Quantifying the Clinical Significance of Cannabis Withdrawal

Abstract

Background and AimsQuestions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt.Methods and ResultsA volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p = 0.0001). Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p = 0.03). Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p = 0.001).ConclusionsCannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes.

The Effects of Lithium Carbonate Supplemented with Nitrazepam on Sleep Disturbance during Cannabis Abstinence

“…Sleep disturbances are one of the most severe and enduring symptoms of cannabis withdrawal, 4,5,32,33 and there are no evidence-based treatment options to target this pervasive withdrawal symptom. This patient population entered our study reporting significant self-rated insomnia symptoms despite using cannabis right up until study entry …”

“…[5][6][7][8] There is some evidence that pharmacotherapy during cannabis abstinence attenuates withdrawal related sleep disturbances, 9 including improvements in polysomnographic measures of sleep effi ciency (but not latency) with the nonbenzodiazepine GABA(A) receptor agonist zolpidem.…”

“…4 During the withdrawal process, sleep diffi culties predict relapse to cannabis use. [5][6][7][8] There is some evidence that pharmacotherapy during cannabis abstinence attenuates withdrawal related sleep disturbances, 9 including improvements in polysomnographic measures of sleep effi ciency (but not latency) with the nonbenzodiazepine GABA(A) receptor agonist zolpidem. 10 While there is a plethora of studies exploring self-reported sleep disturbances associated with cannabis withdrawal, there are very laboratory study examining the muscle relaxant baclofen and the antidepressant mirtazapine.…”

“…4,5,9,10 Recent studies have demonstrated high endorsement frequencies on ratings of sleep disturbances across research and clinical treatment seeking samples (67% to 73% of adults and 33% to 43% of adolescents) lasting months after cessation of cannabis use. 6,10,[15][16][17] Clinically, this is an important issue warranting further attention as it is likely that sleep disturbance during withdrawal impacts on the success of the quit attempt or is associated with relapse.…”

Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery.

“…Importantly, the withdrawal syndrome has been found to be clinically significant and meaningful, insofar as it can lead to distress, continued use, and relapse (Allsop et al, 2012;Budney, Vandrey, Hughes, Thostenson, & Bursac, 2008;Copersino et al, 2006a;Cornelius, Chung, Martin, Wood, & Clark, 2008;Haney et al, 2008;Hasin et al, 2008;Vandrey, Budney, Kamon, & Stanger, 2005). It is noteworthy that while the cannabis withdrawal syndrome might be regarded as less severe than other withdrawal syndromes, such as a heroin withdrawal syndrome, it is of similar magnitude and has similar consequences to nicotine withdrawal, which is a well accepted and clinically valid syndrome (Allsop et al, 2012;Budney et al, 2008;Vandrey et al, 2005;Vandrey, Budney, Hughes, & Liguori, 2008). Indeed, the recently released DSM-5 now includes cannabis withdrawal as a disorder and withdrawal per se as a criterion for cannabis use disorder (American Psychiatric Association, 2013).…”