ORIGINAL RESEARCH article
Front. Public Health
Sec. Substance Use Disorders and Behavioral Addictions
Validation of the Korean Version of the Clinical Opiate Withdrawal Scale
Provisionally accepted
- 1Kyungpook National University Hospital, Daegu, Republic of Korea
- 2Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
- 3Daegu Catholic University Medical Center, Nam-gu, Republic of Korea
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Abstract Background: Prescription opioid use has risen dramatically in South Korea in recent years, yet no standardized Korean-language instrument exists to assess opioid withdrawal. The Clinical Opiate Withdrawal Scale is a widely used clinician-rated measure of opioid withdrawal severity. We aimed to validate a Korean version of the COWS (K-COWS) in patients receiving opioid therapy. Methods: We translated and culturally adapted the 11-item COWS into Korean. A total of 66 adult patients with opioid use disorder experiencing withdrawal symptoms were assessed. Each patient was evaluated with the K-COWS and completed the Subjective Opiate Withdrawal Scale (SOWS), a brief 3-item Opioid Craving Scale (OCS-3), and a single-item Opioid Craving Visual Analog Scale (OC-VAS). We examined internal consistency, factor structure (exploratory and confirmatory factor analysis), and convergent/discriminant validity of the K-COWS. Results: K-COWS showed good internal consistency (Cronbach's α = .79; 95% CI = .71–.86). Exploratory factor analysis supported a two-factor structure (physical vs. autonomic clusters) explaining 39% of the variance. In confirmatory factor analysis, the two-factor model showed marginally acceptable fit (χ2 = 47.76, CFI = .915, RMSEA = .082), whereas the unidimensional alternative showed poor fit. K-COWS correlated strongly with SOWS (r = .74, 95% CI = .61–.83, p < .001), indicating good convergent validity for withdrawal. In contrast, correlations with the craving measures were weak (OCS-3: r = .19, p > .05; OC-VAS: r = .20, p > .05), supporting discriminant validity. Conclusion: K‑COWS is reliable and shows construct validity for withdrawal severity in Korean clinical settings. Given the preliminary nature of the factor structure, the total score is recommended for clinical decision-making. Future studies should assess inter-rater reliability and confirm the structure in larger, diverse samples.
Keywords: K-COWS, Opioid use disorder, Opioid withdrawal, The Clinical Opiate Withdrawal Scale (COWS), Validation
Received: 14 Oct 2025; Accepted: 16 Dec 2025.
Copyright: © 2025 Lee, Im, Ha, Oh, Park, Kim and Kang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tae Young Lee
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