Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence

Abstract

Recently, reports have suggested that cannabis withdrawal occurs commonly in adults with cannabis dependence, though it is unclear whether this extends to those with comorbid depression or to comorbid adolescents. We hypothesized that cannabis withdrawal would be common among our sample of comorbid adolescents and young adults, and that the presence of cannabis withdrawal symptoms would be associated with a self-reported past history of rapid reinstatement of cannabis dependence symptoms (rapid relapse). The participants in this study included 170 adolescents and young adults, including 104 with cannabis dependence, 32 with cannabis abuse, and 34 with cannabis use without dependence or abuse. All of these subjects demonstrated current depressive symptoms and cannabis use, and most demonstrated current DSM-IV major depressive disorder and current comorbid cannabis dependence. These subjects had presented for treatment for either of two double-blind, placebo-controlled trials involving fluoxetine. Cannabis withdrawal was the most commonly reported cannabis dependence criterion among the 104 subjects in our sample with cannabis dependence, being noted in 92% of subjects, using a two-symptom cutoff for determination of cannabis withdrawal. The most common withdrawal symptoms among those with cannabis dependence were craving (82%), irritability (76%), restlessness (58%), anxiety (55%), and depression (52%). Cannabis withdrawal symptoms (in the N=170 sample) were reported to have been associated with rapid reinstatement of cannabis dependence symptoms (rapid relapse). These findings suggest that cannabis withdrawal should be included as a diagnosis in the upcoming DSM-V, and should be listed in the upcoming criteria list for the DSM-V diagnostic category of cannabis dependence.

User Experiences of Development of Dependence on the Synthetic Cannabinoids, 5f-AKB48 and 5F-PB-22, and Subsequent Withdrawal Syndromes

“…Of interest was that in contrast to SCB studies reporting poly substance use (Schifano et al 2010;Vandrey et al 2012;Winstock and Barratt 2013;Caviness et al 2015), dependent users in this study smoked only the identified herbal mixtures containing 5f-AKB48 and 5F-PB-22, and used alcohol and cannabis only when attempting to self-detoxify in efforts to alleviate withdrawals. Severity of natural cannabis withdrawal has predictive validity in use of cannabis or other substances to alleviate symptoms (Copersino et al 2006;Chung et al 2008;Cornelius et al 2008). The study highlights the need for the generation of evidence based medical and psychiatric treatment and detoxification protocols for this particularly severe form of synthetic cannabis withdrawal.…”

Prenatal, perinatal, and adolescent exposure to marijuana: Relationships with aggressive behavior

“…Adult users, particularly those with violence problems, report some instances of aggression during intoxication, but these instances are rare, particularly in comparison to experiences of relaxation during intoxication (Arendt et al, 2007). Research should examine self-report of aggressive A C C E P T E D M A N U S C R I P T The most likely way marijuana could pharmacologically contribute to aggression is through the symptoms of cannabis withdrawal, which can occur in adolescents ceasing prolonged, heavy use, particularly among those with a history of conduct disorder or depression (Cornelius et al, 2008;Vandrey et al, 2005). Cannabis withdrawal causes increases in self-rated aggression (31% of adolescents suffering cannabis withdrawal report a moderate or severe increase in aggression) (Vandrey et al, 2005).…”

“…Another study of a sample of adolescents and young adults seeking treatment for depression symptoms and cannabis dependence symptoms found that 91% experienced at least two symptoms and 73% experienced at least four symptoms of cannabis withdrawal (Cornelius, Chung, Martin, Wood, & Clark, 2008).…”

Nosologic Comparisons of DSM-IV and DSM-5 Alcohol and Drug Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III

“…However, its reliability and validity have since been demonstrated in preclinical, clinical, and epidemiologic studies (Agrawal et al, 2008;Budney & Hughes, 2006;Budney et al, 2004;Copersino et al, 2006;Goldstein & Volkow, 2011;Hasin et al, 2008;Martinez et al, 2007). The clinical significance of cannabis withdrawal is indicated by the use of cannabis or similar substances to relieve withdrawal symptoms, its association with difficulty quitting (Budney et al, 2004;Copersino et al, 2006;Levin et al, 2010), and worse treatment outcomes with greater withdrawal severity Cornelius et al, 2008).…”