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The marijuana withdrawal syndrome: Diagnosis and treatment

Abstract

A subset of marijuana smokers develop a cannabis use disorder and seek treatment for their marijuana use on their own initiative. A less well-known consequence of daily, repeated marijuana use is a withdrawal syndrome, characterized by a time-dependent constellation of symptoms: irritability, anxiety, marijuana craving, decreased quality and quantity of sleep, and decreased food intake. Treatment studies show that rates of continuous abstinence are low (comparable to relapse rates for other abused drugs), and more treatment options are needed. The objective of this review is to update clinicians on the current state of marijuana research and to describe features of marijuana withdrawal to facilitate the diagnosis and treatment of cannabis use disorders.

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References and Recommended Reading

  1. Bauman A, Phongsavan P: Epidemiology of substance use in adolescence: prevalence, trends and policy implications. Drug Alcohol Depend 1999, 55:187–207.

    PubMed  Article  CAS  Google Scholar 

  2. Johnston LD, O’Malley PM, Bachman JG: Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2000. National Institute on Drug Abuse, Bethesda MD 2001, (NIH Publication #01-4923).

  3. Anthony JC, Warner LA, Kessler RC: Comparative epidemiology of dependence on tobacco, alcohol, controlled substances and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 1994, 2:244–268.

    Article  Google Scholar 

  4. Epstein JF: Substance Dependence, Abuse and Treatment: Findings from the 2000 National Household Survey on Drug Abuse. NHSDA Series A-16, DHHS Publication no. SMA 02-3642. Rockville MD: Substance Abuse and Mental Health Services Administration. Office of Applied Studies, 2002. http://www.DrugAbuseStatistics.SAMSHA.gov.

    Google Scholar 

  5. Marijuana Treatment Project Research Group: Brief treatments for cannabis dependence: findings from a randomized multisite trial. J Consult Clin Psych 2004, 72:455–466.

    Article  Google Scholar 

  6. Stephens RS, Roffman RA, Simpson EE: Adult marijuana users seeking treatment. J Consult Clin Psychology 1993, 61:1100–1104.

    Article  CAS  Google Scholar 

  7. Budney AJ, Radonovich KJ, Higgins ST, Wong CJ: Adults seeking treatment for marijuana dependence: A comparison with cocaine-dependent treatment seekers. Exp Clin Psychopharmacology 1998, 6:419–426.

    Article  CAS  Google Scholar 

  8. Budney AJ, Hughes JR, Moore BA, Vandrey R: Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry 2004, 161:1967–1977. The authors present a compelling argument for including marijuana withdrawal in the DSM criteria of dependence. A range of data on marijuana withdrawal is presented.

    PubMed  Article  Google Scholar 

  9. Coffey C, Carlin JB, Degenhardt L, et al.: Cannabis dependence in young adults: an Australian population study. Addiction 2002, 97:187–194.

    PubMed  Article  Google Scholar 

  10. Compton WM, Grant BF, Colliver JD, et al.: Prevalence of marijuana use disorders in the United States: 1991–1992 and 2001–2002. JAMA 2004, 291:2114–2121. This paper shows changes in cannabis use disorders and marijuana potency during a 10-year period.

    PubMed  Article  CAS  Google Scholar 

  11. ElSohly MA, Ross SA, Mehmedic Z, et al.: Potency trends of d9-THC and other cannabinoids in confiscated marijuana from 1980–1997. J Forensic Sci 1997, 45:24–30.

    Google Scholar 

  12. National Center for the Development of Natural Products: Quarterly Report Potency Monitoring Project, May 9, 2003–August 8, 2003: NIDA Marijuana Project. Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, 2003.

  13. Chait LD, Burke KA: Preference for high-versus low-potency marijuana. Pharmacol Biochem Behav 1994, 49:643–647.

    PubMed  Article  CAS  Google Scholar 

  14. Haney M, Ward AS, Comer SD, et al.: Abstinence symptoms following oral THC administration to humans. Psychopharm 1999, 4:385–394.

    Article  Google Scholar 

  15. Jones RT, Benowitz N, Bachman J: Clinical studies of cannabis tolerance and dependence. Ann NY Acad Sci 1976, 282:221–239.

    PubMed  Article  CAS  Google Scholar 

  16. Jones RT, Benowitz NL, Herning RI: Clinical relevance of cannabis tolerance and dependence. J Clin Pharmacology 1981, 21:143S-152S.

    Article  CAS  Google Scholar 

  17. Haney M, Ward AS, Comer SD, et al.: Abstinence symptoms following smoked marijuana in humans. Psychopharm 1999, 4:395–404.

    Article  Google Scholar 

  18. Hart CL, Haney M, Ward AS, et al.: Effects of oral THC maintenance on smoked marijuana self-administration. Drug Alcohol Depend 2002, 67:301–309.

    PubMed  Article  CAS  Google Scholar 

  19. Haney M, Hart CL, Vosburg SK, et al.: Marijuana withdrawal in humans: effects of oral THC or divalproex. Neuropsychopharmacology 2004, 29:158–170.

    PubMed  Article  CAS  Google Scholar 

  20. Hart C, Ward AS, Haney M, et al.: Comparison of smoked marijuana and oral D9-tetrahydrocannabinol in humans. Psychopharmacology 2002, 154:407–415.

    Article  Google Scholar 

  21. Budney AJ, Hughes JR, Moore BA, Novy PL: Marijuana abstinence effects in marijuana smokers maintained in their home environment. Arch Gen Psychiatry 2001, 58:917–924.

    PubMed  Article  CAS  Google Scholar 

  22. Budney AJ, Moore BA, Vandrey RG, Hughes JR: The time course and significance of cannabis withdrawal. J Abnormal Psychology 2003, 112:393–402.

    Article  Google Scholar 

  23. Kouri EM, Harrison PG: Abstinence symptoms during withdrawal from chronic marijuana use. Exp Clin Psychopharmacology 2000, 8:483–492.

    Article  CAS  Google Scholar 

  24. Kouri EM, Pope Jr HG, Lukas SE: Changes in aggressive behavior following discontinuation from long-term marijuana use. NIDA Research Monograph Series 1998, 178:70.

    Google Scholar 

  25. Heishman SJ, Taylor RC, Henningfield JE: Nicotine and smoking: A review of effects on human performance. Exp Clin Psychopharm 1994, 2:345–395.

    Article  CAS  Google Scholar 

  26. Kenford SL, Smith SS, Wetter DW, et al.: Predicting relapse back to smoking: contrasting affective and physical models of dependence. J Consult Clin Psychol 2002, 70:216–227. This study shows that negative affect during nicotine withdrawal predicts relapse to cigarette smoking and may have implications for the role marijuana withdrawal plays in marijuana relapse.

    PubMed  Article  Google Scholar 

  27. Weiner MD, Sussman S, McCuller WJ, Lichtman K: Factors in marijuana cessation among high-risk youth. J Drug Education 1999, 29:337–357.

    Article  CAS  Google Scholar 

  28. Vandrey R, Budney AJ, Kamon JL, Stanger C: Cannabis withdrawal in adolescent treatment seekers. Drug Alcohol Depend 2005, 78:205–210.

    PubMed  Article  Google Scholar 

  29. Boyd S, Gorelick D, Huestis M, et al.: Prevalence and persistence of withdrawal symptoms reported by a non-treatment sample of marijuana smokers. Drug Alcohol Depend 2002, 66:S19.

    Google Scholar 

  30. Budney AJ, Novy PL, Hughes JR: Marijuana withdrawal among adults seeking treatment for marijuana dependence. Addiction 1999, 94:1311–1321.

    PubMed  Article  CAS  Google Scholar 

  31. Budney AJ, Higgins ST, Radonovich KJ, Novy PL: Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. J Consult Clin Psych 2000, 68:1051–1061.

    Article  CAS  Google Scholar 

  32. Stephens RS, Roffman RA, Simpson EE: Treating adult marijuana dependence: a test of the relapse prevention model. J Consult Clin Psychology 1994, 62:92–99.

    Article  CAS  Google Scholar 

  33. Stephens RS, Roffman RA, Curtin L: Extended versus brief treatment for marijuana use. J Consult Clin Psychology 2000, 68:898–908.

    Article  CAS  Google Scholar 

  34. Moore BA, Budney AJ: Relapse in outpatient treatment for marijuana dependence. J Subst Abuse Treat 2003, 25:85–89.

    PubMed  Article  Google Scholar 

  35. Copeland J, Swift W, Roffman R, Stephens R: A randomized controlled trial of brief cognitive-behavioral interventions for cannabis use disorder. J Subst Abuse Treat 2001, 21:55–64.

    PubMed  Article  CAS  Google Scholar 

  36. Vendetti J, McRee B, Miller M, et al.: Correlates of pre-treatment drop-out among persons with marijuana dependence. Addiction 2002, 97:125–134.

    PubMed  Article  Google Scholar 

  37. Stephens RS, Babor TF, Kadden R, et al.: The marijuana treatment project: rationale, design and participant characteristics. Addiction 2002, 97:109–124.

    PubMed  Article  Google Scholar 

  38. Gruber AJ, Pope HG: Marijuana use among adolescents. Pediatr Clin N Am 2002, 49:389–413.

    Article  Google Scholar 

  39. Troisi A, Pasini A, Saracco M, Spalletta G: Psychiatric symptoms in male cannabis users not using other illicit drugs. Addiction 1998, 93:487–492.

    PubMed  Article  CAS  Google Scholar 

  40. Crowley TJ, MacDonald MJ, Whitmore EA, Mikulich SK: Cannabis dependence, withdrawal and reinforcing effects among adolescents with conduct disorder symptoms and substance use disorders. Drug Alcohol Depend 1998, 50:27–37.

    PubMed  Article  CAS  Google Scholar 

  41. Chen K, Kandel DB: Predictors of cessation of marijuana use: an event history analysis. Drug Alcohol Depend 1998, 50:109–121.

    PubMed  Article  CAS  Google Scholar 

  42. Haney M, Hart CL, Ward AS, Foltin RW: Nefazodone decreases anxiety during marijuana withdrawal in humans. Psychopharmacology 2003, 165:157–165.

    PubMed  CAS  Google Scholar 

  43. Shiffman S, Johnston JA, Khayrallah M, et al.: The effect of nefazodone on nicotine craving and withdrawal. Psychopharmacology 2000, 148:33–40.

    PubMed  Article  CAS  Google Scholar 

  44. Hurt RD, Sachs DP, Glover ED: A comparison of sustainedrelease bupropion and placebo for smoking cessation [see comments]. N Engl J Med 1997, 337:1195–1202.

    PubMed  Article  CAS  Google Scholar 

  45. O’Brien CP: Drug addiction and drug abuse (1996). In Goodman’s and Gilman’s The Pharmacological Basis of Therapeutics, Ninth Edition. Edited by Molinoff PB, Ruddon RW. New York: McGraw-Hill; 1996.

    Google Scholar 

  46. Haney M, Ward AS, Comer SD, et al.: Bupropion SR worsens mood during marijuana withdrawal in humans. Psychopharmacology 2001, 155:171–179.

    PubMed  Article  CAS  Google Scholar 

  47. Plasse TF, Gorter RW, Krasnow SH, et al.: Recent clinical experience with dronabinol. Pharmacol Biochem Behav 1991, 40:695–700.

    PubMed  Article  CAS  Google Scholar 

  48. Haney M, Rabkin J, Gunderson E, Foltin RW: Dronabinol and marijuana in HIV+ marijuana smokers: acute effects on caloric intake and mood. Psychopharmacology 2005, E-published ahead of print.

  49. Donovan SI, Stewart JW, Nunes EV, et al.: Divalproex treatment for youth with explosive temper and mood lability: a doubleblind, placebo-controlled, crossover design. Am J Psychiatry 2000, 157:818–820.

    PubMed  Article  CAS  Google Scholar 

  50. Brady KT, Myrick H, Henderson S, Coffey SF: The use of divalproex in alcohol relapse prevention: a pilot study. Drug Alchol Depend 2002, 67:323–330.

    Article  CAS  Google Scholar 

  51. Apelt S, Emirich HM: Sodium valproate in benzodiazepine withdrawal. Am J Psychiatry 1990, 147:950–951.

    PubMed  CAS  Google Scholar 

  52. Levin FR, McDowell D, Evans SM, et al.: Pharmacotherapy for marijuana dependence: a double-blind, placebo-controlled pilot study of divalproex sodium. Am J Addict 2004, 13:21–32.

    PubMed  Article  Google Scholar 

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Haney, M. The marijuana withdrawal syndrome: Diagnosis and treatment. Curr Psychiatry Rep 7, 360–366 (2005). https://doi.org/10.1007/s11920-005-0036-1

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Keywords

  • Bupropion
  • Nefazodone
  • Nicotine Withdrawal
  • Marijuana Smoker
  • Drug Alcohol Depend