Cannabis Withdrawal, Posttreatment Abstinence, and Days to First Cannabis Use Among Emerging Adults in Substance Use Treatment

Davis, Jordan P.; Smith, Douglas C.; Morphew, Jason W.; Lei, Xinrong; Zhang, Saijun

doi:10.1177/0022042615616431

Cited by 47 publications

(35 citation statements)

References 90 publications

(155 reference statements)

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“…In a separate sample of 110 treatment-seeking emerging adults who were heavy cannabis users, those with significant cannabis withdrawal had a 53% greater risk of earlier resumption of cannabis use than those who did not report significant withdrawal symptoms 28 .…”

Section: Introductionmentioning

confidence: 92%

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

Schuster

Fontaine

Nip

et al. 2017

Preventive Medicine

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Young adults with psychiatric illnesses are more likely to use cannabis and experience problems from use. It is not known whether those with a lifetime psychiatric illness experience a prolonged cannabis withdrawal syndrome with abstinence. Participants were fifty young adults, aged 18–25, recruited from the Boston-area in 2015–2016, who used cannabis at least weekly, completed the Structured Clinical Interview for DSM-IV to identify Axis I psychiatric diagnoses (PD+ vs PD−), and attained cannabis abstinence with a four-week contingency management protocol. Withdrawal symptom severity was assessed at baseline and at four weekly abstinent visits using the Cannabis Withdrawal Scale. Cannabis dependence, age of initiation, and rate of abstinence were similar in PD+ and PD− groups. There was a diagnostic group by abstinent week interaction, suggesting a difference in time course for resolution of withdrawal symptoms by group, F(4,46)=3.8, p=0.009, controlling for sex, baseline depressive and anxiety symptoms, and frequency of cannabis use in the prior 90 days. In post hoc analyses, there was a difference in time-course of cannabis withdrawal. PD− had significantly reduced withdrawal symptom severity in abstinent week one [t(46)=−2.2, p=0.03], while PD+ did not report improved withdrawal symptoms until the second abstinent week [t(46) =−4.1, p=0.0002]. Cannabis withdrawal symptoms improved over four weeks in young people with and without a lifetime psychiatric diagnosis. However, those with a psychiatric illness reported one week delayed improvement in withdrawal symptom severity. Longer duration of cannabis withdrawal may be a risk factor for cannabis dependence and difficulty quitting.

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Section: Introductionmentioning

confidence: 92%

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

Schuster

Fontaine

Nip

et al. 2017

Preventive Medicine

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“…The importance of the treatment of CWS on the maintenance of cannabis use or substance use trajectories over time is unclear and awaits further study. From previous literature, there is small evidence for both 1) CWS treatment initiated abstinence or dose reduction12,13 and 2) CWS treatment does not influence cannabis use in the following 18,20,42,109. Frequent cannabis users had reported that withdrawal symptoms negatively influence their desire and ability to quit 12,13,18,105.…”

Section: Impact On Cud or Dependencementioning

confidence: 99%

“…Outpatient treatment programs improved the psychosocial functioning and dropped the cannabis use for a while 12,13. Currently, only a few long-term follow-ups are available, so far showing no sustaining improvement of CUD subsequent to outpatient detoxification attempts 18,20,42,109…”

Section: Impact On Cud or Dependencementioning

confidence: 99%

The cannabis withdrawal syndrome: current insights

Bonnet¹,

Preuss

2017

SAR

184

127

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The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.

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“…At the time of writing, cannabis withdrawal has been investigated in adolescent samples [30, 31], emerging adults [32], adult long-term, daily cannabis users [5, 22], and environments that include closed residential research units [27, 28, 33], outpatient settings [25, 26, 34], and within the context of clinical studies evaluating behavioral and pharmacological interventions for the treatment of cannabis use disorder [9, 10, 11, 13, 35]. …”

Section: Characteristics Of the Cannabis Withdrawal Syndromementioning

confidence: 99%

Cannabis Withdrawal: a Review of Neurobiological Mechanisms and Sex Differences

Schlienz

Budney²,

Lee

et al. 2017

Curr Addict Rep

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Purpose of Review This report provides an updated overview of pre-clinical and clinical research on the etiology and biological substrates of the cannabis withdrawal syndrome. Recent Findings Long-term cannabis use is associated with downregulation of type-1 cannabinoid receptors (CB1). Reduced CB1 receptor density is related to increased withdrawal during early abstinence, and the reduction in CB1 receptor density reverses with extended abstinence. Females have been shown to have increased rate and severity of a subset of cannabis withdrawal symptoms compared with men. Summary Recent studies have extended knowledge of the biological processes and individual difference variables that influence cannabis withdrawal. However, caveats include small sample sizes in clinical studies, participant samples that are predominantly male, and limited examinations of endocannabinoids, enzymes that degrade endocannabinoids, negative allosteric modulators, and other neurobiological systems that may directly impact cannabis withdrawal symptom expression.

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Cannabis Withdrawal, Posttreatment Abstinence, and Days to First Cannabis Use Among Emerging Adults in Substance Use Treatment

Cited by 47 publications

References 90 publications

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

The cannabis withdrawal syndrome: current insights

Cannabis Withdrawal: a Review of Neurobiological Mechanisms and Sex Differences

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