Cannabis withdrawal symptoms common among adolescents treated for substance use disorder
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.
Marijuana Withdrawal Symptoms:
Anxiety - You may feel more anxious in social situations and develop some sort of generalized anxiety. This is the exact opposite of how relaxed you felt while using the drug - your brain is trying to compensate for the chemicals it received while you used marijuana.
Appetite changes - If marijuana helped boost your appetite, you may not feel hungry at all while coming off of the drug. In some cases, people actually feel hungrier coming off marijuana - it totally depends on the case.
Cramps - Some people notice stomach cramps and digestion problems. Others may feel achy.
Cravings (for marijuana) - At some point in time, most people will experience a craving to use marijuana again. This is because you stimulated your brains pleasure center and kept feeding it chemicals to make you feel good. It wants its fix, and knows marijuana makes you feel good, so you will likely crave the drug.
Depersonalization - You may feel like you are not the same person or are going crazy. This is usually a result of intense anxiety. You may have never felt this way before; your brain chemistry has been thrown out of whack.
Depression - Many people experience some sort of depressive symptoms when coming off of the drug. You may feel sad and as though you have lost all zest for life.
Dizziness - Some individuals report feeling dizzy. Try not to lose your cool if this is happening, just accept it as a symptom.
Headaches - Another common withdrawal symptom is that of headaches.
Insomnia - Not being able to sleep at night is a problem, but one that you need to tackle head on. Try learning some relaxation techniques or getting more exercise during the day to help tire yourself out at night.
Irritability - You may experience anger or frustration with the world when coming off of the drug. No one wants to get mad at little things, but this will eventually pass with enough time.
Mood swings - Some people experience extreme changes in mood when trying to quit this drug. You may feel alright one minute and then raging mad or depressed the next.
Nausea - Feeling nauseated, especially before, during, or after eating is common.
Sleep disturbances - You may experience crazy vivid dreams or have disrupted sleep where you wake up in the middle of the night.
Sweating - Some people end up sweating more than they normally would during 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.
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Heavy pot users who quit cold turkey may find themselves lighting up again to quell withdrawal symptoms, researchers say.
In a study of nearly 500 marijuana smokers who tried to kick the habit, about one-third resumed use to relieve or avoid withdrawal symptoms such as irritability and anxiety.
There’s long been a debate over whether pot smokers actually become addicted to the drug and whether withdrawal symptoms are real. They do and they are, says researcher David Gorelick, MD, PhD, of the National Institute on Drug Abuse in Baltimore.
He predicts cannabis withdrawal syndrome will be recognized as a psychiatric disorder in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the bible of mental disorders. It’s due out in 2012.
Gorelick presented the findings at the American Psychiatric Association annual meeting.
Heavy Pot Smokers and Withdrawal Symptoms
The study involved 469 pot smokers, ages 18 to 64, who were recruited using word of mouth and advertisements. None of the participants suffered from recognized psychiatric disorders.
About one in four reported smoking pot more than 10,000 times in their lives - the equivalent of daily use for 27 years. More than half smoked more than 2,000 times.
“These were heavy users,” Gorelick says.
A total of 42.4% experienced at least one withdrawal symptom - most commonly, cravings, irritability, boredom, anxiety, and sleep disturbances - when they tried to quit.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $785 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology and photomedicine.
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Noah Brown
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Massachusetts General Hospital