DSM-5 cannabis withdrawal syndrome: Demographic and clinical correlates in U.S. adults

Abstract

Background: Cannabis withdrawal syndrome (CWS) was newly added to the Diagnostic and Statistical Manual of Mental Disorders in its most recent edition, DSM-5. With cannabis use increasing among U.S. adults, information is needed about the prevalence and correlates of DSM-5 CWS in the general population. This study presents nationally representative findings on the prevalence, sociodemographic and clinical correlates of DSM-5 CWS among U.S. adults. Method: Participants ≥18 years were interviewed in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) in 2012-2013. Among the sub-sample of frequent cannabis users in the prior 12 months (≥3 times a week; N=1,527), the prevalence, demographic and clinical correlates of DSM-5 CWS were examined.Results: In frequent cannabis users, the prevalence of CWS was 12.1%. The most common withdrawal symptoms among those with CWS were nervousness/anxiety (76.3%), hostility (71.9%), sleep difficulty (68.2%) and depressed mood (58.9%). CWS was associated with significant disability (p<0.001), and with mood disorders (adjusted odds ratios [aOR]=1.9-2.6), anxiety disorders (aOR=2.4-2.5), personality disorders (aOR=1.7-2.2) and family history of depression (aOR=2.5) but not personal history of other substance use disorders or family history of substance use problems.

Persistent cannabis use as an independent risk factor for violent behaviors in patients with schizophrenia

“…First, it is possible that people with a higher cumulative use of cannabis are at higher risk of cannabis misuse. Such a consequence could be a direct result of acute or chronic cannabis intake, or of cannabis withdrawal syndrome, all of which have been associated with increased hostility, irritability, and anger among the general population [34][35][36][37] . Indeed, the literature shows that these three factors have repeatedly been associated with violence in people with severe mental illnesses [38][39][40] .…”

Probability and correlates of transition from cannabis use to DSM‐5 cannabis use disorder: Results from a large‐scale nationally representative study

“…In addition, differences between DSM‐IV abuse and dependence diagnoses and DSM‐5 CUD diagnosis may also contribute significantly to this increase. It should be noted that the construction of DSM‐5 CUD was based on several intrinsic changes in the perception of pathological substance use: the understanding among researchers and clinicians that a unidimensional approach may better suit substance use disorders (SUD) , which resulted in incorporating DSM‐IV abuse and dependence into a single diagnostic entity in the DSM‐5; the ‘legal problems’ criterion in DSM‐IV cannabis abuse was replaced by a ‘craving’ criterion in DSM‐5 CUD due to low prevalence of the former and a better theoretical and statistical fit to the DSM‐5 unidimensional construct of the latter ; finally, withdrawal was included as a diagnostic criterion in DSM‐5 CUD due to emerging evidence regarding its prevalence and clinical significance among frequent cannabis users . Considering these changes, there is a need for additional research investigating the probability of transition from cannabis use to DSM‐5 CUD.…”

Is the Urine Cannabinoid Level Measured via a Commercial Point-of-Care Semiquantitative Immunoassay a Cannabis Withdrawal Syndrome Severity Predictor?

“…The abrupt cessation of frequent cannabis intake is followed by a cannabis withdrawal syndrome (CWS), primarily presenting with emotional and behavioral symptoms (1)(2)(3). In US adults frequently using cannabis, the prevalence of CWS was 12.1% (4). Moreover, CWS is a key component of the cannabis dependence syndrome (CDS) as defined in ICD-10, with nearly 90% of these individuals displaying clinically relevant CWS (5).…”

“…However, it is unclear whether levels of this biomarker-as measured by point-of-care testing (POCT)-are really associated with CWS severity in clinical practice, which influences treatment decisions regarding discharge and subsequent outpatient rehabilitation treatment for CDS (3). Greater-severity CWS is not only associated with increased likelihood of CDS but also with increased comorbidity and negative psychosocial outcomes (1)(2)(3)(4). The answer to the question of whether an easily determined POCT biomarker predicts CWS severity thus assumes greater importance in the context of resource allocation.…”