Withdrawal Symptoms Cease over 12 Months When Cannabis Users Acknowledge Use

Withdrawal from cannabis use is common among adolescent outpatients, according to a study published in the Journal of Addiction Medicine.

Researchers from Massachusetts General Hospital (MGH) studied 127 adolescent outpatients aged 14-19 years, of whom 90 patients reported cannabis as their drug of choice. The patients were interviewed, surveyed, and instrumentally tested to see if they believed they had a problem with drug use, withdrawal symptoms, and consequences in their lives stemming from drug use and other psychiatric symptoms and diagnosis. From their answers, the patients were split into 2 groups: patients with cannabis withdrawal symptoms like anxiety, irritability, depression, and difficulty sleeping, and those who did not have withdrawal symptoms. The patients were evaluated later at 3, 6, and 12 months using the same methods.

“Our results are timely given the changing attitudes and perceptions of risk related to cannabis use in the US,” John Kelly, PhD, of the Center for Addiction Medicine in the MGH Department of Psychiatry and senior author of the study, told Internal Medicine World Report in an email. “As more people are able to obtain and consume cannabis legally for medical and, in some states, recreational use, people are less likely to perceive it as addictive or harmful. But research shows that cannabis use can have significant consequences, and we know that among adolescents it is second only to alcohol in rates of misuse.”

Seventy-six (84%) of the cannabis-using patients met criteria for cannabis dependence — which was defined as increased tolerance and use, unsuccessful efforts to reduce or stop using, and continued use regardless of psychological problems aggravated by cannabis. Of the overall group, 36 patients (40%) also met the same criteria for dependence. The researchers hypothesized substance use would lead to severe consequences, such as missing work or school and financial and relationship problems, and found that these issues were greater in participants who reported withdrawal symptoms. Withdrawal symptom participants were also noted to have mood disorders.

Additionally, the research showed that even though the presence of withdrawal symptoms was a strong indication of cannabis dependence, the participants’ ability to decrease cannabis use during the 12-month follow up was not affected. However, withdrawal symptoms did indicate whether or not a participant was able to acknowledge having a problem with substance use at baseline.

Participants who reported withdrawal and acknowledged having a problem were successful in improving their abstinence throughout the study period. Participants who only reported symptoms of withdrawal succeeded in abstaining for the first 3 months, but then had subsequent cannabis use in the following 9 months. The authors reaffirmed this as a common pattern in withdrawal patients.

“The importance of understanding the addictiveness, risks, and harms associated with cannabis use is a major theme of this study's findings,” Kelly concluded. “Recognizing those risks is known to

reduce the likelihood that someone will start to use drugs, and better understanding of the role of substances in the problems experienced by patients may help them cut down on future use. Unfortunately, the general trend in attitudes in the US is to minimize the risks and not recognize the addictiveness of cannabis.”

The experts plan further research to determine the impact of these attitudes in the public. They also hope to learn how to reduce the misconceptions, which could predict if education and awareness could prevent substance use and its associated withdrawal disorders.