The time course and significance of cannabis withdrawal.

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Abstract

Withdrawal symptoms following cessation of heavy cannabis (marijuana) use have been reported, yet their time course and clinical importance have not been established. A 50-day outpatient study assessed 18 marijuana users during a 5-day smoking-as-usual phase followed by a 45-day abstinence phase. Parallel assessment of 12 ex-users was obtained. A withdrawal pattern was observed for aggression, anger, anxiety, decreased appetite, decreased body weight, irritability, restlessness, shakiness, sleep problems, and stomach pain. Onset typically occurred between Days 1-3, peak effects between Days 2-6, and most effects lasted 4-14 days. The magnitude and time course of these effects appeared comparable to tobacco and other withdrawal syndromes. These effects likely contribute to the development of dependence and difficulty stopping use. Criteria for cannabis withdrawal are proposed.

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Most cited references 30

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A 32-item questionnaire on smoking urges was administered to 230 daily cigarette smokers assigned to one of three levels of cigarette deprivation (0, 1 or 6 hours). Factor analyses showed that a two-factor solution best described the item structure for each of the three deprivation levels and for the entire sample. Factor scales of 15 and 11 items derived from rotation to simple structure were highly reliable, 0.95 and 0.93, respectively, and moderately correlated (r = 0.71). Average scores on both scales increased significantly with level of deprivation, and the Factor 1 scale was significantly higher than the Factor 2 scale at all levels. Factor 1 scale items reflected primarily intention and desire to smoke, and anticipation of pleasure from smoking. Factor 2 scale items were comprised primarily of anticipation of relief from negative affect and nicotine withdrawal, and urgent and overwhelming desire to smoke.

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Stephen Higgins (1994)

To assess whether incentives improved treatment outcome in ambulatory cocaine-dependent patients. Forty cocaine-dependent adults were randomly assigned to behavioral treatment with or without an added incentive program. The behavioral treatment was based on the Community Reinforcement Approach and was provided to both groups. Subjects in the group with incentives received vouchers exchangeable for retail items contingent on submitting cocaine-free urine specimens during weeks 1 through 12 of treatment, while the group without incentives received no vouchers during that period. The two groups were treated the same during weeks 13 through 24. Seventy-five percent of patients in the group with vouchers completed 24 weeks of treatment vs 40% in the group without vouchers (P = .03). Average durations of continuous cocaine abstinence documented via urinalysis during weeks 1 through 24 of treatment were 11.7 +/- 2.0 weeks in the group with vouchers vs 6.0 +/- 1.5 weeks in the group without vouchers (P = .03). At 24 weeks after treatment entry, the voucher group evidenced significantly greater improvement than the no-voucher group on the Drug scale of the Addiction Severity Index (ASI), and only the voucher group showed significant improvement on the ASI Psychiatric scale. Incentives delivered contingent on submitting cocaine-free urine specimens significantly improve treatment outcome in ambulatory cocaine-dependent patients.

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Marijuana withdrawal among adults seeking treatment for marijuana dependence.

P L Novy, Alan Budney, Robert J Hughes (1999)

The clinical relevance of marijuana withdrawal has not been established. This study is the first to document the incidence and severity of perceived marijuana withdrawal symptoms in a clinical sample of marijuana-dependent adults. Fifty-four people seeking outpatient treatment for marijuana dependence completed a 22-item Marijuana Withdrawal Symptom checklist based on their most recent period of marijuana abstinence. The majority (57%) indicated that they had experienced > or = six symptoms of at least moderate severity and 47% experienced > or = four symptoms rated as severe. Withdrawal severity was greater in those with psychiatric symptomatology and more frequent marijuana use. This study provides further support for a cluster of withdrawal symptoms experienced following cessation of regular marijuana use. The affective and behavioral symptoms reported were consistent with those observed in previous laboratory and interview studies. Since withdrawal symptoms are frequently a target for clinical intervention with other substances of abuse, this may also be appropriate for marijuana.