B4: 6
Psychostimulants HO4
Amphetamine Withdrawal Assessment Scale
Drug & Alcohol Services Council, SA, 2002
Note: Only use in isolation from other withdrawal scales where the person has solely an
amphetamine use problem.
Note: Total Score is indicative of increasing or decreasing severity of withdrawal. Scores are
not directly linked to pharmacological management as occurs with alcohol scores based on
the CIWA-Ar.
Surname:
Given name:
Date of birth:
Date
Time
Temperature
Pulse
Respiration rate
Blood pressure
Weight
Score range = 0-7
Irritability
Depression
Racing thoughts
Restlessness/Agitation
Feelings of unreality
Drowsiness
Nausea/Vomiting
TOTAL
Sleep (0800 obs only)
Other symptoms
Resource Kit for GP Trainers on Illicit Drug Issues
Part B4 Drugs: Psychostimulants
Amphetamine Withdrawal Assessment Scale cont.
These questions refer to how the person is feeling right now, at the present moment.
1.
Irritability—Observation
Ask ‘Do you feel irritable?’
0
1
4
7
2.
3.
4
7
6.
No sadness
Slow to respond but reactive
Moderately withdrawn
Withdrawn, unresponsive
7.
Normal activity
Some what more than normal
activity
Moderately fidgety or restless
Unable to sit or stand still
No drowsiness
Mild
Moderate
Severe, cannot keep awake
Nausea/Vomiting—Observation
Ask ‘Do you feel sick in the stomach,
have you vomited?’
0
1
4
7
8.
No
Mild
Moderate
Severe feelings of unreality,
everything looks strange or
different
Drowsiness—Observation
Ask ‘Do you feel sleepy or drowsy?’
0
1
4
7
No racing thoughts
Mild
Moderate
Severe
Restlessness/Agitation
Ask ‘Do you feel more restless or agitated
than you are normally?’
0
1
Feelings of unreality
Ask ‘Do you feel that things around you
are not real or change in shape?’
0
1
4
7
Racing thoughts
Ask ‘Are your thoughts racing?’
0
1
4
7
4.
No irritability
Mild
Moderate
Severe
Depression—Observation
Ask ‘Do you feel sad?
0
1
4
7
5.
No nausea or vomiting
Mild nausea
Intermittent nausea with dry
retching
Constant nausea, frequent dry
retching/vomiting
Sleep
Ask ‘How did you sleep last night?’
0
1
4
7
Sufficient sleep
Some sleep
Moderate/restless sleep
No sleep
Cited in deCrespigny, C et al 2003, Alcohol Tobacco and Other Drugs Guidelines for Nurses and
Midwives: Clinical Guidelines. Flinders University and Drug and Alcohol Services Council, Adelaide
Also available at wwww.dasc.sa.gov.au
Resource Kit for GP Trainers on Illicit Drug Issues
Part B4 Drugs: Psychostimulants