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Multidimensionality of the Alcohol Withdrawal Symptom Checklist: A Factor Analysis of the Alcohol Withdrawal Symptom Checklist and CIWA-Ar

Authors

  • Brian Pittman,

    1. NIAAA Center for the Translational Neuroscience of Alcoholism, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
    2. the Alcohol Research Center, VA Connecticut Healthcare System (116-A), West Haven, Connecticut
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  • Ralitza Gueorguieva,

    1. NIAAA Center for the Translational Neuroscience of Alcoholism, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
    2. the Alcohol Research Center, VA Connecticut Healthcare System (116-A), West Haven, Connecticut
    3. the Division of Biostatistics, Department of Epidemiology and Public Health, Yale University School of Public Health, New Haven, Connecticut
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  • Evgeny Krupitsky,

    1. the St. Petersburg Regional Center of Addictions and Psychopharmacology, Pavlov State Medical University, St. Petersburg, Russia
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  • Anatoly A. Rudenko,

    1. the St. Petersburg Regional Center of Addictions and Psychopharmacology, Pavlov State Medical University, St. Petersburg, Russia
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  • Barbara A. Flannery,

    1. RTI International, Baltimore, Maryland
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  • John H. Krystal

    1. NIAAA Center for the Translational Neuroscience of Alcoholism, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
    2. the Alcohol Research Center, VA Connecticut Healthcare System (116-A), West Haven, Connecticut
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  • This study was supported by the U.S. National Institute on Alcohol Abuse and Alcoholism (1-R21-AA014543-01A1, I-P50 AA-12870-04, KO5 AA 14906-01), the U.S. Department of Veterans Affairs through support for the Alcohol Research Center based at the VA Connecticut Healthcare System (JK).

Reprint requests: Brian Pittman, Connecticut Mental Health Center, 34 Park Street, 3rd Floor CNRU, New Haven, CT 06519; Fax: 203-974-7662; E-mail: brian.pittman@yale.edu

Abstract

Background: This study evaluated the factor structure of 2 scales for measuring the severity of the alcohol withdrawal syndrome (AWS): a self-rated scale, the Alcohol Withdrawal Symptoms Checklist (AWSC), and an observer-rated scale, the Clinical Institute Withdrawal Assessment—Alcohol, Revised (CIWA-Ar).

Methods: Alcohol-dependent male inpatients [n=127, age: 43.0±9.7 (mean±SD) years] were recruited from an inpatient treatment unit. Both measures of AWS were assessed repeatedly during the initial week of sobriety in these patients. An exploratory factor analysis was applied to the data collected on the first study day.

Results: Five independent factors accounted for 64% of total variance in the AWSC: autonomic arousal, depression, nausea and vomiting, alcohol craving, and tension/anxiety. Three items (abdominal pain, hallucinations, confusion) could not be included in the analysis due to insufficient variance. Three dimensions identified for the CIWA-Ar (autonomic arousal, nausea and vomiting, tension/anxiety) were also captured by the ASWC. Total AWSC scores correlated well with total CIWA-Ar scores (r=0.72), supporting validity of the AWSC. Lower correlations between total CIWA-Ar and the 5 factors (r=0.32–0.52) suggested that the CIWA-Ar and AWSC factors had discriminative value.

Conclusions: Self-rated measures of AWS could play an important role in complementing observer-rated measures in clinical and research settings. In this sample, the AWSC appeared to identify multiple dimensions of AWS with face validity for clinical relevance.

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