More than 80 percent of participants met criteria for cannabis dependence, problem recognition a major determinant of usage reduction
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.
In my opinion, the addition of Cannabis Withdrawal Syndrome to the DSM is without merit. The symptoms that are arbitrarily assigned to the syndrome are so general as to describe many people and their desire for things. This is akin to declaring the existence of a “golf withdrawal syndrome.”
I use pot orally most nights. I’m solidly intoxicated each time and, due to my oral consumption, I’m stoned for a longer period than smokers. Yet I regularly quit for reasons other than a desire to stop using the drug permanently. Upcoming travel for work is the most common reason. I also quit every month or two in order to reduce my tolerance to the drug, since edibles are not inexpensive (I’m in Colorado and the taxes make the prices artificially high – pun unintended). The fact that I routinely use for a couple of months and then quit in order to economize, calls the supposedly addictive nature of MJ into question for me. I’ve used pot extensively (for fun and exactly a frequently as I choose) without issue and without the slightest craving, stands as anecdotal evidence that DSM inclusion is in error. I’ve frankly never met anyone who struggles with pot. I say that while living in a state that has had legalized sale of MJ for three years and with lots of friends who partake.
I believe that the reason for inclusion in the DSM-V is political. It is an attempt to meet obscene FDA categorization (schedule 1, for god’s sake!) with a clinical description supporting the federal position. It’s interesting to me that the feds (and now the psychiatric community) maintain that there is no medical use for MJ when it clearly has, numerically, more uses than any production pharmaceutical. For some disorders, it is the ONLY effective treatment. It also has efficacy for some diseases (seizures & Dravet Syndrome) where all for-profit pharmaceuticals fail miserably. There is simply a long-standing bias against this drug, and now the APA has joined the uninformed government in pillorying this benign plant.
I inhaled every day for 6 years from age 17-23 – got a BS (math) with a GPA of 3.8 – then a MBA. Stopped smoking for 25 yrs (literally from once a day to zero the next) with zero effects. Have smoked 3-5x a week for the past 5 yrs – and can stop on a dime with no after effects. This ‘research’ is not based on reality folks.
I have 46 years of experience with cannabis, with a 16 year “time out” from before my daughter’s birth until she left for college. In that time I’ve stopped consuming cannabis dozens of times for various reasons. Withdrawal symptoms consisted of nothing more than a couple of days of reduced appetite and some irritability and a couple of nights of disturbed sleep. I had much more severe withdrawals when I quit drinking three mugs of coffee every day and they lasted for a week. A minor head cold is far more annoying than cannabis withdrawal.
I’m finding much more propaganda than science in this Science Blog.
The sample is biased considering it is taken from a group of people who are outpatients in a substance use disorder clinic. It is wholly unrepresentative of the population at whole. If you went into a prison you’d find a higher percentage of murderers than in a random sample of people off the street. Come on Science Blog!
Science blog? Joke blog more like! On what scientific research do you base your bogus claims on? Addictive? Withdrawls? Since when? This article from beginning to end has to be the biggest load of false, outlandish, unscientific, prohibitionist crap I’ve ever had the misfortune to read.
Missing the point: a “temporary” abstinence (say, 47 hours) ENHANCES certain benefits of cannabis use such as CREATIVITY, the uprush of usable fascinating ideas which could be named LEAP (Long-term Episodic Associative Performance memory).
If everyone were instructed from the start to look for this benefit, needless to say “habitual” every6day use would be discounted and avoided by most users.
Another question which I hope researchers will look into: are the users studied ingesting the cannabis by means of “joints” i.e. giant Hot Burning Overdose Monoxide dosages which inflict harm blamed on the cannabis, rather than using a vaporizer (385F/195C) or a 25-mg-per-serving Flexible Drawtube One-Hitter?
So, some of the teens reported “anxiety, irritability, depression”? Yes, those *have* to be due to cannabis withdrawal, because teenagers *never* experience those moods normally, right?!
Just try relating to a recovering heroin junkie or drunk how rough your cold turkey from weed is; they’ll probably punch you in the throat …
Studies like this of cannabis “addiction” by vested interests in its illegality are no more valid than school lunch programs designed by the processed food industry.
Withdrawal symptoms from Cannabis? I would believe it if the test subjects could not stop using cannabis. Anxiety, irritability, depression, and trouble sleeping are all probably ailments the Cannabis was solving in half the participants who felt these “withdrawal symptoms”. This does nothing more than draw the dividing line even further between Cannabis and hard drugs, because it proves a Cannabis user is responsible enough to realize when they have a problem using cannabis, and can just put it down. This does not happen with a crack or heroin addict because the withdrawal symptoms of those drugs are truly withdrawal symptoms.