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.
"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]. "
[Show abstract][Hide abstract] 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.
"The cannabis withdrawal phenomenon has received growing interest in recent years. Cannabis withdrawal does not typically cause significant medical or psychiatric problems as do opioid, alcohol, or benzodiazepine withdrawal , but implications of withdrawal symptoms include the risk of relapse and the well-being of patients . "
[Show abstract][Hide abstract] ABSTRACT: Evidence is accumulating that a cannabis withdrawal syndrome is common, of clinical significance, and has a clear time course. Up till now, very limited data exist on the cannabis withdrawal symptoms in patients with co-morbid substance use disorders, other than cannabis use and tobacco use.
Symptoms of withdrawal were assessed through patient self-reports during detoxification in Danish residential rehabilitation centers. Patients (n = 90) completed booklets three times during their first month at the treatment centre. Self-reported withdrawal symptoms was rated using the DSM-5 Withdrawal Symptom Check List with withdrawal symptoms from all classes of substances, with no indication that the described symptoms should be attributed to withdrawal. Self-reported time since last use of cannabis was used as a predictor of cannabis withdrawal severity.
With the exception of loss of appetite, time since last use of cannabis was associated with all types of withdrawal symptoms listed in the DSM-5. Only four of 19 symptoms intended to measure withdrawal from other substances were related to time since last use of cannabis, including vivid, unpleasant dreams.
The findings yield strong support to the notion of a cannabis withdrawal syndrome, and gives further evidence for the inclusion of the criterion of vivid, unpleasant dreams. Further, the findings speak against the significance of demand characteristics in determining the course of the symptoms of cannabis withdrawal.
"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. "
[Show abstract][Hide abstract] 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 · 3.69 Impact Factor
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