Headache |
0: Not present |
1: Very mild |
2: Mild |
3: Moderate |
4: Moderately severe |
5: Severe |
6: Very severe |
7: Extremely severe |
Auditory disturbances |
0: Not present |
1: Very mild harshness or ability to frighten |
2: Mild harshness or ability to frighten |
3: Moderate harshness or ability to frighten |
4: Moderately severe hallucinations |
5: Severe hallucinations |
6: Extremely severe hallucinations |
7: Continuous hallucinations |
Visual disturbances |
0: Not present |
1: Very mild photosensitivity |
2: Mild photosensitivity |
3: Moderate photosensitivity |
4: Moderately severe visual hallucinations |
5: Severe visual hallucinations |
6: Extremely severe visual hallucinations |
7: Continuous visual hallucinations |
Tactile disturbances |
0: None |
1: Very mild paresthesias |
2: Mild paresthesias |
3: Moderate paresthesias |
4: Moderately severe hallucinations |
5: Severe hallucinations |
6: Extremely severe hallucinations |
7: Continuous hallucinations |
Orientation and clouding of sensorium |
0: Oriented and can do serial additions |
1: Cannot do serial additions |
2: Disoriented for date by no more than 2 calendar days |
3: Disoriented for date by more than 2 calendar days |
4: Disoriented for place and/or patient |
Total score is a simple sum of each item score (maximum score is 67) |
Score: |
<10: Very mild withdrawal |
10 to 15: Mild withdrawal |
16 to 20: Modest withdrawal |
>20: Severe withdrawal |