Cannabis withdrawal symptoms common among adolescents treated for substance use disorder
September 2, 2014
Science Daily/Massachusetts General Hospital
Although cannabis -- commonly known as marijuana -- is broadly believed to be nonaddictive, a study by Massachusetts General Hospital (MGH) investigators found that 40 percent of cannabis-using adolescents receiving outpatient treatment for substance use disorder reported experiencing symptoms of withdrawal, which are considered a hallmark of drug dependence. Study participants reporting withdrawal were more likely to meet criteria for severe substance use and for mood disorders, although the presence or absence of withdrawal did not appear to change long-term treatment outcomes. The report will be published in the Journal of Addiction Medicine and has been released online.
"Our results are timely given the changing attitudes and perceptions of risk related to cannabis use in the U.S.," says John Kelly, PhD, of the Center for Addiction Medicine in the MGH Department of Psychiatry, senior author of the study. "As more people are able to obtain and consume cannabis legally for medical and, in some states, recreational use, people are less likely to perceive it as addictive or harmful. But research shows that cannabis use can have significant consequences, and we know that among adolescents it is second only to alcohol in rates of misuse."
While several previous studies have looked at the incidence of cannabis withdrawal in adolescents and its relationship to treatment outcomes, few have included follow-up periods longer than 30 days or examined the relationship of withdrawal to factors such as the severity and consequence of cannabis use and the presence of other psychiatric symptoms. The current study enrolled 127 adolescents between ages 14 and 19 being treated at an outpatient substance use disorder clinic, 90 of whom indicated that cannabis was the substance they used most frequently.
Upon entering the study and at follow-up visits 3, 6 and 12 months later, participants received comprehensive assessments including interviews by study staff and completion of survey instruments analyzing factors related to substance use -- including whether or not they thought they might have a problem with drug use -- withdrawal symptoms, consequences in their lives attributable to substance use, and other psychiatric symptoms and diagnoses. Based on their answers, participants were divided into two groups -- those who reported cannabis withdrawal symptoms such as anxiety, irritability, depression and difficulty sleeping and those who did not.
Of the 90 cannabis-using participants, 76 (84 percent) met criteria for cannabis dependence -- which include increased tolerance and use of cannabis, unsuccessful efforts to reduce or stop using, and persistent use in spite of medical and psychological problems made worse by cannabis. Withdrawal symptoms were reported by 36 participants (40 percent of the overall group), all of whom also met criteria for dependence. At the study's outset, substance use was likely to be more severe and consequences -- such as missing work or school, financial and relationship problems -- tended to be greater in participants reporting withdrawal symptoms, who also were more likely to have mood disorders.
While the presence of withdrawal symptoms is a strong indicator of cannabis dependence, the authors note, it did not significantly impact the ability of participants to reduce their use of cannabis during the 12-month follow-up period. The factor that did appear to make a difference was whether or not an individual recognized having a problem with substance use upon entering the study. Participants who both reported withdrawal symptoms and recognized having a problem had a small but steady improvement in abstinence through the entire study period. Those who reported withdrawal symptoms but did not recognize a substance use problem had a slight increase in abstinence in the first 3 months, but then had some increase in cannabis use during the subsequent 9 months, a pattern that was also seen in participants not experiencing withdrawal.
"We hypothesize that participants who experience withdrawal symptoms but do not recognize having a substance use problem may not attribute those symptoms to cannabis withdrawal," says Claire Greene, MPH, corresponding author of the report. "Those who do acknowledge a substance-use problem may correctly attribute those symptoms to cannabis withdrawal, giving them even more motivation to change their substance use behavior." Formerly with the MGH Center for Addiction Medicine, Greene is now a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health.
Kelly, the Spallin Associate Professor of Psychiatry in Addiction Medicine at Harvard Medical School, adds, "The importance of understanding the addictiveness, risks and harms associated with cannabis use is a major theme of this study's findings. Recognizing those risks is known to reduce the likelihood that someone will start to use drugs, and better understanding of the role of substances in the problems experienced by patients may help them cut down on future use.
"Unfortunately, the general trend in attitudes in the U.S. is to minimize the risks and not recognize the addictiveness of cannabis," he continues. "Further research is needed determine the impact of these changing public attitudes and investigate the benefits of programs that reduce these misconceptions, which could allow us to predict whether increased education and awareness could help reduce the onset of, and harm caused by, cannabis use disorders." The study was supported by National Institute of Alcohol Abuse and Alcoholism grant R01AA015526.
https://www.sciencedaily.com/releases/2014/09/140902094103.htm
More than one in ten heavy cannabis users experience withdrawal after quitting cannabis
October 22, 2018
Science Daily/Columbia University's Mailman School of Public Health
As the number of Americans who regularly use cannabis has climbed, so too has the number of those experiencing cannabis withdrawal symptoms. A new study by researchers at the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center finds that 12 percent of frequent marijuana smokers experienced Cannabis Withdrawal Syndrome (CWS), which includes emotional, behavioral and physical symptoms. The study is published in the journal Drug and Alcohol Dependence.
CWS was first included in the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5, published in 2013. The new study is the first large-scale report on the link between CWS and DSM-5 psychiatric disorders among frequent U.S. adult cannabis users.
"In a rapidly changing landscape of marijuana laws and attitudes, cannabis use continues to increase among American adults. As a result, more information on the prevalence and correlates of clinical withdrawal in the general population is of critical importance," said Deborah Hasin, PhD, professor of Epidemiology at Columbia Mailman School of Public Health.
Study participants were interviewed as part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), the only nationally representative survey that measures clinically diagnosed cannabis withdrawal syndrome, which encompasses six psychological symptoms and one or more physical symptoms. Face-to-face interviews in respondents' homes were conducted with 36,309 participants. The final analysis was based on 1,527 participants who were frequent cannabis users, defined as using the drug three or more times a week during the year prior to the interview.
CWS symptoms were associated with numerous psychiatric disorders, significant mental disability, and a family history of depression. Psychiatric disorders included mood disorders; anxiety disorders, including social phobia, agoraphobia, and panic disorder; personality disorders; and post-traumatic stress disorder.
Among withdrawal symptoms, the most commonly reported were nervousness/anxiety (76 percent), hostility (72 percent), sleep difficulty (68 percent) and depressed mood (59 percent). While physical symptoms were reported less frequently than behavioral and emotional symptoms, headaches, shakiness/tremors, and sweating were also prevalent.
Frequent cannabis users were primarily male (66 percent), white (59 percent), aged 18-29 (50 percent), college educated (49 percent), never married (54 percent), and with low household income (45 percent). While frequency of use (within a week) was not significantly associated with withdrawal symptoms, the number of joints smoked per day was significantly associated with withdrawal symptoms.
Cannabis withdrawal syndrome was not significantly associated with family history of drug or alcohol problems, but significantly associated with family history of depression.
"Cannabis withdrawal syndrome is a highly disabling condition," noted Hasin, who is also a professor in the Department of Psychiatry. "The syndrome's shared symptoms with depressive and anxiety disorders call for clinician awareness of cannabis withdrawal symptoms and the factors associated with it to promote more effective treatment among frequent cannabis users."
In an earlier study by Hasin and colleagues (LINK TK), cannabis withdrawal symptoms were prevalent and associated with psychiatric disorders and intensity of cannabis use. However, at that time,NESARC did not cover the DSM-5 cannabis withdrawal symptoms. As a new diagnosis, much remains to be learned about DSM-5 CWS, according to Hasin and colleagues.
"Most users of the newer modes of administration -- vaping and edibles -- also smoke cannabis. Therefore, for users in modes other than smoking, the amount of consumption could be underestimated," said Hasin. "Given the increase in cannabis potency in recent decades, developing reliable measures to investigate the effect of cannabis concentration and mode of administration will be important in advancing our understanding of cannabis withdrawal syndrome."
Co-authors are Ofir Livne (lead author), Lev Hasharon Medical Center, Israel; Dvora Shmulewitz, Columbia University Medical Center; and Shaul Lev-Ran, Lev Hasharon Medical Center and Tel Aviv University.
The study of cannabis withdrawal was supported by the National Institute on Drug Abuse. The NESARC-III survey was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support by the National Institute on Drug abuse, and by the Intramural Research Program of the NIAAA.
https://www.sciencedaily.com/releases/2018/10/181022122837.htm