The Prevalence of Cannabis Withdrawal and Its Influence on Adolescents' Treatment Response and Outcomes

Abstract

Background Withdrawal, a diagnostic indicator of cannabis use disorder, is often minimized or ignored as a consequence of cannabis use, particularly among adolescents. This study aims to characterize cannabis withdrawal among adolescents in outpatient treatment for substance use disorder and evaluate the clinical significance of withdrawal as a predictor of substance-related outcomes. Methods Adolescent outpatients (N=127) reporting cannabis as their drug of choice (n=90) were stratified by presence of withdrawal and compared on demographic and clinical variables at treatment intake. Hierarchical linear models compared the effect of withdrawal on percent days abstinent (PDA) and related outcomes over a 1-year follow-up period. Results Adolescents reporting withdrawal (40%) were more likely to meet criteria for cannabis dependence, have higher levels of substance use severity, report more substance-related consequences, and have a mood disorder. Withdrawal was not associated with PDA over the follow-up period; however, this relationship was moderated by problem recognition such that adolescents reporting withdrawal and a drug problem improved at a greater rate with respect to PDA than those that didn’t recognize a problem with drugs and didn’t report withdrawal. Discussion Withdrawal is common among adolescent outpatients and is associated with a more clinically severe profile. In this sample, all adolescents reporting withdrawal met criteria for cannabis dependence, suggesting that withdrawal is a highly specific indicator of cannabis use disorder. While withdrawal doesn’t appear to be independently associated with substance use outcomes post-treatment, moderating factors such as drug problem recognition should be taken into account when formulating treatment and continuing care plans.

Prolonged cannabis withdrawal in young adults with lifetime psychiatric illness

“…Additionally, many prior studies on cannabis withdrawal investigated treatment-seeking cannabis users with more frequent, heavier and earlier initiation of use than the average participant enrolled in the current trial. It is therefore possible that patterns of withdrawal by psychiatric history may differ for more severe patient populations 23, 50–51 . Another noteworthy limitation is that, although the time since last cannabis use was within one week of the baseline visit, it was not standardized beyond that parameter.…”

“…Cannabis withdrawal has been identified as a key criterion of cannabis use disorder 21,22 , impacting between 35% to 75% of adolescents and young adults with a use disorder attempting to reduce or discontinue use 23 . According to the DSM-V, the cannabis withdrawal syndrome involves the manifestation of three or more of the following six symptoms: irritability or anger; nervousness or anxiety; sleep difficulty (i.e., insomnia, disturbing dreams); decreased appetite or weight loss; restlessness; depressed mood; and at least one physical symptom causing discomfort (i.e., abdominal pain, shakiness/tremors, sweating, fever, chills, headache) 24–26 .…”

“…Due to the long half-life of Δ9-tetrahydrocannabinol (THC) and its metabolites, the cannabis withdrawal syndrome may last for several days to weeks following last use. Importantly, the presence of withdrawal symptoms with abstinence has been found to be a marker for problematic cannabis use, predicting severity of use, rapid reinstatement of use during a quit attempt, and problems from use 21,26,27 In a sample of adolescent cannabis users followed over one year, greater withdrawal symptom severity was associated with fewer days abstinent 23 …”

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

“…Although cannabis withdrawal was associated with difficulty achieving abstinence in two cross-sectional, retrospective-recall studies (Budney, Vandrey, Hughes, Thostenson, & Bursac, 2008; Cornelius et al, 2008), only two studies have prospectively investigated whether cannabis withdrawal predicts posttreatment abstinence (Arendt et al, 2007; Greene & Kelly, 2014). …”

“…Greene and Kelly (2014) reported that adolescents endorsing one or more withdrawal symptom had equivalent posttreatment outcomes compared with those not experiencing withdrawal (Greene & Kelly, 2014). However, the presence of withdrawal interacted with problem recognition, with those reporting withdrawal and ability to acknowledge problems having better posttreatment outcomes.…”