Cannabis Medical Questionnaire Form
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1The Cannabis Withdrawal Scale
Instructions: This version of the CWS asks about symptoms experienced over the last 24 hours,
and can be administered by an interviewer OR by self report.
The following statements describe how you have felt over the last 24 hours. Please circle the
number that most closely represents your personal experiences for each statement. For each
statement, please rate its negative impact on normal daily activities on the same scale
(0 = Not at all to 10 = Extremely), writing the number in the right hand column.
Negative
Impact on
daily activity
Not at all
Moderately
Extremely
(0 – 10)
1
The only thing I could think about
0
1
2
3
4
5
6
7
8
9
10
was smoking some cannabis
2
I had a headache
0
1
2
3
4
5
6
7
8
9
10
3
I had no appetite
0
1
2
3
4
5
6
7
8
9
10
4
I felt nauseous (like vomiting)
0
1
2
3
4
5
6
7
8
9
10
5
I felt nervous
0
1
2
3
4
5
6
7
8
9
10
6
I had some angry outbursts
0
1
2
3
4
5
6
7
8
9
10
7
I had mood swings
0
1
2
3
4
5
6
7
8
9
10
8
I felt depressed
0
1
2
3
4
5
6
7
8
9
10
9
I was easily irritated
0
1
2
3
4
5
6
7
8
9
10
10
I had been imagining being stoned
0
1
2
3
4
5
6
7
8
9
10
11
I felt restless
0
1
2
3
4
5
6
7
8
9
10
12
I woke up early
0
1
2
3
4
5
6
7
8
9
10
13
I had a stomach ache
0
1
2
3
4
5
6
7
8
9
10
14
I had nightmares and/or strange
0
1
2
3
4
5
6
7
8
9
10
dreams
15
Life seemed like an uphill struggle
0
1
2
3
4
5
6
7
8
9
10
16
I woke up sweating at night
0
1
2
3
4
5
6
7
8
9
10
17
I had trouble getting to sleep
0
1
2
3
4
5
6
7
8
9
10
at night
18
I felt physically tense
0
1
2
3
4
5
6
7
8
9
10
19
I had hot flashes
0
1
2
3
4
5
6
7
8
9
10
Score by summing each items value to a maximum withdrawal score of 190 (you can derive two
scores from the scale: one for withdrawal intensity and one for the negative impact of withdrawal
– each separate score has a theoretical maximum of 190).
Allsop, D., Norberg, M., Copeland, J., Fu, S. & Budney, A.J. (2011). The Cannabis Withdrawal Scale Development:
Patterns and Predictors of Cannabis Withdrawal and Distress. Drug and Alcohol Dependence 119 (1-2), 123-129
Correspondence concerning this article should be addressed to Jan Copeland, National Cannabis Prevention
and Information Centre, University of New South Wales, Sydney, Australia 2031. Phone: +61 2 9385 0231
E-mail:
j.copeland@unsw.edu.au
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