Objective: Though it has enjoyed widespread popularity, Gorski's post-acute withdrawal syndrome (PAWS) model of relapse has been subjected to little scientific scrutiny. A scale to operationalize Gorski's 37 warning signs was developed and tested in a larger prospective study of predictors of relapse. Of central interest were: (1) whether the warning signs hypothesized by Gorski are interrelated in a meaningful single factor and (2) whether the hypothesized syndrome would accurately predict subsequent relapses.
Method: A sample of 122 individuals (84 men) entering treatment for alcohol problems was followed at 2-month intervals for 1 year. The Assessment of Warning-signs of Relapse (AWARE) scale was administered at each assessment point, and the occurrence of both slips (any drinking) and relapses (heavy drinking) was monitored during each subsequent 2-month interval. Principal factor analysis was used to study the factor structure of the warning signs.
Results: Of the 37 warning signs, 28 clustered as a robust single factor with excellent internal consistency (Cronbach's alpha: 0.92-0.93). A conservative evaluation of test-retest stability across 2-month intervals estimated reliability at r = 0.80. After covarying for prior drinking status, clients' AWARE scores significantly predicted subsequent slips and relapses. Relapse rates for clients with highest AWARE scores, as projected by regression equations, were 33 to 46 percentage points higher than those for clients with lowest AWARE scores, after taking into account prior drinking status.
Conclusions: This scale of Gorski's warning signs appears to be a reliable and valid predictor of alcohol relapses.