title: Examining the factor structure of the Clinical Opiate Withdrawal Scale: A secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003.
abstract: BACKGROUND
  The Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal in clinical trials and practice. The aims of this study were to examine the inter-item correlations and factor structure of the COWS in opioid-dependent men and women.
  
  
  METHODS
  This is a secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 0003, a randomized clinical trial that compared buprenorphine/naloxone tapering strategies. The trial included 11 sites in 10 US cities. Participants were opioid-dependent individuals (n=516) that had data on the COWS. The COWS at study baseline was analyzed in this study.
  
  
  RESULTS
  Inter-item correlations showed weak to moderate relationships among the items. A 1-factor model did not fit the data for men (comparative fit index (CFI)=.801, root mean square error of approximation (RMSEA)=.073, weighted root mean square residual (WRMR)=1.132) or women (CFI=.694, RMSEA=.071, WRMR=.933), where resting pulse rate was not related to withdrawal for men, and yawning and gooseflesh skin was not related to withdrawal for women. A reduced model comprised of only the 8 items that were significantly related to the construct of withdrawal in both men and women, and an exploratory 2-factor model, were also assessed but not retained due to inconsistencies across gender.
  
  
  CONCLUSIONS
  When traditional psychometric models are applied to the COWS, it appears that the scale may not relate to a single underlying construct of withdrawal. Further research testing the hypothesized factor structure in other opioid-dependent samples is needed.
authors.affiliation: College of Nursing, Washington State University, Spokane, WA, United States; Department of Psychology, Washington State University, Pullman, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Translational Addictions Research Center, Washington State University, Spokane, WA, United States. Electronic address: celestina@wsu.edu.
authors.forename: Celestina
authors.initials: C
authors.lastname: Barbosa-Leiker
authors.affiliation: College of Nursing, Washington State University, Spokane, WA, United States; Department of Psychology, Washington State University, Pullman, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Translational Addictions Research Center, Washington State University, Spokane, WA, United States.
authors.forename: Sterling
authors.initials: S
authors.lastname: McPherson
authors.affiliation: Department of Psychology, Washington State University, Pullman, WA, United States.
authors.forename: Mary Rose
authors.initials: MR
authors.lastname: Mamey
authors.affiliation: Department of Psychology, Washington State University, Pullman, WA, United States.
authors.forename: G Leonard
authors.initials: GL
authors.lastname: Burns
authors.affiliation: Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Translational Addictions Research Center, Washington State University, Spokane, WA, United States; Washington State University Medical Sciences, Spokane, WA, United States.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Layton
authors.affiliation: College of Nursing, Washington State University, Spokane, WA, United States; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, United States; Translational Addictions Research Center, Washington State University, Spokane, WA, United States.
authors.forename: John
authors.initials: J
authors.lastname: Roll
authors.affiliation: Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, United States; Integrated Substance Abuse Programs, University of California, Los Angeles, CA, United States.
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000188:drug therapy; D011594:Psychometrics; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination
keywords: Clinical Opiate Withdrawal Scale; Opiate dependence; Opiate withdrawal; Psychometrics