The cannabis withdrawal syndrome

Center for Addiction Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Current Opinion in Psychiatry (Impact Factor: 3.55). 06/2006; 19(3):233-8. DOI: 10.1097/01.yco.0000218592.00689.e5
Source: PubMed

ABSTRACT 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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    • "Studies have unequivocally documented the occurrence of a cannabis dependence syndrome by demonstrating that cannabis has reinforcing properties in nonhuman primates and that abstinence from the drug causes withdrawal in humans [Tanda and Goldberg, 2003; Fattore et al. 2008]. This withdrawal syndrome can last from 1 to 3 weeks after cannabis cessation [Budney and Hughes, 2006]. The risk of relapse after a period of abstinence is significant [Perkonigg et al. 2008]. "
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    ABSTRACT: Cannabis is the most commonly used illicit drug in the world. However, only few studies have shown the efficacy of pharmacologic agents in targeting cannabis withdrawal symptoms or reducing the reinforcing effects of cannabis. Baclofen has been shown to reduce cannabis withdrawal symptoms and the subjective effects of cannabis. We think that the clinical utility of baclofen for cannabis dependence is a reasonable approach. A case report using baclofen is presented and provides preliminary support for the use of baclofen in the management of cannabis dependence.
    Therapeutic Advances in Psychopharmacology 02/2014; 4(1):50-2. DOI:10.1177/2045125313512324 · 1.53 Impact Factor
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    • "While spontaneous withdrawal symptoms are difficult to detect in experimental animals (Aceto et al., 1996, 2001), pronounced somatic withdrawal symptoms (e.g., wet dog shakes, paw tremors) are inducible by challenging dependent animals with a cannabinoid CB1 receptor antagonist (Aceto et al., 1995; Tsou et al., 1995). Clinical studies further described a spontaneous cannabis-withdrawal syndrome, characterized by: anxiety, weight loss, restlessness, sleep problems, chills, depressed mood, physical discomfort , shakiness, and sweating (Budney and Hughes, 2006). Together, these preclinical and clinical reports indicate that the majority of abused drugs are capable of producing some form of withdrawal. "
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    ABSTRACT: Environmental and interoceptive cues are theorized to serve as 'signals' that motivate drug seeking, effects that may be augmented in the withdrawn state. Phasic dopamine release events are observed in the nucleus accumbens in response to such motivational salient stimuli and are thought to be necessary for drug-associated cues to trigger craving. We recently demonstrated how dopamine neurons encode stimuli conditioned to a negative event, as might occur during conditioned withdrawal, and stimuli predicting the avoidance of negative events, as might occur as an addict seeks out drugs to prevent withdrawal. In this review we first discuss how the subsecond dopamine release events might process conditioned withdrawal and drug seeking driven by negative reinforcement processes within the context of our dopamine data obtained during conditioned avoidance procedures. We next describe how the endocannabinoid system modulates phasic dopamine release events and how it might be harnessed to treat negative affective states in addiction. Specifically, we have demonstrated that endocannabinoids in the ventral tegmentum sculpt cue-induced accumbal surges in dopamine release and, therefore, may also be mobilized during drug withdrawal.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 08/2013; 52. DOI:10.1016/j.pnpbp.2013.07.019 · 4.03 Impact Factor
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    • "Proposed inclusion of cannabis withdrawal in DSM-5 1719 of DSM-5 cannabis withdrawal. Irritability, sleep difficulty , restlessness, depressed mood and nervousness were the most common withdrawal symptoms (see Table 2), consistent with findings from previous studies investigating cannabis withdrawal (Budney & Hughes, 2006 ; Vandrey et al. 2008 ; Ehlers et al. 2010 ; Preuss et al. 2010 ; Gillespie et al. 2011). Males were more likely to have exhibited cannabis withdrawal and abuse/dependence than females. "
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    ABSTRACT: BACKGROUND: Various studies support the inclusion of cannabis withdrawal in the diagnosis of cannabis use disorder (CUD) in the upcoming DSM-5. The aims of the current study were to (1) estimate the prevalence of DSM-5 cannabis withdrawal (criterion B), (2) estimate the role of genetic and environmental influences on individual differences in cannabis withdrawal and (3) determine the extent to which genetic and environmental influences on cannabis withdrawal overlap with those on DSM-IV-defined abuse/dependence. Method The sample included 2276 lifetime cannabis-using adult Australian twins. Cannabis withdrawal was defined in accordance with criterion B of the proposed DSM-5 revisions. Cannabis abuse/dependence was defined as endorsing one or more DSM-IV criteria of abuse or three or more dependence criteria. The classical twin model was used to estimate the genetic and environmental influences on variation in cannabis withdrawal, along with its covariation with abuse/dependence. RESULTS: Of all the cannabis users, 11.9% met criteria for cannabis withdrawal. Around 50% of between-individual variation in withdrawal could be attributed to additive genetic variation, and the rest of the variation was mostly due to non-shared environmental influences. Importantly, the genetic influences on cannabis withdrawal almost completely (99%) overlapped with those on abuse/dependence. CONCLUSIONS: We have shown that cannabis withdrawal symptoms exist among cannabis users, and that cannabis withdrawal is moderately heritable. Genetic influences on cannabis withdrawal are the same as those affecting abuse/dependence. These results add to the wealth of literature that recommends the addition of cannabis withdrawal to the diagnosis of DSM-5 CUD.
    Psychological Medicine 11/2012; 43(8):1-10. DOI:10.1017/S0033291712002735 · 5.43 Impact Factor
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