Quantifying the Clinical Significance of Cannabis Withdrawal

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Abstract

Background and Aims

Questions 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 Results

A 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).

Conclusions

Cannabis 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.

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Most cited references 34

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Signs and symptoms of tobacco withdrawal.

J R Hughes, D Hatsukami (1986)

To test the validity, magnitude, and clinical significance of the signs and symptoms of tobacco withdrawal defined by DSM-III, both observed and reported signs and symptoms were measured in 50 smokers during two days of ad lib smoking and then during the first four days of abstinence. Observer and subject ratings of the DSM-III symptoms of craving for tobacco, irritability, anxiety, difficulty concentrating, and restlessness increased after cessation. In addition, bradycardia, impatience, somatic complaints, insomnia, increased hunger, and increased eating occurred after cessation. The frequency and intensity of these symptoms varied across subjects; however, the average distress from tobacco withdrawal was similar to that observed in psychiatric outpatients. Subjects who had more withdrawal discomfort were more tolerant to the cardiovascular effects of nicotine. Subjects who had more withdrawal discomfort did not have a lower rate of smoking cessation.

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The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

M Gossop, P Griffiths, B Powis … (1995)

The Severity of Dependence Scale (SDS) was devised to provide a short, easily administered scale which can be used to measure the degree of dependence experienced by users of different types of drugs. The SDS contains five items, all of which are explicitly concerned with psychological components of dependence. These items are specifically concerned with impaired control over drug taking and with preoccupation and anxieties about drug use. The SDS was given to five samples of drug users in London and Sydney. The samples comprised users of heroin and users of cocaine in London, and users of amphetamines and methadone maintenance patients in Sydney. The SDS satisfies a number of criteria which indicate its suitability as a measure of dependence. All SDS items load significantly with a single factor, and the total SDS score was extremely highly correlated with the single factor score. The SDS score is related to behavioural patterns of drug taking that are, in themselves, indicators of dependence, such as dose, frequency of use, duration of use, daily use and degree of contact with other drug users; it also shows criterion validity in that drug users who have sought treatment at specialist and non-specialist agencies for drug problems have higher SDS scores than non-treatment samples. The psychometric properties of the scale were good in all five samples, despite being applied to primary users of different classes of drug, using different recruitment procedures in different cities in different countries.

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The cannabis withdrawal syndrome.

Alan Budney, Robert J Hughes (2006)

The demand for treatment for cannabis dependence has grown dramatically. The majority of the people who enter the treatment have difficulty in achieving and maintaining abstinence from cannabis. Understanding the impact of cannabis withdrawal syndrome on quit attempts is of obvious importance. Cannabis, however, has long been considered a 'soft' drug, and many continue to question whether one can truly become dependent on cannabis. Skepticism is typically focused on whether cannabis use can result in 'physiological' dependence or withdrawal, and whether withdrawal is of clinical importance. The neurobiological basis for cannabis withdrawal has been established via discovery of an endogenous cannabinoid system, identification of cannabinoid receptors, and demonstrations of precipitated withdrawal with cannabinoid receptor antagonists. Laboratory studies have established the reliability, validity, and time course of a cannabis withdrawal syndrome and have begun to explore the effect of various medications on such withdrawal. Reports from clinical samples indicate that the syndrome is common among treatment seekers. A clinically important withdrawal syndrome associated with cannabis dependence has been established. Additional research must determine how cannabis withdrawal affects cessation attempts and the best way to treat its symptoms.

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Author and article information

Contributors

: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 26 September 2012

Volume: 7

Issue: 9

Electronic Location Identifier: e44864

Affiliations

[1 ]National Cannabis Prevention and Information Centre, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia

[2 ]Centre for Forensic Science, School of Chemistry and Forensic Science, University of Technology Sydney (UTS), New South Wales, Australia

[3 ]Geisel School of Medicine at Dartmouth, Hanover, Lebanon, New Hampshire, United States of America

University of Granada, Spain

Author notes

* E-mail: d.allsop@ 123456unsw.edu.au

Competing Interests: Professor Alan Budney has provided consultation to GW Pharmaceuticals. Dr. Allsop, Professor Copeland, and Dr. Norberg are currently carrying out an investigator driven clinical trial using materials donated by GW Pharmaceuticals. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. All other authors report no competing interest exists.

Conceived and designed the experiments: DJA JC MMN AJB. Performed the experiments: DJA. Analyzed the data: DJA. Contributed reagents/materials/analysis tools: SF AM JL. Wrote the paper: DJA JC MN AJB.

Article

Publisher ID: PONE-D-12-08365

DOI: 10.1371/journal.pone.0044864

PMC ID: 3458862

PubMed ID: 23049760

SO-VID: a068c492-99ca-4578-84f0-60232e563a80

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 22 March 2012

Date accepted : 9 August 2012

Page count

Pages: 12

Funding

Dr. Allsop is supported by a project grant (1006036) from the National Health and Medical Research Council, Australia. Funding for the work was provided by the Australian Government Department of Health and Ageing. Dr. Budney's contribution was funded in part by the National Institute on Drug Abuse, DA15186 and DA23526. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Quantifying the Clinical Significance of Cannabis Withdrawal

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Abstract

Background and Aims

Methods and Results

Conclusions

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PLOS Climate

Most cited references 34

Signs and symptoms of tobacco withdrawal.

The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users.

The cannabis withdrawal syndrome.

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