Summary: Researchers report that about one in ten heavy cannabis users experience cannabis withdrawal syndrome after stopping use.
Source: Columbia University.
As regular cannabis use has risen across the United States, so has the prevalence of withdrawal symptoms among users. Researchers at the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center report that 12 percent of frequent cannabis users met criteria for Cannabis Withdrawal Syndrome (CWS), a condition that includes emotional, behavioral, and physical symptoms. The findings appear in the journal Drug and Alcohol Dependence.
Cannabis Withdrawal Syndrome was formally introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‑5) in 2013. This study is the first large-scale analysis linking DSM‑5 defined CWS with other psychiatric disorders among frequent adult cannabis users in the United States.
“With rapid changes in laws and social attitudes toward marijuana, adult use of cannabis is increasing. Accurate information about how often clinically significant withdrawal occurs and which factors are associated with it is essential,” said Deborah Hasin, PhD, professor of Epidemiology at the Columbia Mailman School of Public Health.
The research used data from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), the only nationally representative survey that assesses DSM‑5 cannabis withdrawal symptoms. Trained interviewers conducted face‑to‑face interviews in participants’ homes with 36,309 adults. The present analysis focused on 1,527 respondents who were frequent cannabis users, defined as using cannabis three or more times per week during the year prior to interview.
Investigators assessed withdrawal using DSM‑5 criteria, which include six psychological symptoms and at least one physical symptom. CWS was associated with a wide range of psychiatric diagnoses, notable functional impairment, and a family history of depression. Psychiatric conditions linked with withdrawal included mood disorders; several anxiety disorders such as social phobia, agoraphobia, and panic disorder; personality disorders; and post‑traumatic stress disorder.
The most commonly reported withdrawal symptoms were nervousness or anxiety (reported by 76 percent of those with CWS), increased hostility (72 percent), sleep difficulties (68 percent), and depressed mood (59 percent). Physical symptoms were less common than emotional and behavioral symptoms but included headaches, shakiness or tremors, and sweating for many individuals.
In this sample, frequent cannabis users tended to be male (66 percent), white (59 percent), aged 18–29 (50 percent), college educated (49 percent), never married (54 percent), and living in lower household income brackets (45 percent). While frequency of use measured as occasions per week was not significantly associated with experiencing withdrawal, the number of joints smoked per day did show a significant relationship with withdrawal symptoms.
Family history of drug or alcohol problems was not significantly associated with cannabis withdrawal, but a family history of depression was linked to higher rates of CWS.
“Cannabis withdrawal can be highly disabling,” noted Hasin, who also holds a professorship in the Department of Psychiatry. “Because many withdrawal symptoms overlap with depressive and anxiety disorders, clinicians should be alert to the possibility that mood and anxiety symptoms in frequent cannabis users may reflect withdrawal. Recognizing these associations can improve assessment and treatment planning.”
Earlier work by Hasin and colleagues found that withdrawal symptoms were common and related to psychiatric conditions and use intensity, though earlier datasets did not capture the DSM‑5 definition of CWS. As a relatively new diagnostic category, DSM‑5 cannabis withdrawal merits further study to clarify its course, risk factors, and best treatment approaches.
Hasin and colleagues also noted a methodological challenge: newer modes of cannabis administration such as vaping and edible products are often used in combination with smoking, which can lead to underestimates of total consumption when studies focus primarily on smoked cannabis. Given the increase in average potency of cannabis products over recent decades, better measurement of cannabis concentration and administration mode will be important for future research into withdrawal and related harms.
Funding: The study was supported by the National Institute on Drug Abuse. The NESARC‑III survey received primary support from the National Institute on Alcohol Abuse and Alcoholism with supplemental support from the National Institute on Drug Abuse and from the Intramural Research Program of the NIAAA.
Source: Stephanie Berger – Columbia University
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Original Research: The study appears in the journal Drug and Alcohol Dependence.