. K. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289-294.
Minnesota Nicotine Withdrawal Scale - Revised. The University of Vermont, 21 Aug. 2012. Web. 23 Sept. 2014.
General References
The website for the scales is https://www.med.uvm.edu/behaviorandhealth/research/minnesota-tobacco-withdrawal-scale. The scales were originally reported in 1986 (Reference 2). Five articles have described the psychometrics of the scale (References 3-7). Three articles have comprehensively reviewed what is known about tobacco withdrawal (References 1, 4, 8).
Hughes, J. R. (2007). The effects of abstinence from tobacco: Valid symptoms and time course. Nicotine & Tobacco Research, 9, 315-327.
Hughes, J. R., & Hatsukami, D. K. (1986). Signs and symptoms of tobacco withdrawal. Archives of General Psychiatry, 43, 289-294.
Shiffman, S., West, R. J., & Gilbert, D. G. (2004). Recommendation for the assessment of tobacco craving and withdrawal in smoking cessation trials. Nicotine & Tobacco Research, 6, 599-614.
Hughes, J. R. (2007). Measurement of the effects of abstinence from tobacco. A qualitative review. Psychology of Addictive Behaviors, 21, 127-137.
West, R., Ussher, M., Evans, M., Rashid, M. (2006). Assessing DSM-IV nicotine withdrawal symptoms: A comparison and evaluation of five different scales. Psychopharmacology, 184, 619-627.
Etter, J. F., & Hughes, J. R. (2006). A comparison of the psychometric properties of three cigarette withdrawal scales. Addiction, 101, 362-372.
Javitz, H., Lerman, C., & Swan, G. (2012). Comparative dynamics of four smoking withdrawal symptom scales. Addiction, epub ahead of print.
Hughes, J. R. (2007). The effects of abstinence from tobacco: Etiology, determinants, epidemiology, significance. Nicotine & Tobacco Research, 9, 329-339.
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. Geneva, Switzerland: World Health Organization.
Etter, J. (2005). Self-administered questionnaire to measure cigarette withdrawal symptoms: The Cigarette Withdrawal Scale. Nicotine & Tobacco Research, 7, 47-57.
West, R., & Hajek, P. (2004). Evaluation of the mood and physical symptoms scale (MPSS) to assess cigarette withdrawal. Psychopharmacology, 177, 195-199.
McNair, D. M., Lorr, J., & Droppelman, L. F. (1992). Profile of mood states manual. North Tonawanda, NY: Multi-Health Systems.
Shiffman, S., & Jarvik, M. E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacologia, 50, 35-39.
Schneider, N. G., & Jarvik, M. E. (1984). Time course of smoking withdrawal symptoms as a function of nicotine replacement. Psychopharmacology, 82, 143-144.
Welsch, S. K., Smith, S. S., Wetter, D. W., Jorenby, D. E., Fiore, M. C., & Baker, T. B. (1999). Development and validation of the Wisconsin Smoking Withdrawal Scale. Experimental and Clinical Psychopharmacology, 7(4), 354-361.
Shiffman, S., Paty, J. A., Gnys, M., Kassel, J. A., & Hickcox, M. (1996). First lapses to smoking: Within-subjects analysis of real-time reports. Journal of Consulting and Clinical Psychology, 64, 366-379.
Hughes, J. R., Helzer, J. E., & Lindberg, S. A. (2006). Prevalence of DSM/ICD-defined nicotine dependence. Drug and Alcohol Dependence, 85, 91-102.
Protocol ID
721001
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX721001_Tobacco_Use_Withdrawal_Angry | ||||
| PX721001010000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Anxious | ||||
| PX721001020000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Appetite | ||||
| PX721001060000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Confident_Rating_Accurate | ||||
| PX721001200000 | How confident are you that this rating is more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Constipation | ||||
| PX721001100000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Coughing | ||||
| PX721001120000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Craving_Smoke | ||||
| PX721001040000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Depressed | ||||
| PX721001030000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Difficulty_Concentrating | ||||
| PX721001050000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Dizziness | ||||
| PX721001110000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Dreaming_Nightmares | ||||
| PX721001130000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Impatient | ||||
| PX721001090000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Insomnia | ||||
| PX721001070000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Nausea | ||||
| PX721001140000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Observed_Angry | ||||
| PX721001160000 | Rate the subject on the following symptoms more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Observed_Anxious | ||||
| PX721001170000 | Rate the subject on the following symptoms more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Observed_Depressed | ||||
| PX721001180000 | Rate the subject on the following symptoms more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Observed_Restless | ||||
| PX721001190000 | Rate the subject on the following symptoms more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Restless | ||||
| PX721001080000 | Please rate yourself for the period for the more | N/A | ||
| PX721001_Tobacco_Use_Withdrawal_Sore_Throat | ||||
| PX721001150000 | Please rate yourself for the period for the more | N/A | ||
Measure Name
Withdrawal from Tobacco Use
Release Date
February 20, 2015
Definition
Withdrawal is measured by the feelings and reactions experienced because of the absence of tobacco.
Purpose
The Minnesota Withdrawal Scale -- Revised records the feelings and reactions experienced because of the absence of tobacco.
Keywords
Withdrawal symptoms, drug withdrawal, tobacco withdrawal, smoking withdrawal, nicotine withdrawal, quitting, dependence, withdrawal
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 721001 | Withdrawal from Tobacco Use |
Publications
Garcia-Cazarin, M.L., Mandal, R.J., Grana, R., Wanke, K.L., Meissner, H. (2020) Host-agent-vector-environment measures for electronic cigarette research used in NIH grants. Tobacco Control. 2020 January; 29(1). doi: 10.1136/tobaccocontrol-2017-054032